From the Guidelines
The recommended dose of midazolam for procedural sedation and pain management is 1 mg (or no more than 0.03 mg/kg) injected over 1-2 minutes in healthy adults younger than 60 years of age, with additional doses of 1 mg (or 0.02-0.03 mg/kg) administered at 2-minute intervals until adequate sedation is achieved 1.
Key Considerations
- The dose of midazolam should be reduced by 20% or more in patients older than 60 and those with ASA physical status III or greater 1.
- When midazolam is used with an opioid, a synergistic interaction occurs and a reduction in the dose of midazolam may be indicated 1.
- A total intravenous dose greater than 6 mg usually is not required for routine endoscopic procedures 1.
Side Effects and Precautions
- The major side effect of midazolam is respiratory depression, which can be fatal when combined with an opioid 1.
- Cardiac dysrhythmia and disinhibition reactions are rare but possible side effects of midazolam 1.
- Midazolam clearance is reduced in the elderly, obese, and those with hepatic or renal impairment, which may affect the duration of its effects 1.
From the FDA Drug Label
For sedation/anxiolysis/amnesia prior to and during procedures or prior to anesthesia USUAL PEDIATRIC DOSE (NON-NEONATAL) It should be recognized that the depth of sedation/anxiolysis needed for pediatric patients depends on the type of procedure to be performed. For all pediatric patients, regardless of the indications for sedation/anxiolysis, it is vital to titrate midazolam and other concomitant medications slowly to the desired clinical effect. The initial dose of midazolam should be administered over 2 to 3 minutes Pediatric patients less than 6 months of age: Limited information is available in non-intubated pediatric patients less than 6 months of age Pediatric patients 6 months to 5 years of age: Initial dose 0. 05 to 0.1 mg/kg. A total dose up to 0.6 mg/kg may be necessary to reach the desired endpoint but usually does not exceed 6 mg. Pediatric patients 6 to 12 years of age: Initial dose 0.025 to 0.05 mg/kg; total dose up to 0. 4 mg/kg may be needed to reach the desired endpoint but usually does not exceed 10 mg. Pediatric patients 12 to 16 years of age: Should be dosed as adults
The recommended dose of midazolam for procedural sedation and pain management is:
- Pediatric patients 6 months to 5 years of age: Initial dose 0.05 to 0.1 mg/kg, total dose up to 0.6 mg/kg
- Pediatric patients 6 to 12 years of age: Initial dose 0.025 to 0.05 mg/kg, total dose up to 0.4 mg/kg
- Pediatric patients 12 to 16 years of age: Dosed as adults 2
From the Research
Recommended Dose of Midazolam for Procedural Sedation and Pain Management
The recommended dose of midazolam for procedural sedation and pain management varies depending on the patient population and the specific procedure.
- For preoperative sedation, a dose of 0.07-0.1 mg/kg given by intramuscular injection one hour before surgery is recommended 3.
- For conscious sedation, a dose of 0.1-0.15 mg/kg intravenously in divided doses is usually adequate 3.
- For pediatric patients, the effective dose of midazolam oral solution for alleviating preoperative anxiety is 0.8254 mg/kg (95% CI: 0.6915-0.8700 mg/kg) 4.
- For patients undergoing procedural sedation in the emergency department, a median dose of 4mg of midazolam is used 5.
- For prehospital management of traumatic severe pain, a dose of 0.04 mg/kg of midazolam is used in combination with morphine 6.