Recommended Dosing of Versed (Midazolam) for an 11-Year-Old Before a Procedure
For an 11-year-old child requiring procedural sedation, the recommended dose of midazolam (Versed) is 0.05-0.10 mg/kg intravenously (maximum single dose: 5 mg) or 0.25-0.50 mg/kg orally (maximum: 20 mg). 1
Route-Specific Dosing
Intravenous (IV) Administration
- Administer 0.05-0.10 mg/kg given over 2-3 minutes (maximum single dose: 5 mg) 1
- Peak effect occurs at 3-5 minutes after administration 1
- Dose/observe and redose/observe every 3-5 minutes to avoid oversedation 1
- For adjunct to endotracheal intubation, a higher dose of 0.2 mg/kg may be used 1
Oral (PO) Administration
- Administer 0.25-0.50 mg/kg (maximum: 20 mg) 1
- Children under 6 years old may require higher doses up to 1 mg/kg, but this does not apply to an 11-year-old 1, 2
- Oral midazolam has been shown to be effective for producing sedation and anxiolysis even at doses as low as 0.25 mg/kg 3
Intramuscular (IM) Administration
- For seizures: 0.2 mg/kg (maximum: 6 mg per dose); may repeat every 10-15 minutes 1
- IM dosing can be used as a reference for intranasal administration as well 2
Monitoring and Safety Considerations
- Continuous monitoring of oxygen saturation via pulse oximetry is essential during procedural sedation 1, 2
- Be prepared to provide respiratory support regardless of route of administration 1
- The most common serious complications involve compromise of the airway or depressed respirations 1
- Paradoxical agitation may occur, especially in younger children (0.6% incidence reported) 1
- Flumazenil should be available to reverse life-threatening respiratory depression if needed 1
Potential Adverse Events
- Oxygen desaturation (reported in 0.8% of cases) 1
- Respiratory depression (13% experienced desaturation in one study) 1
- Risk of adverse events appears to be dose-related, with higher doses increasing risk 4
- When combined with opioids, there is increased incidence of respiratory depression 1, 5
Important Clinical Considerations
- Titration of drug to effect is crucial; ensure previous dose has taken full effect before administering additional medication 1
- Recovery time is typically shorter with midazolam compared to other sedatives 2
- For children 6-12 years of age, lower initial doses (0.025-0.05 mg/kg) may be appropriate with titration up to 0.4 mg/kg to achieve desired effect 6
- Midazolam has a faster onset and shorter duration of action than other benzodiazepines 6
- The half-life in children over 12 months is reported to be 0.8 to 1.8 hours 6
Practical Administration Tips
- When using IV midazolam, administer slowly over 2-3 minutes to minimize risk of respiratory depression 1
- Have resuscitation equipment readily available including supplemental oxygen and airway management tools 1, 2
- The pediatric patient should be accompanied by a parent, legal guardian, or other responsible person 1
Remember that the ability to rescue from a deeper level of sedation than intended is essential for safe sedation practice 1.