Midazolam Dosing for a 7-Month-Old Infant
For a 7-month-old infant, the recommended midazolam dose for sedation/anxiolysis is 0.05-0.10 mg/kg intravenously given over 2-3 minutes (maximum single dose: 5 mg). 1
Route-Specific Dosing Recommendations
Intravenous (IV) Administration
- For sedation/anxiolysis: 0.05-0.10 mg/kg given over 2-3 minutes 1
- Peak effect occurs at 3-5 minutes after administration 1
- Dose, observe, and redose every 3-5 minutes as needed to avoid oversedation 1
- For adjunct to endotracheal intubation: 0.2 mg/kg (allow 2-3 minutes for effect before administering muscle relaxant) 1
- For continuous infusion in intubated patients: Start with 0.05-0.2 mg/kg loading dose over 2-3 minutes, followed by 1 μg/kg/minute (0.06 mg/kg/hour) 2, 3
Oral (PO) Administration
Intramuscular (IM) Administration
- For seizures: 0.2 mg/kg (maximum: 6 mg per dose); may repeat every 10-15 minutes 1
- For sedation: 0.1 to 0.15 mg/kg is usually effective 3
Monitoring and Safety Considerations
- Increased risk of apnea when combined with other sedative agents, particularly opioids 1, 2
- Always be prepared to provide respiratory support regardless of administration route 1
- Continuous monitoring of oxygen saturation is essential 2
- Monitor for hypotension, particularly when administered rapidly 2, 4
- Paradoxical agitation may occur, especially in younger children 1
Special Considerations for Infants
- Limited information is available for non-intubated infants less than 6 months of age 3
- Infants are particularly vulnerable to airway obstruction and hypoventilation; therefore, titration with small increments to clinical effect and careful monitoring are essential 3
- Midazolam has a longer half-life in neonates (12 hours) compared to older children (0.8-1.8 hours) 5, 4
- Administer cautiously to infants, particularly if fentanyl is also given, due to increased risk of hypotension 4
Antidote Information
- Flumazenil may be administered to reverse life-threatening respiratory depression caused by midazolam 1, 2
- Be aware that flumazenil will also reverse the anticonvulsant effects and may precipitate seizures if midazolam was used for seizure control 1
Practical Administration Tips
- Titrate slowly to the desired clinical effect 3
- For IV administration, the initial dose should be given over 2-3 minutes 3
- Wait an additional 2-3 minutes to fully evaluate the sedative effect before initiating a procedure or repeating a dose 3
- If other CNS depressants are coadministered, the dose of midazolam should be adjusted accordingly 3
Remember that the effectiveness of midazolam is high (97.8% in dental procedures), but careful dosing and monitoring are essential to minimize adverse effects 6.