What is Midazolam (Midazolam) used for?

From the Guidelines

Midazolam is primarily used for procedural sedation and induction of general anesthesia, particularly in endoscopic procedures, due to its rapid onset of action and shorter duration of effect. The use of midazolam in this context is supported by studies such as the one by Cole et al, which compared diazepam with midazolam for endoscopic sedation and found midazolam to be more potent and faster acting, with fewer adverse events 1.

Some key points to consider when using midazolam for procedural sedation include:

• The initial intravenous dose in healthy adults younger than 60 years of age is 1 mg (or no more than .03 mg/kg) injected over 1–2 minutes 1.
• Additional doses of 1 mg (or .02–.03 mg/kg) may be administered at 2-minute intervals until adequate sedation is achieved 1.
• Patients older than 60 and those with ASA physical status III or greater require a dose reduction of 20% or more 1.
• The major side effect of midazolam is respiratory depression, and deaths from respiratory depression have been reported in patients receiving midazolam and an opioid 1.

Overall, midazolam is a useful agent for procedural sedation and induction of general anesthesia, but its use requires careful consideration of the patient's individual characteristics and close monitoring for potential adverse effects. The benefits of midazolam, including its rapid onset and shorter duration of action, make it a preferred choice for many endoscopic procedures.

From the FDA Drug Label

Midazolam Injection is indicated: intramuscularly or intravenously for preoperative sedation/anxiolysis/amnesia; intravenously as an agent for sedation/anxiolysis/amnesia prior to or during diagnostic, therapeutic or endoscopic procedures, such as bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures either alone or in combination with other CNS depressants; intravenously for induction of general anesthesia, before administration of other anesthetic agents. Midazolam is used for:

• Preoperative sedation/anxiolysis/amnesia
• Sedation/anxiolysis/amnesia prior to or during diagnostic, therapeutic or endoscopic procedures
• Induction of general anesthesia
• Sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in a critical care setting 2

From the Research

Midazolam Uses

• Midazolam is used in anesthesia as a premedication, for anesthesia induction, and for maintenance in general anesthesia 3.
• It is also used for sedation in local anesthesia, and has anti-anxiety and sedative effects when administered intravenously during spinal or epidural anesthesia 3.
• Midazolam is used for sedation before diagnostic and therapeutic medical procedures in adults and children, and can be administered orally, intravenously, intranasally, or intramuscularly 4.
• In patients with epilepsy, midazolam is used as a rescue therapy for seizure clusters, and is available as a nasal spray or for injection 5.
• Midazolam has a good anterograde amnesia-inducing effect, and can prevent and reduce the occurrence of intraoperative awareness during general anesthesia 6.

Administration and Dosage

• The dosage of midazolam for premedication is 0.04 mg/kg to 0.08 mg/kg, administered intramuscularly 15 minutes before entering the operating room 3.
• For anesthesia induction, midazolam is used in combination with barbiturate or propofol to take advantage of synergistic effects 3.
• The ED50 for intravenous midazolam-induced amnesia is 0.031 mg/kg, and the ED95 is 0.044 mg/kg 6.
• The duration of amnesia induced by midazolam is correlated to sedation grade, BIS, and age, and is not correlated to visual memory or auditory memory 6.

Clinical Significance

• Midazolam is a useful addition to the formulary due to its rapid, nonpainful induction and lack of venous irritation 7.
• The use of midazolam for sedation before procedures in adults and children has been shown to be effective in reducing anxiety and discomfort, although the evidence is not always consistent 4.
• Midazolam has been shown to be effective in preventing and reducing the occurrence of intraoperative awareness during general anesthesia, although the dosage and duration of amnesia must be carefully controlled to avoid adverse side effects 6.