Adverse Drug Reaction with Midazolam Use in Emergency Department

Abstract

ABSTRAK Midazolam adalah salah satu ubat yang paling biasa digunakan sebagai ubat pelali di Jabatan Kecemasan (ED). Ini adalah satu kajian retrospektif yang dijalankan ke atas 380 pesakit dari Disember 2012 hingga Mei 2014 di ED, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). ABSTRACTMidazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from 3 Med & Health 2016;11(1): 2-10 Procedural sedation is commonly used for outpatient medical procedures and done by non-anesthesiology physicians (Knape et al. 2007). The use of midazolam in the ED is unique in terms that the location possess different issues and risks to the physician. Among issues that is different to normal outpatient clinic is the occurrence which is unpredictable, the timing is time dependent and sometimes emergent, gastric state is variable (either fasted or not). Patients are unselected and may have underlying systemic disease (Godwin et al. 2005). Hence, even though the adverse effects of midazolam was extensively studied in various clinical locations, the data for midazolam use in ED especially throughout Malaysia, is still lacking. Midazolam Use in Emergency DepartmentAdverse reactions from midazolam use include urinary retention, nausea, vomiting and excessive somnolence December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.