Midazolam: A review of therapeutic uses and toxicity

Nordt, Sean Patrick; Clark, Richard F.

doi:10.1016/s0736-4679(97)00022-x

Cited by 280 publications

(207 citation statements)

References 62 publications

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“…Midazolam (MDZ), 1-benzodiazepine, is widely used to sedate patients in intensive care units and to induce anesthesia because of the rapid onset and short duration of its effects (Nordt and Clark, 1997). MDZ is rapidly and extensively metabolized by the liver and intestinal microsomal enzymes (Heizmann and Ziegler, 1981;Kronbach et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To explore the effect of hepatic function on loss of consciousness (LOC) and bispectral index (BIS) during sedation with midazolam (MDZ). Methods: Forty-five patients were assigned to three groups according to their liver function. Thirty of these patients with diagnoses of cholelithiasis were scheduled laparoscopic cholecystectomy, including 15 patients with normal liver function (normal group), and 15 patients with moderately abnormal liver function based on the results of ultrasonic diagnosis of a moderately fatty liver and elevated alanine transaminase levels of less than three times normal (moderate group). The other 15 patients with end-stage liver disease (severe group) underwent liver transplantation. Each patient was administered MDZ by way of target-controlled infusion to increase the concentration gradually. At the time of LOC, the BIS was recorded and a blood sample was withdrawn for measurement of the concentration of MDZ. The concentration of MDZ (EC 50 ) and the BIS value (BIS 50 ) at which 50% of patients lose consciousness were calculated using logistic regression. Results: At the time of LOC, the EC 50 of MDZ and the BIS 50 were similar in the normal and moderate groups (P>0.05). LOC occurred at a lower EC 50 of MDZ and at a higher BIS 50 in the severe group, compared with the normal and moderate groups (P<0.01). Conclusions: Patients with end-stage liver disease were more sensitive to MDZ and this affected the prediction of their time of LOC following MDZ administration. There were no changes in response in patients with moderately abnormal hepatic function.

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Section: Introductionmentioning

confidence: 99%

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

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“…For instance, it is important to say that isolated auto-medication produces harmful and undesirable consumption. These drugs, which belong to a group of small tranquilizers, due to their wide therapeutic power, are the reason for abuse and are prescribed in excess in general medical practice (2)(3) .…”

Section: Introductionmentioning

confidence: 99%

“…Sedation and sleepiness can deteriorate mental and motor functions, reduce the capability of attention, concentration and decision and cause anterograde amnesia. Therefore, it is important to call attention to these effects, which can be presented as an overdose when combined with other depressants of the CNS (2) .They produce physical dependence when used for a long time and, when interrupted in an abrupt way, this can cause the abstinence syndrome (4) . Acute intoxication, either accidental or suicidal, with these drugs is very frequent, even though mortality by overdose is very low (less than 1%) (5) .They are also used for phobic confusion, panic, post-traumatic stress, convulsive disorders, syndrome of alcohol abstinence and barbiturates, in insomnia crises and, also, in cases of anxiety (used worldwide) (6) .…”

Section: Introductionmentioning

confidence: 99%

Consumption of benzodiazepines without prescription among first-year nursing students at the University of Guayaquil, school of nursing, Ecuador

Paredes

Miasso

Tirapelli

2008

Rev. Latino-Am. Enfermagem

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Pinos Paredes N, Miasso AI, Tirapelli CR. Consumption of benzodiazepines without prescription among first-year nursing students at the University of Guayaquil. Rev Latino-am Enfermagem 2008 maio-junho; 16(especial):634-9.This study aimed to determine the consumption of benzodiazepines without prescription among firstyear students from a nursing school of a public University in Ecuador. This is a descriptive, transversal and explanatory study with a quantitative approach. A questionnaire was used for data collection. The population studied was of 181 students. The results showed that 10.5% of the students had consumed benzodiazepine without prescription once in their lives. Of these, 6.1% consumed benzodiazepine in the last year, and 3.9% are currently consuming it. The diazepam was the most consumed BZD without prescription and pharmacies, were the place of higher access. The main reasons for the benzodiazepine consumption were: insomnia, anxiety, stress, depression, family and economical problems. The use of benzodiazepines with non-medicinal purposes is related to problems such as memory loss, retirement syndrome and sedation. When benzodiazepines are consumed jointly with alcohol or other drugs they can lead to coma or death. This study shows the serious consequences benzodiazepines cause when used by nursing students in Ecuador.DESCRIPTORS: auto medication; GABA-A receptors; students, nursing CONSUMO DE BENZODIACEPINAS SIN PRESCRIPCIÓN MÉDICA EN LOS/AS ESTUDIANTES DE PRIMER AÑO DE LA ESCUELA DE ENFERMERÍA DE LA UNIVERSIDAD DE GUAYAQUIL, ECUADORLa finalidad de este estudio fue determinar el consumo de benzodiacepinas sin prescripción en estudiantes del primer año de enfermería de una universidad pública de Ecuador. Se trata de un estudio transversal, descriptivo y exploratorio, con aproximación cuantitativa. Un cuestionario fue usado para la recolecta de los datos. La población estudiada fue compuesta por 181 estudiantes. Los resultados muestran que el 10,5% de los estudiantes consumió benzodiacepinas sin prescripción médica alguna vez en la vida. Del total, el 6,1% consumió en el último año y el 3,9% usan actualmente. El Diazepan fue la BZD más usada sin prescripción médica, siendo la farmacia el local de mayor acceso. Entre los principales motivos para el consumo de benzodiacepinas se encuentran: insomnio, ansiedad, estrés, depresión y problemas familiares o económicos. El uso de benzodiacepinas con propósitos no-medicinales está relacionado a problemas de pérdida de la memoria, síndrome de abstinencia y sedación. Cuando son combinados con alcohol u otras drogas, pueden llevar a la coma y a la muerte. Este estudio muestra las graves consecuencias que las benzodiacepinas pueden ocasionar cuando utilizados por estudiantes de enfermería en Ecuador. DESCRIPTORES: automedicación; receptores GABA-A; estudiantes de enfermería CONSUMO DE BENZODIAZEPINOS SEM PRESCRIÇÃO MÉDICA ENTRE ESTUDANTES DO PRIMEIRO ANO DA ESCOLA DE ENFERMAGEM DA UNIVERSIDADE DE GUAYAQUIL, EQUADORO objetivo deste estudo foi determinar o consumo...

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“…Choral hydrate is associated with significant adverse effects, including death, and safer alternatives for pediatric procedural sedation should be sought and utilized. There are a number of alternative sedating agents, some oral, nasal, rectal, and parenteral and some parenteral only, e.g., midazolam, proprofol, ketamine, ketofol, with more predictable pharmacokinetics and better safety profiles [19,20]. Regarding efficacy, there is conflicting data regarding which agent is best.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Chloral Hydrate Poisonings and Death Following Outpatient Procedural Sedation

et al. 2014

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Introduction Chloral hydrate has been used medicinally since the 1800 s as a sedative hypnotic, most commonly for procedural sedation. As it is administered orally and available in a liquid formulation, it is used almost exclusively in pediatric patients despite many safer and more effective alternative agents being available. Case Series We present three cases of pediatric chloral hydrate poisoning, all occurring following procedural sedation in outpatient clinic settings and presenting to the emergency department. The ages ranged from 15 months to 4 years of age and all required resuscitation. Unfortunately, the 4-yearold died. Conclusion Choral hydrate is associated with significant adverse effects, including death, and safer alternatives for pediatric procedural sedation should be sought and utilized. There are a number of more effective sedative agents with more predictable pharmacokinetic and safety profiles than chloral hydrate including parenteral and oral agents. The practice of pre-procedure sedation should be performed only in a supervised setting where cardiorespiratory monitoring can occur in all cases.

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Midazolam: A review of therapeutic uses and toxicity

Cited by 280 publications

References 62 publications

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Consumption of benzodiazepines without prescription among first-year nursing students at the University of Guayaquil, school of nursing, Ecuador

Pediatric Chloral Hydrate Poisonings and Death Following Outpatient Procedural Sedation

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