UNCONTROLLED WHEN PRINTED
Introduction
- A water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. This is due to its bonding with receptors in the CNS; its action to increase the inhibitory effect of the g-aminobutyric acid (GABA) neurotransmitter on the GABA receptors and subsequent membrane threshold.
- Midazolam is lipid-soluble in physiological pH and it reaches the CNS quickly.
Indications
- Prolonged seizure activity - generalised seizure lasting ≥ 5 minutes OR recurrent / status seizure activity as per CPG
- Focal seizure activity which is prolonged (≥ 5 minutes) and is associated with a GCS ≤ 12 as per CPG
- Second-line IV agent for maintenance of sedation after Droperidol administration for Disturbed and/or abnormal behaviour
Critical Care Paramedic only
- For the purpose of providing and maintaining procedural sedation
Contraindications
- Hypersensitivity
Precautions / Notes
- Early monitoring as soon as practicable is required when administering midazolam; including SpO2, respiratory rate, pulse and blood pressure
- SpO2 and etCO2 monitoring must be applied whenever level of consciousness drops (~RASS <0)
- Paediatrics - have a low threshold to consult with ASMA when repeat or maintenance doses are required for sedation
- Use of Midazolam after Ketamine sedation requires ASMA consult
- Psychostimulants, in toxic levels can produce severe agitation and psychotic behaviour.
Management
Seizures
Adult < 70 years:
- IM
- 5mg, repeat once after 10 min if needed and no IV access.
- IV/IO
- 2.5 - 5mg, repeat dose 2.5mg every 5 min as needed to 15mg max.
Adult ≥ 70 years or frail:
- IM
- 2.5mg, repeat once after 10 min if required and no IV access.
- IV/IO
- 2.5mg, repeat dose 1mg every 5 min as needed to 15mg max.
Paediatric:
- IM
- 0.2mg/kg max single bolus 5mg, repeat once after 10 min if needed and no IV access.
- IV/IO
- 0.1mg/kg to a max single bolus dose of 2.5mg, repeat as needed every 5 min to a 10mg max.
The use of Midazolam in both adults and paediatric patients for other seizure types outside of CPG requires ASMA authority.
Maintenance of Sedation (IV Only)
Adult < 70 years of age:
- IV
- 1 - 2mg, titrated to effect every 5-10 mins as required to a total max dose 5mg
Adult ≥ 70 years or frail:
- IV
- 0.5 - 1mg, titrated to effect every 5-10 mins as required to a total max dose 5mg
Paediatric (6-15 years of age):
- IV
- 0.5mg - 1mg, titrated to effect every 5-10 mins as required to a total max dose 5mg
Special Considerations
- Respiratory depression
- Hypotension
- Anterograde and retrograde amnesia
- Myasthenia Gravis
References
References
Presentation
15mg in 3mls (5mg/ml)
| MUST BE LABELLED |
DILUTION
IM
- Do NOT dilute in general
IV / IO
- Dilute 15mg / 3ml with 12ml NaCl in 20ml syringe (equivalent to 1mg/ml)
- Part dilution into a 10 ml syringe is no longer advocated
| MUST BE LABELLED |
| Colour assist: |
|---|
Discarding unused medication must be witnessed and countersigned by attendant and credible witness.
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Date of Issue
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