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When midazolam fails.

Christine Cheng1, Célia Roemer-Becuwe, Jose Pereira

  • 1Palliative Care Program, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.

Journal of Pain and Symptom Management
|March 13, 2002
PubMed
Summary
This summary is machine-generated.

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Midazolam may not effectively sedate patients in palliative care due to complex factors. Alternative medications like phenobarbital or propofol may be necessary when midazolam fails.

Area of Science:

  • Palliative Care Medicine
  • Neuropharmacology

Background:

  • Palliative sedation is crucial for managing intractable symptoms like agitated delirium or irreversible stridor.
  • Midazolam is the standard first-line agent for palliative sedation.
  • Instances of midazolam failure necessitate exploring alternative strategies.

Observation:

  • Two cases illustrate situations where midazolam failed to achieve adequate sedation.
  • This failure appears to stem from multifaceted underlying mechanisms.

Findings:

  • GABA(A) receptor heterogeneity and functional alterations contribute to variable responses to midazolam.
  • Concomitant medications, patient-specific factors (age, health status, comorbidities), and lifestyle (alcohol, smoking) influence drug efficacy.

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Implications:

  • Understanding these mechanisms is key to optimizing palliative sedation.
  • Evidence-based guidelines are needed for managing midazolam failure.
  • Consideration of alternative agents like phenobarbital or propofol should be prompt when midazolam is ineffective.