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Related Experiment Videos

Midazolam infusions in critically ill patients.

M P Shelly1, M A Sultan, A Bodenham

  • 1Intensive Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.

European Journal of Anaesthesiology
|January 1, 1991
PubMed
Summary

Continuous intravenous midazolam infusion provides comfort for intensive care patients but may lead to tolerance and prolonged awakening, especially in those with renal impairment. Careful monitoring is crucial to avoid drug accumulation.

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Area of Science:

  • Pharmacology
  • Intensive Care Medicine
  • Critical Care

Background:

  • Midazolam hydrochloride is commonly used for sedation in intensive care units (ICUs).
  • Continuous intravenous infusion is a frequent administration method for sedatives in critically ill patients.
  • Benzodiazepine tolerance and prolonged emergence are potential complications of sedative infusions.

Purpose of the Study:

  • To prospectively assess the effects of continuous intravenous midazolam hydrochloride infusion for sedation in intensive care patients.
  • To evaluate patient comfort, development of tolerance, and awakening times after midazolam cessation.

Main Methods:

  • Prospective study of fifty consecutive intensive care patients.
  • Continuous intravenous infusion of midazolam hydrochloride for sedation.

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  • Assessment of patient comfort, daily dose requirements, and time to awaken after infusion cessation.

    • Main Results:

    • Patient comfort was acceptable in all fifty patients.
    • Increasing daily midazolam doses were required, suggesting benzodiazepine tolerance.
    • Awakening times were prolonged, particularly in patients with renal failure (44.6 +/- 42.5 h) compared to those without (13.6 +/- 16.4 h).
    • Patients with combined hepatic and renal failure experienced significantly longer awakening times (124 and 140 h).

    Conclusions:

    • Continuous intravenous midazolam infusion ensures good patient comfort but necessitates dose escalation, indicating potential tolerance.
    • Drug accumulation and delayed awakening are significant risks, especially in patients with renal or hepatic impairment.
    • Prolonged infusions without regular assessment of consciousness increase the risk of adverse outcomes.