Postoperative sedation with midazolam in heart surgery patients: pharmacokinetic considerations

Midazolam remains one of the few drugs that can safely be used for the sedation of intubated patients in an intensive care unit. Midazolam pharmacokinetics in patients recovering from cardiac surgery were recently reported and found to be different from the drug's kinetics in young and healthy patients or volunteers. In particular, the elimination half-life was prolonged (10.6 h) and the metabolic clearance was reduced. For the clinician, pharmacokinetics parameters do not have a straightforward meaning. The purpose of the present paper is to review the pharmacokinetics of midazolam in this category of patients, and to examine what kind of practical information and dosing recommendation can be derived.