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Sedation of children requiring artificial ventilation using an infusion of midazolam

P D Booker, A Beechey, A R Lloyd-Thomas

    British Journal of Anaesthesia
    |October 1, 1986
    PubMed

    Insights

    Midazolam infusion effectively sedated most children after open heart surgery. While generally safe, variable drug levels and high cortisol were observed, warranting further investigation into pediatric sedation.

    Area of Science:

    • Pediatric Anesthesiology
    • Critical Care Medicine
    • Pharmacology

    Background:

    • Open heart surgery in children requires effective sedation for recovery.
    • Midazolam is a commonly used sedative in pediatric intensive care.

    Purpose of the Study:

    • To evaluate the efficacy and safety of midazolam infusion for sedating children post-open heart surgery.
    • To assess potential midazolam accumulation and its effect on adrenal function.

    Main Methods:

    • Studied 50 children (6 months to 9 years) undergoing open heart surgery.
    • Administered midazolam infusion, alone or with morphine, during ventilation.
    • Monitored clinical sedation and performed serum midazolam assays and Synacthen tests in a subset of patients.

    Main Results:

    • 47 of 50 children were sedated uneventfully.
    • No clinical evidence of midazolam accumulation was observed.
    • Variable serum midazolam concentrations were noted; all patients showed normal adrenal response to Synacthen despite high basal cortisol.

    Conclusions:

    • Midazolam infusion is a viable sedation strategy for pediatric open heart surgery patients.
    • Further research is needed to understand the variability in midazolam concentrations and the implications of high basal cortisol levels in this population.

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