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Steady-state plasma concentrations of midazolam in critically ill infants and children

J Hughes1, A M Gill, H Mulhearn

  • 1Institute of Child Health, Alder Hey Children's Hospital, Liverpool, England.

The Annals of Pharmacotherapy
|January 1, 1996
PubMed

Insights

Plasma clearance of midazolam increases with age in critically ill children, with higher clearance observed in those 3 years and older. Significant variations in midazolam concentrations highlight the need for individualized dosing in pediatric intensive care.

Area of Science:

  • Pharmacology
  • Pediatric Critical Care
  • Clinical Pharmacy

Background:

  • Midazolam is a commonly used sedative in pediatric intensive care.
  • Understanding its pharmacokinetic profile in critically ill children is crucial for safe and effective use.

Purpose of the Study:

  • To determine the steady-state plasma concentrations of midazolam in critically ill infants and children.
  • To investigate the relationship between age and midazolam plasma clearance.

Main Methods:

  • Prospective, uncontrolled study over 18 months in a pediatric intensive care unit.
  • Thirty-eight infants and children (1 month to 13 years) receiving continuous intravenous midazolam infusion for mechanical ventilation.
  • Plasma concentrations and infusion rates were analyzed to calculate plasma clearance.

Main Results:

  • Plasma clearance of midazolam was significantly higher in children aged 3 years and older (13.0 mL/min/kg) compared to younger children (2.3-3.1 mL/min/kg).
  • Midazolam infusion rates were similar across age groups, but plasma concentrations were lower in older children (128 ng/mL) versus younger children (395-790 ng/mL).
  • Considerable interindividual variability in steady-state midazolam concentrations was observed.

Conclusions:

  • Midazolam plasma clearance increases with age in critically ill pediatric patients.
  • Age-related differences in midazolam pharmacokinetics necessitate careful dose titration and monitoring.
  • Significant interindividual variability underscores the importance of personalized sedation strategies.
Abstract

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