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Sedation with intravenous midazolam in the pediatric intensive care unit
1Department of Pediatrics, New York Hospital-Cornell Medical Center, New York, USA.
Insights
Benzodiazepines like midazolam and lorazepam are crucial for managing anxiety and agitation in pediatric intensive care units (ICUs). Careful dosage adjustment is essential to balance sedation benefits against potential adverse effects like withdrawal.
Area of Science:
- Pharmacology
- Pediatric Critical Care
Background:
- Physical and emotional distress significantly impacts pediatric intensive care unit (ICU) patients.
- Intravenous (IV) benzodiazepines are vital for managing distress during procedures like assisted ventilation.
Purpose of the Study:
- To review the role and properties of benzodiazepines in pediatric ICU sedation.
- To compare midazolam and lorazepam for sedation efficacy and adverse effects.
Main Methods:
- Pharmacological properties of midazolam and lorazepam were analyzed.
- Clinical application in pediatric ICUs and associated adverse effects were discussed.
Main Results:
- Midazolam offers rapid onset and short duration, facilitating titration.
- Lorazepam shares some properties but has a longer elimination half-life.
- Key adverse effects include withdrawal symptoms and delayed awakening.
Conclusions:
- Benzodiazepines, particularly midazolam and lorazepam, are essential for pediatric ICU sedation.
- Dosage individualization based on patient factors is critical.
- Balancing therapeutic effects with potential adverse events is paramount.
Abstract:
Physical and emotional distress can have important effects on patients in the pediatric intensive care unit (ICU). Intravenous (IV) infusion of benzodiazepines is an important adjunct to assisted ventilation and other potentially distressing ICU procedures. Combined with intermittent or continuous infusion of opioids, the benzodiazepines provide smooth control of anxiety, pain, and agitation. Intravenous midazolam (Versed Roche Laboratories) is distinguished from diazepam (Valium, Roche Products) by its water solubility, short elimination half-life, and generally short duration of action. These pharmacological properties, which are also shared, in part, with the more slowly eliminated drug lorazepam (Ativan, Wyeth-Ayerst), facilitate titration of the rate of infusion against patient response and permit regulation of the depth of sedation. The major adverse effects of long-term benzodiazepine infusion are withdrawal symptoms and, occasionally, delayed awakening. The dosage needed to initiate and maintain sedation must be adjusted to body weight, degree of sedation desired, and concomitant medications, as well as to underlying health and cardiovascular status. Benzodiazepines, such as midazolam and lorazepam, represent important choices among drugs used for sedation in the pediatric ICU.