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Safety and effectiveness of high‐dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant‐affected patients
Author(s) -
Spain David,
Crilly Julia,
Whyte Ian,
Jenner Linda,
Carr Vaughan,
Baker Amanda
Publication year - 2008
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2008.01066.x
Subject(s) - medicine , midazolam , sedation , emergency department , dosing , anesthesia , prospective cohort study , emergency medicine , psychiatry
Objectives: To trial high‐dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant‐induced behavioural disorders. End‐points were effectiveness and safety. Methods: A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant‐induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end‐point of rousable drowsiness. Results: Sixty‐two patients were enrolled. Two‐thirds of the patients required only one dose of midazolam; 88% of the sample were sedated with two doses. Six and a half per cent of patients were not sedated after four doses. A Glasgow Coma Score of eight or less was prolonged in eight patients. Airway problems requiring an adjunct were present in four patients. Recent psychostimulant use was present in only 55% after full assessment. Conclusions: High‐dose midazolam protocols cannot be supported as universally safe. High‐dose protocols for severe behavioural disturbance are not more effective, with failures occurring even after repeated dosing.