Midazolam (dormicum®): Clinical practice guidelines

Three benzodiazepines are available for IV injection and are commonly used in anesthesia practice: diazepam, lorazepam, and midazolam. The last is the most frequently used in anaesthesia practice. Benzodiazepines induce amnesia and sedation secondary to potentiation of the inhibitory neurotransmitter gamma amino-butyric acid (GABA). Although sleep inducing doses of midazolam (0,2-0,4 mg/kg) may produce unconsciousness in one to three minutes it is commonly used for sedation and to ensure amnesia and premedication. The effects of midazolam on the cardiovascular system are minimal. Mild decreases in blood pressure and heart rate are indicative of its sedative effect. There have been reports of respiratory depression with diazepam, however this response is dose dependent and can be marked if concomitant doses of narcotics are used. Because of its potential for depressing respiration, especially if given with narcotics, the respiratory response of these patients needs to be monitored Intravenous midazolam should be titrated to effect and the benzodiazepine antagonist flumazenil should be immediately available.