Midazolam

INTRODUCTION

Indications

PO: Preprocedural sedation and anxiolysis in pediatric patients. IM, IV: Preoperative sedation/anxiolysis/amnesia. IV: Provides sedation/anxiolysis/amnesia during therapeutic, diagnostic, or radiographic procedures (conscious sedation): Aids in the induction of anesthesia and as part of balanced anesthesia. As a continuous infusion, provides sedation of mechanically ventilated patients during anesthesia or in a critical care setting, status epilepticus.

Action

Acts at many levels of the CNS to produce generalized CNS depression. Effects may be mediated by gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Short-term sedation. Postoperative amnesia.

Adverse Reactions/Side Effects

CNS: agitation, drowsiness, excess sedation, headache. EENT: blurred vision. Resp: APNEA, LARYNGOSPASM, RESPIRATORY DEPRESSION, bronchospasm, coughing. CV: CARDIAC ARREST, arrhythmias. GI: hiccups, nausea, vomiting. Derm: rashes. Local: phlebitis at IV site, pain at IM site.

PHYSICAL THERAPY IMPLICATIONS

^*Implications refer primarily to any residual effects that occur typically within 24 hr after anesthesia.

Examination and Evaluation

• Continually monitor for signs of cardiac arrest such as sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea, and loss of consciousness. Seek immediate medical assistance if patient develops these signs.

• Assess respiration and notify physician or nursing staff immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory depression. Signs include decreased or absent respiration, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Apnea or severe respiratory depression requires emergency care.

• Monitor signs of laryngeal spasm and bronchospasm, including tightness in the throat and chest, wheezing, cough, and severe shortness of breath. Notify physician or nursing staff immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Report excessive or prolonged sedation, agitation, or blurred vision; that is, CNS symptoms that persist more than 12 hr after the drug has been discontinued.

• If used to stop a severe, prolonged seizure (status epilepticus), watch for seizures after midazolam is discontinued. Report a return of seizure activity to the physician or nursing staff immediately.

• If used during mechanical ventilation, observe whether the patient is adequately sedated and the chest wall is relaxed and compliant with ventilation. Notify physician or nursing staff if the patient is agitated or appears to be resisting mechanical ventilation.

• Monitor injection site for pain, swelling, and inflammation consistent with phlebitis. Report prolonged ...