Single Dose Of Midazolam Research Articles

Conscious sedation for dental treatment

Conscious sedation for dental treatment

Effects of midazolam on equine innate immune response: a flow cytometric study

Benzodiazepines (BDZ) are among the most frequently used class of psychotropic drugs employed in veterinary medicine in Brazil and worldwide due to their anxiolytic, muscle relaxant and anticonvulsant effects [J. Clin. Pharmacol. 33 (1993) 124]. Peripheral benzodiazepine receptor (PBR) sites were described in peripheral organs, endocrine steroidogenic tissues and immune organs and cells. Midazolam is a mixed-type agonist of PBRs. The present study is focused on the effects of midazolam on equine peripheral blood neutrophils, peritoneal macrophages and cortisol levels in plasma. Adult horses were treated with a single dose of midazolam (0.06 or 0.1 mg/kg) or with 0.9% NaCl. Immune cells were collected 24 h after treatment for flow cytometry analysis of Staphylococcus aureus-induced phagocytosis and oxidative burst. Plasma cortisol concentration was measured 30, 90, 180 and 360 min after midazolam treatment. Midazolam induced a dose-dependent reduction on: (1) peripheral blood neutrophil and peritoneal macrophage oxidative burst; (2) the capacity of both peripheral blood neutrophils and peritoneal macrophages to phagocyte S. aureus. Increments on plasma cortisol concentration were not found after 0.06 and 0.1 mg/kg of midazolam. The effects on oxidative burst of neutrophils and macrophages from horses treated with midazolam were interpreted as a consequence of an impairment of S. aureus-induced phagocytosis. The present data suggest that midazolam, most probably acting on PBRs present on equine macrophage and neutrophil membranes, might have changed some mechanisms related to both phagocytosis and oxidative burst. These results support the use of flow cytometry to identify functional properties and dysfunction of equine immune cells. They also confirm the notion that changes in the functional capacity of the immune system may represent an important hazard of exposure to drugs or chemicals.

The effectiveness of midazolam as a single pharmacologic agent to facilitate endotracheal intubation by paramedics

Objective. Endotracheal intubation (ETI) remains the “gold standard” for securing a patient's airway. In recent years, the use of pharmacologic agents to assist paramedics achieve successful intubation of problematic airways has become more common. This study was done to determine the efficacy of intravenous midazolam, a short-acting benzodiazepine, as a drug to facilitate intubation in patients resistant to conventional ETI. Methods. This retrospective observational study reviewed the 22-month experience of a suburban municipal EMS system after midazolam was introduced as an agent to be used for systemic sedation to facilitate ETI. All calls where midazolam was used were reviewed on a monthly basis by investigators via retrospective review of the prehospital care reports. Results. During the study period 13,212 emergency responses occurred, resulting in 154 ETIs by paramedics. Midazolam was used to facilitate 20 (13%) of these ETIs. “Clenched teeth and failed conventional intubation were the most commonly cited indications for facilitated intubation. Eleven patients had medical complaints and nine were trauma patients. Successful ETI with midazolam was achieved in 17 of 20 (85%) cases. In 85% (15 of 17) of these cases, a single dose of midazolam was sufficient for ETI [mean dose 3.6 mg (SD 1.1 mg)]. The three patients with failed ETI received multiple doses of midazolam [mean dose 5.0 mg (SD 2.0 mg)]. Conclusion. The prehospital use of single-dose IV midazolam is generally effective in accomplishing facilitated ETI in patients resistant to conventional (nonpharmacologic) ETI.

Dynamics of Slow-Wave Activity and Spindle Frequency Activity in the Human Sleep EEG: Effect of Midazolam and Zopiclone

Electroencephalographic slow-wave activity (SWA; power density in the 0.75 to 4.5 Hz band) and spindle frequency activity (SFA; 11.25 to 15.0 Hz) exhibit a typical time course and a distinct mutual relationship during sleep. Because benzodiazepines (BDZ) suppress SWA and enhance SFA, we investigated the effect of two BDZ-receptor agonists on the dynamics of these EEG parameters. A single dose of midazolam (15 mg), zopiclone (7.5 mg), or placebo was administered before bedtime to healthy young men. Although the two drugs reduced SWA and enhanced SFA, their time course across and within sleep cycles as well as their mutual relationship were little affected. The results constitute further evidence that hypnotics acting as BDZ-receptor agonists do not substantially interfere with the homeostatic aspect of sleep regulation.

Sedative and respiratory effects of intramuscular midazolam as a premedicant: Influence of gender.

We compared the sedative and respiratory effects of intramuscular midazolam in men and women in a randomized, single-blind trial. The patients (203 men and 195 women) received a single dose of midazolam (0.05, 0.075, 0.1, or 0.15 mg·kg-1) intramuscularly 45 min before arriving at the operating room. Assessments in the operating room included sedation level and respiratory status rated on an objective four-point scale. Men given 0.075, 0.1, or 0.15 mg·kg-1 of midazolam exhibited greater sedation than did women given comparable doses. Midazolam 0.15 mg·kg-1 depressed respiration more frequently in men than in women. Plasma concentrations of midazolam were determined in 10 men, and 10 women randomly selected from the patients who received 0.15 mg·kg-1 of midazolam. A higher plasma concentration of midazolam, associated with a higher degree of sedation and respiratory depression, was attained in men than in women. These findings suggest that the optimal dose per unit body weight of intramuscular midazolam as premedication should be lower in men than in women to prevent over-sedation and respiratory depression.