What is the role of benzodiazepines in pediatric sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Benzodiazepines are used as sedative-hypnotic agents. They have anxiolytic, amnestic, and skeletal muscle relaxant properties. However, they do not have any analgesic properties. They exert effects on gamma-aminobutyric acid (GABA) receptors and potentiate GABA neuron inhibitory actions, as well as result in chlorine channel opening and postsynaptic neuronal hyperpolarization.

Midazolam is commonly used because of its short half-life and prompt onset of action. Diazepam is also used, but it has a long half-life and active metabolites. Lorazepam is a poor choice for procedural sedation, because of its long duration of action.

The benzodiazepine reversal agent is flumazenil; the pediatric dose is 0.01-0.02 mg/kg IV, which may be repeated every minute to a maximum cumulative dose of 1 mg. Flumazenil can precipitate seizures in patients who have ingested tricyclic antidepressants (TCAs) or are long-term benzodiazepine users.

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