What is the role of midazolam in pediatric sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Midazolam is a favored sedative-hypnotic agent for procedural sedation because its water solubility allows it to be administered via several different routes (eg, oral, IV, IM, intranasal, and rectal).

Midazolam has a rapid onset of action when administered IV (2-5 min), is easily titrated, is associated with less pain at the injection site, and has a shorter duration of action than other commonly used benzodiazepines. The dose-response curve is highly variable in children; weight-based dosing produces variable levels of sedation in agitated children of the same weight; this is common with IM and PO dosing.

Dosing in children younger than 6 months has not been established. When midazolam is given IV, 2-3 minutes should be allowed to elapse after a dose before additional doses are administered.

In children aged 6 months to 12 years, midazolam is given as 0.05-0.1 mg/kg IV, titrated to the desired effect. Younger children (ie, < 5 years) may require larger cumulative doses, as high as 0.6 mg/kg or 6 mg.

In children older than 12 years, midazolam is given as 0.01-0.05 mg/kg IV (approximately 0.5-4 mg); the dose may be given slowly or infused over several minutes and may be repeated every 10-15 minutes. Do not exceed a cumulative dose of 10 mg. The oral dose is 0.25-1 mg/kg/dose, not to exceed 20 mg/dose. The IM dose is 0.1-0.15 mg/kg/dose 30-60 minutes before the procedure or operation, not to exceed 10 mg/dose. The intranasal dose is 0.2-0.5 mg/kg.

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