What is the role of midazolam in emergency department (ED) sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Midazolam is a benzodiazepine with a unique imidazole ring that allows for both lipophilic and hydrophilic properties. [5] When the pH is less than 4, it is water soluble and the chance of pain at the injection site is lowered. Unlike other benzodiazepines, midazolam becomes lipophilic at a pH greater than 4. Midazolam crosses the blood-brain barrier with ease as a lipophilic molecule, producing sedation in less than 5 minutes.

The total dose in adults is 0.02-0.1 mg/kg. The initial pediatric dose is 0.05-0.15 mg/kg IV or IM. The duration of action is about 30 minutes, although sedation may be prolonged in elderly patients. Midazolam is metabolized by the hepatic microsomal system and is not affected by renal failure (caution with cirrhosis). [4]

Midazolam is the fastest acting of its class because of its lipophilic abilities, and it is superior to lorazepam and diazepam in its amnestic effects, making it the ideal benzodiazepine for use in short ED procedures. [1]

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