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Intravenous sedation : One or more intravenous administrations over a single operating session.
In most circumstances, the 2mg/ml formulation is more convenient for titration purposes.
Adults: An assessment should be made of the degree of sedation necessary for the planned procedure.
The dose should be titrated against the response of the patient. The desired titration end point will depend upon the procedure. Full sedation will be evident by drowsiness, slurred speech but response to commands will be maintained.
As a guide, it is recommended that 0.4ml of Midazolam 5mg/ml solution (equivalent to 2mg midazolam) be administered intravenously over 30 seconds. If after 2 minutes, sedation is not adequate, incremental doses of 0.1ml to 0.2ml of Midazolam 5mg/ml solution (0.5 to 1mg midazolam) should be given.
Usual dose range 2.5mg – 7.5mg total dose (equivalent to around 0.07mg/kg body weight).
Dosages greater than 5.0mg are not usually necessary.
Elderly people: OLDER PATIENTS ARE MORE SENSITIVE TO THE EFFECTS OF BENZODIAZEPINES. IN THESE PATIENTS DOSES GREATER THAN 3.5MG ARE NOT USUALLY NECESSARY AND LOW DOSES AS LITTLE AS 1MG – 2MG (0.2 – 0.4ML) MAY BE ADEQUATE. THE INITIAL DOSE SHOULD NOT EXCEED 1 – 1.5MG (0.2 – 0.3ML).
Paediatric population: Midazolam Injection has not been evaluated for use as an intravenous sedative in children.
Sedation by continuous infusion in intensive care : For sedation in the intensive care unit, dosages vary considerably and the dosage of Midazolam Injection should be individualised and titrated to the desired state of sedation according to the clinical need, physical status, age and concomitant medication.
Patients receiving Midazolam Injection for sedation by continuous infusion in the intensive care situation should receive ventilatory support.
Safety of continuous infusion of midazolam injection for periods of over fourteen days in duration has not been established in clinical trials.
Adults and children : Loading dose : For patients already sedated, a loading dose of midazolam is not required. To induce sedation, a loading dose of 0.03 – 0.3mg/kg is recommended, depending on the level of sedation required. This should be administered over a five minute period.
Maintenance dose : The dosage varies considerably. A dose between 0.03 – 0.2mg/kg per hour is recommended, commencing at the lower end of the range.
The dosage should be reduced or the loading dose should even be omitted in hypovolaemic, vasoconstricted and hypothermic patients.
Intravenous bolus sedation : Where analgesia is provided by a narcotic analgesic the latter should be administered first, the dose of midazolam should be carefully titrated and low doses 1 – 2mg (0.2 – 0.4ml) may be adequate. In the elderly, smaller doses as little as 0.5 – 1mg (0.1 – 0.2ml) may be adequate.
Sedation by continuous infusion in intensive care : Where analgesia is provided by narcotic analgesics, the rate of infusion of Midazolam Injection should be titrated carefully to the sedative needs of the patient.
Intravenous induction of anaesthesia : One or more bolus intravenous injections over a single anaesthetic session.
Adults : The dose should be titrated against the individual response of the patient. Midazolam Injection should be given by slow intravenous injection until there is a loss of eyelid reflex, response to commands and voluntary movements.
In anticipating the required dose of midazolam, both the premedication already given and the age of the patient are important. Young, fit unpremedicated patients may require at least 0.3mg/kg body-weight, whereas patients premedicated with an opiate usually require only 0.2mg/kg body-weight.
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