ICU Advantage Lecture: Midazolam (Versed)

Introduction

• Presenter: Eddie Watson from ICU Advantage
• Goal: Simplify complex critical care topics for ICU success
• Announcement: Pre-order for ICU Advantage Academy for CE credits and ad-free learning
• Launch date: March 15th

Midazolam Overview

• Trade Name: Versed
• Synthesis: 1975 by Walser and Fry at Hoffman LaRoche (Swiss pharmaceutical)
• Favorable Aspects:
  • Water solubility
  • Less risk of thrombophlebitis

Pharmacology

• Drug Class: Benzodiazepine
• Uses:
  • Induction of anesthesia
  • Conscious sedation
  • Treat status epilepticus
• Mechanism of Action:
  • Binds GABA receptors
  • Potentiates endogenous GABA
  • CNS depression
  • Suppression of seizure activity

Indications

• Perioperative sedation
• Anxiolysis
• Anesthesia induction
• Amnesia
• Status epilepticus

Contraindications & Cautions

• Hypersensitivity to the drug
• Caution with:
  • Older adults
  • Debilitated patients
  • Acute illnesses
  • Heart failure
  • Respiratory, renal, or hepatic disease
  • Increased fall risk
• Paradoxical reactions possible (agitation, aggression, involuntary movements)

Adverse Effects

• Central Nervous System: Oversedation, drowsiness, amnesia, seizures, involuntary movements
• Cardiovascular: Heart rate and blood pressure variations, less common hypotension
• ENT: Nystagmus
• Gastrointestinal: Nausea, vomiting
• Respiratory: Decreased respiratory rate, oxygen saturation, apnea

Formulations and Concentrations

• Oral: 2 mg/mL syrup (100 mL bottle), single-use cups (10 mg, 5 mg)
• IV Push: 1 mg/mL (common), 5 mg/mL available
• Continuous Sedation: 1 mg/mL (50 mg in 50 mL or 100 mg in 100 mL)

Dosing

• IV Push: 1-2 mg common, larger doses possible
• IV Infusion:
  • Start at 2 mg/hour
  • Titrate for response
  • Max 10 mg/hour, higher in cases like status epilepticus

Pharmacokinetics

• Onset: 90 seconds to 5 minutes
• Peak: 5-7 minutes
• Duration: Less than 2 hours (up to 6 hours in cirrhosis)
• Metabolism: Liver and gut, excreted in urine

Antidote

• Flumazenil (Ramazacon): 0.2 mg IV push

Nursing Considerations

• Administer only by trained personnel
• Have antidote and rescue equipment ready
• Monitor:
  • Blood pressure
  • Heart rate and rhythm
  • Respirations
  • Airway integrity
  • Continuous pulse oximetry
• Adjust dosing for hepatic impairments and renal failure

Conclusion

• No specific laboratory studies required for midazolam
• Feedback and support requested via likes, comments, and memberships
• Stay tuned for future lessons and more learning opportunities