Midazolam (Versed) Overview

Introduction

• Presenter: Eddie Watson
• Channel: ICU Advantage
• Goal: To simplify complex critical care subjects for ICU success

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Midazolam (Versed)

Background

• Synthesis: 1975 by Walser and Fry at Hoffmann-La Roche
• Popularity: Preferred over other benzodiazepines due to water solubility and lower risk of thrombophlebitis
• Recognition: Studied for anticonvulsant properties in 1970s, used for status epilepticus by 1990s

Mechanism of Action

• Type: Benzodiazepine
• Function: Induces anesthesia and conscious sedation
• Action: Binds GABA receptors, potentiates effects of endogenous GABA
• Effect: Depresses the CNS, suppresses seizure spread

Indications

• Perioperative sedation
• Anxiolysis
• Anesthesia induction
• Amnesia
• Treatment for status epilepticus
• Procedural sedation and continuous sedation in intubated/ventilated patients

Contraindications

• Hypersensitivity
• Caution in:
  • Older adults
  • Debilitated patients
  • Acute illness
  • HF, respiratory, renal, hepatic disease
  • Increased risk of falls
• Paradoxical reactions: Agitation, aggressive behavior, involuntary movement

Adverse Effects

• CNS: Oversedation, drowsiness, amnesia, seizures, involuntary movements, paradoxical behaviors
• Cardiovascular: Variations in HR and BP, hypotension (less common than Propofol)
• ENT: Nystagmus
• GI: Nausea and vomiting
• Respiratory: Decreased respiratory rate, decreased O2 SATs, apnea

Common Concentrations

• PO: 2 mg/mL in 100 mL bottle or 10 mg in 5 mL cup
• IV: 1 mg/mL (most common), 5 mg/mL also available
• Continuous Sedation: 1 mg/mL (50 mg/50 mL or 100 mg/100 mL)

Common Dosing

• IV Push: 1-2 mg common, larger doses possible
• IV Infusion: Start at 2 mg/hr, titrate to effect, max 10 mg/hr (higher in special cases: status epilepticus, brain injury, elevated ICP, proning)

Pharmacokinetics

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

Antidote

• Name: Flumazenil (Romazicon)
• Dose: 0.2 mg IV

Nursing Considerations

• Training: Administer only by trained individuals
• Antidote Ready: Flumazenil should be available
• Rescue Equipment: Code cart, bag valve mask, suction
• Monitoring: BP, HR, rhythm, respirations, airway integrity, continuous pulse oximetry
• Hepatic Impairment: Prolonged duration
• Renal Failure: 50% dose reduction
• Labs: No relevant identified lab studies

Outro

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