A PROSPECTIVE-STUDY OF THE ADVERSE-EFFECTS OF MIDAZOLAM ON WITHDRAWALIN CRITICALLY-ILL CHILDREN

Fifty-three critically ill infants and children received midazolam as sedation in a regional intensive care unit. Assessment of the level of sedation was carried out at regular intervals on withdrawal of midazo lam. Forty-nine patients were fully alert within 4h of midazolam being stopped. Four patients took from 6h to 1 week to become fully alert. Four patients had abnormal behaviour highly suggestive of midazolam wi thdrawal. The onset of abnormal behaviour was within 12h of discontinu ation of midazolam. The duration of the abnormal behaviour ranged from 3h to 1 week. One child had a paradoxical reaction to midazolam. The overall incidence of adverse effects to midazolam in the patients stud ied was 17%. No adverse effects were observed in infants; all adverse effects were observed in children. We have shown that it is possible t o prospectively study the toxicity of sedatives in critically ill infa nts and children.