SEDATION WITH INTRAVENOUS MIDAZOLAM IN THE PEDIATRIC INTENSIVE-CARE UNIT

Physical and emotional distress can have important effects on patients in the pediatric intensive care unit (ICU), Intravenous (IV) infusion of benzodiazepines is an important adjunct to assisted ventilation an d other potentially distressing ICU procedures. Combined with intermit tent or continuous infusion of opioids, the benzodiazepines provide sm ooth control of anxiety, pain, and agitation. Intravenous midazolam (V ersed(R) Roche Laboratories) is distinguished from diazepam (Valium(R) , Poche Products) by its water solubility, short elimination half-life , and generally short duration of action. These pharmacological proper ties, which are also shared, in part, with the more slowly eliminated drug lorazepam (Ativan(R), Wyeth-Ayerst), facilitate titration of the rate of infusion against patient response and permit regulation of the depth of sedation. The major adverse effects of long-term benzodiazep ine infusion are withdrawal symptoms and, occasionally, delayed awaken ing, The dosage needed to initiate and maintain sedation must be adjus ted to body weight, degree of sedation desired, and concomitant medica tions, as well as to underlying health and cardiovascular status. Benz odiazepines, such as midazolam and lorazepam, represent important choi ces among drugs used for sedation in the pediatric ICU.