Sedation with Continuous Infusion of Midazolam for Ventilated Patient in Intensive Care Unit

Koh, Shin Ok; Nam, Sang Beom; Bang, Eun Chi

Abstract

BACKGROUND: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring.
METHODS
We started continuous infusion of midazolam at a rate of 0.5~1.0 ug/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion.
RESULTS
The mean loading dose, infusion rate and total dose of midazolam were 4.1+/-0.9 mg, 1.2+/-0.4 ug/kg/minute and 251.9+/-84.0 mg. The mean duration of infusion was 59.0+/-37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion.
CONCLUSIONS
Continuous infusion of midazolam at a rate of 1.2+/-0.4 ug/kg/minute after 4.1+/-0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.