Midazolam can be used for anxiolysis and hypnosis during the maintenance phase of general anesthesia and is also superior to thiopental in the maintenance of anesthesia because of the less need for adjunct medications. Because of its easy mode of administration through the buccal and intranasal routes, it is a viable option in children to manage seizures. For its use in anesthesia, the response to the induction dose is more variable compared to thiopental. Midazolam has a high rate of tolerance, and the dose can be increased to maintain the therapeutic effect. Because of its water-soluble nature, midazolam has a rapid onset of action and can be used to manage status epilepticus when intravenous administration of other medications is not feasible. Intravenous midazolam is used for the induction of anesthesia and also in the management of acute seizures. Summarize interprofessional team strategies for improving care coordination and communication to properly use midazolam to improve patient outcomes in the varied scenarios where it can be effective.Review the adverse event profile of midazolam.Describe the various indications where midazolam can be effective.Summarize the mechanism of action of midazolam.This activity will highlight the mechanism of action, adverse event profile, pharmacology, monitoring, and relevant interactions of midazolam, pertinent for members of the interprofessional team in the treatment of patients where it is of clinical value. Midazolam is an adjunct medication to regional and local anesthesia for a wide range of diagnostic and therapeutic procedures and has greater patient and clinician acceptance. Midazolam can be used for anxiolysis and hypnosis during the maintenance phase of general anesthesia. Because of its water-soluble nature, midazolam has a rapid onset of action and can be used to manage status epilepticus when intravenous administration of other medications is not feasible. Weak anesthetic effects and not suitable for painful proceduresĮarlier used in pediatric patients but no longer recommended.Intravenous midazolam is used for the induction of anesthesia and also in the management of acute seizures.Less respiratory and cardiovascular risk compared to other anesthetics.Short duration of effects and quick recovery.
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It is most commonly used for pediatric dentistry. Nitrous oxide has been used for sedation and analgesia for years in children and adults.Paradoxical excitation (opposite-to-intended effects).Methohexital is a barbiturate used in pediatric patients. Light sedation allows patient response to verbal and physical stimulation.
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Brief decrease in intracranial pressureĭexmedetomidine is a hypnotic sedative that produces light sedation effects, used in children and adults.Minimal cardiovascular and respiratory effects.Lack of histamine release and allergic reactions.Rapid onset and ultra-short duration of effects.Cardiovascular depression and hypotensionĮtomidate is a hypnotic sedative agent useful in adults with hypotension and trauma.Burning, stinging and pain with injection.Rapid onset of deep sedation and ultra-short duration of effects, useful for initiating sedation.Often an anesthesiologist is required to administer propofol and monitor its use because of the deep sedation it can induce. Propofol is a hypnotic sedative agent used in both adults and children. Hypertension and increased heart rate (tachycardia).Excessive bronchial secretions and salivation (needs pretreatment with a medication known as glycopyrrolate).Delirium and hallucinations in patients older than 15.Patients may not be able to speak or respond purposefully.Lack of effects on laryngeal and pharyngeal reflexes.Rapid onset and very short duration of effects.Ketamine is a dissociative anesthetic used for both children and adults. Respiratory depression or apnea (cessation of breathing).
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