Midazolam
Personnel and Equipment for Monitoring and Depression
Midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. Midazolam has been associated with reports of respiratory depression, airway obstruction, desaturation, hypoxia, and apnea, most often when used concomitantly with other central nervous system depressants. Midazolam should be used only in hospital or ambulatory care settings, including physicians’ and dentists’ offices, that can provide for continuous monitoring of respiratory and cardiac function. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured [see WARNINGS]. For deeply sedated patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure.
Risks From Concomitant Use with Opioids (benzodiazepines)
Monitoring data
- Midazolam must never be used without individualization of dosage particularly when used with other medications capable of producing central nervous system depression.
- Prior to the intravenous administration of midazolam in any dose, the immediate availability of oxygen, resuscitative drugs, age-and size-appropriate equipment for bag/valve/mask ventilation and intubation, and skilled personnel for the maintenance of a patent airway and support of ventilation should be ensured.
- Patients should be continuously monitored with some means of detection for early signs of hypoventilation, airway obstruction, or apnea, i.e., pulse oximetry. Hypoventilation, airway obstruction, and apnea can lead to hypoxia and/or cardiac arrest unless effective countermeasures are taken immediately. The immediate availability of specific reversal agents (flumazenil) is highly recommended. Vital signs should continue to be monitored during the recovery period.
- When used for sedation/anxiolysis/amnesia, midazolam should always be titrated slowly in adult or pediatric patients.