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 and other potentially distressing ICU procedures. Combined with intermittent or continuous infusion of opioids, the benzodiazepines provide smooth control of anxiety, pain, and agitation. Intravenous midazolam (Versed® Roche Laboratories) is distinguished from diazepam (Valium®, Roche Products) by its water solubility, short elimination half-life, and generally short duration of action. These pharmacological properties, which are also shared, in part, with the more slowly eliminated drug lorazepam (Ativan®, 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 benzodiazepine infusion are withdrawal symptoms and, occasionally, delayed awakening. The dosage needed to initiate and maintain sedation must be adjusted to body weight, degree of sedation desired, and concomitant medications, as well as to underlying health and cardiovascular status. Benzodiazepines, such as midazolam and lorazepam, represent important choices among drugs used for sedation in the pediatric ICU.