Midazolam observational studies

In a prospective, observational study in 30 children undergoing adenoidectomy anesthesia was induced with midazolam and thiopental (both potent anticonvulsants) and maintained with sevoflurane no electroencephalo-graphic epileptiform activity was observed (21). 

In a prospective observational study of the prevalence of adverse behavioral events, such as anxiety and sleep disturbance, in the 2-week period after discharge from the emergency department, in children aged 3 months to 18 years, the prevalence of behavioral disturbances was low in those who received fentanyl 4-midazolam ( = 109) however, when compared with those who received ketamine-b midazolam ( = 120), the fentanyl-b midazolam group had a 2.6 times increased odds of being in the highest quintile of the Post Hospital Behavior Questioimaire [42 ]. 

Observational studies Several studies have reported better recovery with a combination of remifentanil + midazolam compared with combinations of fentanyl +midazolam and... 

Observational studies In a prospective study of 516 children undergoing CT scans, who received midazolam 0.212 mg/kg, there was adequate sedation in 5.9 minutes and only a few patients required additional boluses [22 ]. There were adverse effects in 9.1% of patients, including desaturation in 6.9%, all of whom were treated successfully with oxygen, hiccups in 1.4%, and agitation in 0.79%. All the adverse effects were self-limitmg. 

In a prospective non-randomized observational study of behavioral changes and vomiting after discharge in 554 children who had undergone procedural sedation with ketamine alone (66%), ketamine + midazolam (19%), or midazolam + fenta-nyl (15%) questionnaires were collected... 

Consistent with their depressant and sedative effects, benzodiazepines administered acutely typically decrease CFF threshold.119 120 Specifically, significant decreases have been reported for 1 mg alprazolam, 10 mg diazepam, and 15 mg quazepam 121 4 to 11 mg midazolam 122 7.5 to 50 mg oxazepam 123 1 and 2 mg lorazepam 124 and 0.5 mg triazolam and 1 mg flunitrazepam.120 As is evident, this effect on CFF threshold was observed at therapeutic doses of each drug, and when multiple doses were tested, the effect was dose-related. However, there are reports of acute, therapeutic doses of diazepam (5 mg)125 and lorazepam (1 and 2 mg)125,126 having no effect on CFF threshold. One study investigating numerous benzodiazepines120 reported next-day impairment after acute doses of triazolam (0.5 mg) and lormetazepam (1 to 2 mg). No studies were found that examined the effect of chronic benzodiazepine administration on CFF threshold. 

A similar phenomenon has been observed with the well-established mechanism-based inhibitor, diltiazem (108). Diltiazem (Cardizem SR , 120 mg b.i.d. for 7 days) caused a decrease in small bowel CYP3A activity of 62% with no corresponding change in intestinal CYP3A mRNA or protein expression. Many clinical studies have shown that diltiazem, a calcium channel blocker, inhibits the metabolism of CYP3A substrates, such as triazolam (109), midazolam (110), and... 

Midazolam, Triazolam, and Flurazepam The feasibility of intranasal administration of midazolam, flurazepam, and triazolam has been studied and compared with oral absorption in dogs. There was a 3.4-fold increase in the Cmax after nasal administration, from 5.5-8.7ng/mL to 17.4-30.0 ng/mL. The mean tm showed comparable values for both routes. The Tnmx obtained after nasal administration of midazolam was found to be 15 min, as compared with the 15-45 min observed for oral dosing, while the Cmax after nasal administration was 6.5-20.3 ng/mL, as compared with 3.0-8.6ng/mL observed for the oral route. Like midazolam and triazolam, flurazepam also showed a shorter half-life, 15 min, as compared with 15 15 min with oral administration. The Cmax for oral administration was 0.14-0.59 ng/mL after nasal administration it was in the range of 2.6-11.1 ng/mL, a 16.4-fold increase. Since the gastrointestinal tract at bedtime is likely to be in the fed state, causing a twofold decrease in the absorption of midazolam and triazolam, the nasal route may be a better option for the treatment of amnesia, since these drugs cross the nasal mucosa effectively without the use of an absorption enhancer, as shown in these studies [108],... 

In situ nasal absorption studies of midazolam were carried out in rats. The effects of solution concentration, osmolality, and pH on nasal absorption were studied using the in situ perfusion technique. The absorption of midazolam was reported to be prevented at osmolalities in the range of 142-450 mOsm/kg however, a hypoosmotic 3-mOsm/kg solution resulted in significant absorption, where the pH rose from 3.3 to 6.5. No lag time in absorption was observed when the solutions were buffered at a pH of either 5.5 or 7.4 however, at pH 3.3, no absorption was seen, suggesting... 

Due to its greater anesthetic potency and more favorable side effects profile, S-ketamine has supplanted racemate in several European countries [204], In a study examining the utility of the S enantiomer preoperative medication in pediatric patients [204], the enantiomer was given by the rectal route to 40 children with or without midazolam. Another 22 children were premedicated only with midazolam. The authors found that S-ketamine had no advantage over midazolam alone as a preoperative sedative, and that S-ketamine was much less effective than had been observed previously in a similar cohort of subjects given racemic ketamine. The authors speculated [204] that perhaps the enantiomers are absorbed differently by the rectal route of administration. 

A number of human studies have shown that St. John s wort decreases plasma levels of alprazolam (Markowitz et al. 2000, 2003) and midazolam (Dresser et al. 2003 Gurley et al. 2002, 2005 Wang et al. 2001 Xie et al. 2005) in healthy volunteers. These effects are not observed with low hyper-forin-containing extracts (Arold et al. 2005) or after a short duration (3 days or less) of treatment (Markowitz et al. 2000). 

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