A prospective study of the adverse effects of midazolam on withdrawal in critically ill children

Abstract

Fifty-three critically ill infants and children received midazolam as sedation in a regional intensive care unit. Assessment of the level of sedation was carried out at regular intervals on withdrawal of midazolam. Forty-nine patients were fully alert within 4 h of midazolam being stopped. Four patients took from 6 h to 1 week to become fully alert. Four patients had abnormal behaviour highly suggestive of midazolam withdrawal. The onset of abnormal behaviour was within 12 h of discontinuation of midazolam. The duration of the abnormal behaviour ranged from 3 h to 1 week. One child had a paradoxical reaction to midazolam. The overall incidence of adverse effects to midazolam in the patients studied was 17%. No adverse effects were observed in infants; all adverse effects were observed in children. We have shown that it is possible to prospectively study the toxicity of sedatives in critically ill infants and children.

Direct reporting of suspected adverse drug reactions by patients

“…Analysis of disease specific and generic quality of life in BHACAS-1 and -2 patients at a median of three years' follow-up likewise revealed no difference between on and off pump groups. 11 Training and OPCAB Whilst some practising surgeons remain to be convinced of the merits of OPCAB, this is not the case with the next generation of surgeons. In a survey of cardiothoracic trainees in the UK, 96% felt that training in OPCAB was essential (S Bays, GD Angelini, unpublished).…”

“…In truth, the evidence to date indicates that OPCAB, when compared with conventional CABG, is associated with at least equivalent clinical outcome at lower cost. [1][2][3][4][5][6][7][8][9][10][11] Furthermore, training in OPCAB techniques, as part of a structured programme, has been shown to be safe and successful. 12,13 Existing evidence challenges the paradigm that conventional on-pump CABG represents the gold standard in surgical revascularization.…”

Infections in children

“…More recently, there have been case reports of unconsciousness or prolonged sedation following the concomitant use of midazolam with the antibiotic erythromycin [244,245]. The enhancement of the sedative effect of midazolam is thought to be due to inhibition of its metabolism by erythromycin [246].…”

Untitled

“…In a neonatal intensive care unit in New Delhi, moderate hypotension was reported in six (19%) of 32 VLBW babies who received midazolam sedation during mechanical ventilation, but there was no increase in any adverse neurological event (44). Midazolam has also been reported to cause adverse effects (delayed time to become fully alert/abnormal behaviour) on withdrawal in critically ill children (45).…”