Comparison of the Effect of Midazolam or Vecuronium on Blood Pressure and Cerebral Blood Flow Velocity in the Premature Newborn

Abstract

The effect of midazolam and vecuronium on mean arterial pressure (MAP) and mean cerebral blood flow velocity (MCBFV) was evaluated in premature infants (birthweight 550-2,560 g; gestational age 26-36 weeks) randomised to receive either 0.1 mg/kg midazolam (n = 7) or 0.05 mg/kg vecuronium (n = 8) intravenously. MAP, by means of an indwelling arterial cathether, and MCBFV, by means of noninvasive pulsed-Doppler of the middle cerebral artery, were measured every 5 min, starting at 10 min prior to until 1 h after drug administration. A transient 25-43% decrease in MCBFV (mean 0.06 m/s) dependent on a 8-23% decrease in blood pressure (mean 9 mm Fig) was noted in all patients within 15 min following administration of midazolam, which returned to baseline values within 1 h. In 2 out of 7 infants, a plasma expander was required. In contrast, vecuronium only decreased the MCBFV in 3 of 8 infants. Thus, a bolus of midazolam transiently decreased blood pressure and MCBFV, and should be used cautiously in sick preterm infants.

Premedication for Nonemergency Endotracheal Intubation in the Neonate

“…In a randomized, double-blind trial (stopped after only 16 intubations because of adverse events and reported in a letter to the editor), preterm infants who received midazolam and atropine for intubation had more desaturations, and 29% required cardiopulmonary resuscitation compared with those in the groups that received either atropine alone or no premedication. 32 Midazolam can cause hypotension in both preterm and term infants, [33][34][35][36] decreased cardiac output in older children, 37 and decreased cerebral blood flow velocity in premature infants. 33,38 The studies that demonstrated these effects were not performed as part of premedication for intubation, and the results may not be applicable to the circumstances necessitating endotracheal intubation.…”

Use of Analgesic and Sedative Drugs in the NICU: Integrating Clinical Trials and Laboratory Data

“…As a potentially harmful drug, midazolam should be prescribed with extreme caution (116,140,141). Midazolam is often used as additional treatment when analgesia is considered insufficient or as a means to decrease analgesic use but no evidence supports this practice in the neonate.…”

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

“…However, adverse effects of both midazolam and morphine have been described. Intravenous midazolam has been associated with hypotension [3][4][5][6] , myoclonus [4,[6][7][8] , and respiratory depression [5] whereas the adverse effects of morphine include hypotension [9,10] , bradycardia [9] , and respiratory depression [9,10] . The precise influence of midazolam and morphine on cerebral oxygenation and hemodynamics in premature infants is still unknown.…”