Diazepam or midazolam for external DC cardioversion (The DORM Study)

Abstract

Physician-led cardioversion of atrial arrhythmias using intravenous sedation is effective and well tolerated. Sedation with diazepam was associated with fewer minor adverse events and a quicker recovery time than midazolam.

Diazepam or midazolam for orotracheal intubation in the ICU?

“…In comparative studies with diazepam in several procedures, midazolam proved more effective at inducing rapid sedation. 16,[18][19][20] Midazolam is known to be rapidly absorbed and the onset of action is, therefore, faster than that of diazepam and its effects are expected to occur sooner than those of diazepam. In addition, the dose of both drugs to reach adequate sedation was similar.…”

“…[5][6][7][8][9][10][11][12][13][14] It has repeatedly been shown that physician-led sedation using the benzodiazepine diazepam is also safe and has a positive impact on patient acceptability of the procedure. 15,16 In several countries, benzodiazepines are still the main drug of choice for procedures instead of using newer, rapidly acting, anesthetics, largely driven by cost concerns. 16 In the Santa Casa Hospital Complex (seven hospitals and eight ICUs), midazolam is the drug most used -and frequently solely used -for sedation in procedures like upper endoscopy, cardioversion or intubation.…”

“…15,16 In several countries, benzodiazepines are still the main drug of choice for procedures instead of using newer, rapidly acting, anesthetics, largely driven by cost concerns. 16 In the Santa Casa Hospital Complex (seven hospitals and eight ICUs), midazolam is the drug most used -and frequently solely used -for sedation in procedures like upper endoscopy, cardioversion or intubation.…”

“…6,16,17 The awakening time is considerably longer for midazolam so that any time gained with induction of sedation is lost in the longer recovery. 15,16,[18][19][20] However, most patients that need urgent intubation in the ICU will need continuous sedation, mainly due to respiratory insufficiency.…”

“…16,17,21,22 Hypotension is observed with both diazepam and midazolam. This side effect can be of relevance when inducing sedation in a patient already hemodinamically unstable as several patients in need of urgent intubation.…”