Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient.

Abstract

In many endoscopy units midazolam is replacing diazepam as the intravenous sedative of first choice. Midazolam is approximately twice as potent as diazepam. Although generally considered a safe drug, there have been a number of recent reports, particularly in the elderly, of the drug causing hypotension, respiratory depression and even death. There have been at least ten studies comparing diazepam with midazolam for upper gastrointestinal endoscopy but many have involved relatively small numbers and none have adequately addressed the question of dosage in the elderly. We have carefully recorded the dose of intravenous midazolam used to produce adequate sedation prior to upper gastrointestinal endoscopy in 800 consecutive patients. The dose of midazolam decreased markedly with age in both male and female patients. There was a highly significant correlation in both sexes between age and the dose of midazolam (rho -0.787, P < 0.001 for males and rho -0.768, P < 0.001 for females). There was only a small difference in dose in men and women, an average of 1 mg; and no difference in dose over the age of 70 years. In patients over 70 years of age the dose of midazolam necessary for endoscopy is often so small that overdosage is all too easy.

Correlation between precise and simple tests in recovery of dynamic balance function after intravenous sedation with midazolam in the elderly

“…Excessive sedation, airway obstruction, and respiratory failure may occur in elderly patients when the same dose of a benzodiazepine sedative as that needed for younger patients is administered, because the pharmacodynamics and/or pharmacokinetics of these drugs are different for the elderly and younger persons [18,19].Therefore, careful titration is needed to achieve an optimal sedation level in intravenous sedation, especially for the elderly [20,21]. On this occasion, it is desirable to evaluate the sedation level objectively.…”

Pharmacokinetic‐EEG effect relationship of midazolam in aging BN/BiRij rats

“…(Mandema et al, 1991a,b (Greenblatt et al, 1984;Smith et al, 1984). This implies, that changes in the volume parameters cannot explain the decreased dose requirement reported by Bell et al (1987). In man, a lower total body clearance and an increased elimination half-life were found in elderly males, but not in females (Greenblatt et al, 1984;Servin et al, 1987).…”

“…Also in the treatment of sleep disorders in the elderly, midazolam was reported to be effective and well-tolerated, provided that it is given in a carefully titrated, appropriate dose (Lachnit et al, 1983). Several authors emphasized the importance of titrating the dose, since dose requirement for midazolam is reduced in elderly patients (Kanto et al, 1986;Bell et al, 1987;Oldenhof et al, 1988). In a study in 800 patients in which the dose of intravenous midazolam required to produce adequate sedation prior to upper gastro-intestinal endoscopy was measured, an important decrease of approximately 75% in dose requirement from the age of 15 years to the age of 85 years was observed (Bell et al, 1987).…”

Impact of Fentanyl Associated with Midazolam in Sedation for Transesophageal Echocardiography

“…Bell e cols. 7 , estudando 800 pacientes consecutivos submetidos a endoscopia digestiva alta, observaram uma marcada diminuição na dose em relação à idade; em pacientes mais jovens a dose utilizada era maior que nos mais idosos. No nosso estudo, apesar de não ser o objetivo, a população era de pacientes relativamente jovens e não houve diferença entre idade e gênero.…”