Abstract
Twenty-four patients in a paediatric intensive care unit mostly undergoing cardiac surgery, received a midazolam dosage between 50–400 μg/kg per hour as a continuous intravenous infusion partly in combination with fentanyl [0,5–2,5 μg/kg per hour] for analgesia and sedation. The mean duration of midazolam infusion was 11.6 days (range 38h–40 days). Blood samples for the HPLC assay of serum midazolam concentration were taken and the clearance estimated. The efficiency of sedation in correlation to the midazolam concentration was evaluated by a clinical sedation score. Serum midazolam concentrations between 100–400 μg/l were sufficient for sedation. Dosage had to be increased during therapy according to an increased midazolam clearance. The evaluation of the sedation score showed that sedation of artifically ventilated infants and young children can be established by continuous intravenous infusion of midazolam.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Anand KJS, Sippel WG, Aynsley-Green A (1987) Randomized trial of fentanyl anaesthesia in preterm babies undergoing surgery: effect of the stress response. Lancet I: 62–66
Arzneitelegramm (1986) Todesfälle nach Midazolam. Arzneitelegramm 12: 117
Birch B, Miller R (1988) Safety of midazolam. Lancet II: 683
Booker PD, Beechey A, Lloyd-Thomas AR (1986) Sedation of children requiring artificial ventilation using an infusion of midazolam. Br J Anaesth 58: 1104–1108
Cole WHJ (1982) Midazolam in pediatric anaesthesia. Anaesth Intensive Care 10: 36
Diament M, Stanley P (1988) The use of midazolam for sedation of infants and children. AJR 150: 377–378
Dick W (1981) Med. Sedierung während der Langzeitbeatmung. Intensivmed. 18: 162
Driessen JJ, Dirksen MSC, Rutten JMJ, Santmann F (1989) Continuous infusion of midazolam during anaesthesia and postoperative sedation after maxillofacial surgery. Acta Anaesthesiol Scand 33: 116–121
Dundee JW, Halliday NJ, harper KW (1984) Midazolam: a review of it's pharmacological properties and therapeutic use. Drugs 28: 519–543
Fahnenstich F, Haverkamp F, Bindl F, Kowalewski S (1989) Midazolam-paradoxe Reaktion bei Neugeborenen. Intensivmedizin, Notfallmedizin, Anästhesiologie, Georg Thieme Verlag Vol. 69: 154
halloway A, Jordan D, Brock-Utne J (1982) Midazolam for the intravenous induction of anaesthesia in children. Anaesth Intensive Care 10: 340
Hoffmann P, Imhoff M (1988) Analgesie und Sedierung bearmeter Patienten in der Intensivmedizin. Zentraibl Chir 113: 500–513
Kanto JH (1985) Midazolam: the first water soluble benzodiazepine. Pharmacotherapy 5: 138–155
Kehlet H (1984) Influence of regional anaesthesia on postoperative morbidity. Ann Chir Gynaecol 73: 171–176
Kwan Lam T, Keung W, Seung Chan Y (1988) Use of midazolam in children. Lancet II: 565
Lloyd-Thomas AR, Booker PD (1986) Infusion of midazolam in pediatric patients after cardiac surgery. Br J Anaesth 58: 1109–1115
Lynn AM, Opheim KE, Tyler DL (1984) Morphine infusion after pediatric cardiac surgery. Crit Care Med 12: 863–866
McGrath PJ, Johnson GG (1988) Pain management in children. Can J Anaesth 35: 107–110
Michalk S, Moncore C, Fichelle A (1988) Midazolam infusion for basal sedation in intensive care: absence of accumulation. Intensive Care Med 16: 37–41
Mühlendahl KE von (1987) Midazolam-Amnesie bei kleinen kurzdauernden Eingriffen bei Kindern. Päd Praxis 36: 435–437
Otte J, Stewens J, Tegtmeyer FK (1987) Midazolam zur Sedierung von Kindern bei schmerzhaften Eingriffen. Monatsschr Kinderheilkd 135: 487–491
Reves JG, Fragen R (1985) Midazolam: pharmacology and use. Anesthesiology 62: 310–324
Salonen M, Kanto J, Jisalo E (1987) Midazolam as an induction agent in children: a pharmacokinetic and clincial study. Anesth Analg 66: 625–628
Silvasi DL, Rosen D, Rosen K (1988) Continuous intravenous midazolam infusion for sedation in the pediatric intensive care unit. Anaesth Analg 67: 286–288
Yaster M, Deshapande KJ (1988) Management of pediatric pain with opioid analgesics. J Pediatr 113: 421–429
Author information
Authors and Affiliations
Additional information
Dedicated to the 65th birthday of Prof.Dr. Erich Gladtke
Rights and permissions
About this article
Cite this article
Hartwig, S., Roth, B. & Theisohn, M. Clinical experience with continuous intravenous sedation using midazolam and fentanyl in the paediatric intensive care unit. Eur J Pediatr 150, 784–788 (1991). https://doi.org/10.1007/BF02026712
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02026712