midazolam
Meaning of midazolam: Speed in and speed out is the point: it suits a procedure that lasts minutes, not a symptom that lasts months.
Definition of midazolam
Midazolam is a short acting benzodiazepine used to produce sedation, ease anxiety, relax muscles and stop a seizure that will not stop on its own. It takes effect quickly and wears off faster than most drugs in its class, which suits it to procedures rather than to daily use. It also blocks the laying down of new memories while it acts.
Where is it used?
| Setting | Purpose |
|---|---|
| Before and during procedures | Sedation and relief of anxiety for endoscopy, dental work, imaging and minor surgery |
| General anesthesia | Given as one component of the mixture that starts or maintains it |
| Prolonged seizures | Halts a seizure that is not stopping by itself, including outside hospital |
| Intensive care | A continuous infusion keeping a person on a ventilator comfortable |
| Palliative care | Eases agitation, distress and severe breathlessness late in an illness |
How does it work, and how is it given?
Midazolam strengthens the action of GABA, the main quieting signal in the brain, so nerve cells fire less readily. Sedation, reduced anxiety, muscle relaxation and suppression of seizure activity all follow from that single mechanism. Its chemistry is unusual and useful. It stays dissolved in the acidic solution it is supplied in, then changes shape at the body's own acidity to become fat soluble, which lets it enter the brain a minute or two after an injection. It can be given into a vein or a muscle, swallowed as a syrup, placed inside the cheek, or sprayed into the nose, and the last two matter because they need no needle and work where no vein is available. The liver breaks it down, and the product of that breakdown has activity of its own, so the effect lingers when kidney function is poor or an infusion has run for days.
What are the risks?
The main one is that breathing slows or stops, and the danger multiplies when an opioid painkiller is given alongside it, which is common during procedures. Blood pressure can fall. Older adults and young children sometimes respond with agitation and confusion instead of calm. Monitoring of breathing, oxygen level and heart rhythm is standard practice whenever it is used for sedation. A specific antidote, flumazenil, reverses the effect, but it wears off sooner than midazolam does and can provoke seizures in someone already dependent on benzodiazepines, so reversal is not a straightforward undo. Infusions running for days produce tolerance and physical dependence, and stopping abruptly after that causes withdrawal.
Also known as
Used in a sentence
Midazolam was given intravenously before the procedure to reduce the patient's anxiety and provide sedation.
Good to know
Midazolam's amnesia-producing effect, in which a person may not recall the procedure afterward, is distinct from sedation itself, which refers to the level of consciousness during the procedure.