醫學筆記匯整 ED Notes

臨床上很常用的藥物 -- Midazolam : Dormicum 5mg/1mL/amp
在眾多 BZD 中
Midazolam 屬於Rapid onset, short duration
duration 各家說法不同, 從 30 分鐘到 2 小時都有
Tintinalli average Effective Action 為 30 - 80 mins

另外 BZDs 皆由肝代謝
只有 Lorazepam 較特別, 不透過cytochrome P450
所以使用BZDs 在肝功能異常病人上需注意

BZD類藥物盡量減少併用其他中樞抑制藥物
以避免過度鎮靜甚至呼吸抑制

低血壓/呼吸抑制這是大家都熟知的副作用了

Procedural sedation recommended IV Dose:
Weight-based: 0.1 mg/kg and 0.05 mg/kg in elderly
or 1 - 2.5 mg ; 0.5 mg in elderly

If elderly, underweight or comorbid conditions :
lower initial doses of 0.5 - 1.5 mg
repeat doses should not exceed 1 mg
and more time should be allowed between repeat doses (3 - 5 minutes)
Total doses in these patient populations typically do not exceed 3.5 mg.

了鎮靜外
另一個常用的情況是癲癇
IM midazolam was determined to be as safe and effective as IV lorazepam.
However, IV lorazepam is still considered
the initial agent of choice if IV access is available.

The goal of treatment is seizure control as soon as possible

and within 30 minutes of presentation

若已經到了Refractory status epilepticus
也是 continuous midazolam Infusions 登場的時候了

Refractory status epilepticus is defined as persistent seizure activity
despite the IV administration of adequate amounts of two antiepileptic agents and usually exceeds 60 minutes