Psychopharmacologic Drugs : Anxiolytics, Sedatives and Hypnotics
IDORM1 “Dormicum injection” 5 mg/ml; 3 ml/amp
IMIDA1 “Midatin injection” 5 mg/ml; 1 ml/amp
[泡法]
(1) pure infusion
(2) 1支是15mg，常用的泡法是3支(total 45mg)泡成45mL (1mL=1mg)；根據guideline，其劑量範圍是0.04-0.2mg/kg/hr；對一位50公斤重的病人，其infusion rate是2-10mL/hr
[備註]
(1) pure Dormicum一定要用CVC給藥(因會靜脈炎)
(2) 60%腎臟代謝，40%肝臟代謝
適應症：知覺鎮靜、急救加護病房鎮靜、麻醉誘導及維持、手術前給藥。
Usual dose:
Induction of general anesthesia: IV
Adult
(unpremedicated p’ts, < 55 yrs): 0.3-0.35 mg/kg IV.
(unpremedicated p’ts, > 55 yrs): 0.3 mg/kg IV over 20-30 sec and allowing 2 min for effect, max. 0.6 mg/kg.
(premedicated p’ts, < 55 yrs): 0.25 mg/kg IV 20-30 sec and allowing 2 min for effect.
Amnesia induction-Anxiety-Preoperative sedation: IM
Adult (high risk p’ts, < 60 yrs): 0.07-0.08 mg/kg (≒5 mg) 1 h before surgery.
Procedural sedation: IV/IM
Adult (healthy, < 60 yrs): 1-2.5mg IV titrated slowly, max infusion rate 1.25 mg/min.
Pediatric: 0.1-0.15 mg/kg IM (up to 0.5 mg/kg for more anxious p’ts); total dose usually <10 mg.
(6 mon-5 yrs): IV, initial dose 0.05-0.1 mg/kg over 2-3 min, total dose up to 0.6 mg/kg may be necessary; total dose usually <6 mg.
(6-12 yrs): IV, initial dose 0.025-0.05 mg/kg over 2-3 min; total dose up to 0.4 mg/kg may be needed; total dose usually does not exceed 10 mg.
(12-16 yrs): IV, dose as adult, total dose usually does not exceed 10 mg.
Status epilepticus: IV
Adult (refractory): initial, 200 mcg/kg, via slow bolus injection; maintenance 0.75-10 mcg/kg/min IV for 12-24 h, then slowly taper off while the p’t is observed. midazolam may be continued if seizures recur.
Dose adjustment:
Liver disease, Renal failure (CrCl < 10 ml/min): decrease dose by 50%.
Geriatric: procedural sedation (p’ts > 60 yrs, and debilitated or chronically ill) 1-1.5 mg IV titrated slowly, max. infusion rate 0.75 mg/min. A total dose > 3.5 mg is usually not necessary.
Contraindication:
Acute narrow-angle glaucoma, untreated open-angle glaucoma, intrathecal or epidural administration (due to the presence of the preservative benzyl alcohol).
Adverse effect:
Common: hiccoughs, nausea, vomiting, coughing, oversedation, headache.
Serious:agitation, involuntary movements, apnea, decreased tidal volume and/or respiratory rate decrease, airway obstruction, oxygen desaturation in pediatric p’ts, respiratory arrest usually in combinations with CNS depressant drugs, cardiac arrest usually in combinations with CNS depressant drugs, hypotensive episodes.