Midazolam

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happyabe

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So I am bit confused about the duration of the amnestic, not sedative, effects of midazolam. Say 4 mg IV is administered; on average, how long will a patient remain amnestic? Obviously patient factors are important, but does anyone know if studies have been done to show the duration of the amnestic effects?
 
So I am bit confused about the duration of the amnestic, not sedative, effects of midazolam. Say 4 mg IV is administered; on average, how long will a patient remain amnestic? Obviously patient factors are important, but does anyone know if studies have been done to show the duration of the amnestic effects?

Roughly about 30 min-1 hour.

When do you know it's working? An attending once told me, once theyre speech starts slurring, is usually a good sign it's 'kicked' in
 
This is the best I could find, I can't get an online version of what appears to be an abstract that has not been published:

J Conn State Dent Assoc. 1988 Spring;62(2):80-5.
Intensity and duration of amnesia from intravenous midazolam given for sedation.
Hupp JR, Becker LE.

A clinical study was performed investigating the ability of intravenous midazolam to cause amnesia for visual, auditory and painful stimuli presented during surgical removal of third molars. Various stimuli were presented prior to and after administration of a sufficient quantity of midazolam to produce profound sedation. Recall was then tested immediately after, one day, and one week following the surgery. The study found that midazolam produces at least 20 minutes of profound amnesia for all stimuli in 93 +/- 6% of individuals. However, little correlation was found between the dose of midazolam and the duration of amnesia. Anesthesia literally means the loss of sensation. In the clinical dental situation, the principle sensation lost, when using either regional or general anesthesia, is pain perception. Although prevention of pain sensation is the primary reason patients request local anesthesia prior to invasive dental care, for many patients, control of pain only partially prepares them to receive dental care. These patients request the adjunctive use of sedation or general anesthesia, not for further pain control, but rather requiring periodontal or oral/maxillofacial surgery in which such factors as the sight and taste of blood, the noise of bone-cutting equipment, or the pressure placed on the jaws is not eliminated by local anesthetics. Although effective anxiolytic oral, inhalational, or parenteral agents have been available for several decades, patients still usually retain their memory of events occurring during their dental care, particularly anxiety-provoking events. This memory of the uncomfortable portions of dental care stimulates additional anxiety so that patients may procrastinate when dental care is necessary.
 
There's also this one, I was able to read the full-text article (which didn't add much):

Anaesthesia. 1980 May;35(5):459-61.
Amnesic action of midazolam.
Dundee JW, Wilson DB.

Midazolam 5 mg, a water-soluble benzidiazepine, given intravenously to adults had a maximum effect of impairing memory for postcards shown between 2 and 5 min after injection. This effect has mainly passed off in 20 min.
 
excellent responses! This is what I'd expected, i.e., the amnestic effects are variable and not predictable.

Also, I too have heard that the amnestic effects are more evident once a patient begins to slur.
 
excellent responses! This is what I'd expected, i.e., the amnestic effects are variable and not predictable.

Also, I too have heard that the amnestic effects are more evident once a patient begins to slur.



I try to ask all my block patients if they remember receiving the block (usually with 2-5mg midaz). The results are variable. If they slur speech, they usually don't remember anything. But I've had people very alert after 5mg who remembered nothing; and pretty sleepy people after 5mg who remember everything.
 
I try to ask all my block patients if they remember receiving the block (usually with 2-5mg midaz). The results are variable. If they slur speech, they usually don't remember anything. But I've had people very alert after 5mg who remembered nothing; and pretty sleepy people after 5mg who remember everything.


FWIW, the last time I went under GA I was given 5mg midaz and remembered pretty much everything. I was getting masked, and I remember the CRNA saying there was a leak. (He wasn't holding the mask, and every time I exhaled it would lift off.. perhaps this was the source of the "leak")..

The last thing I remember before waking up was "You're doing really well... Really well.."
 
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