Midazolam is a powerful benzodiazepine medication usually given intravenously (IV) or as an oral syrup for children. Benzodiazepine medications, particularly those administered IV, quickly work on the brain's gamma-Aminobutyric acid neurotransmitter system to decrease anxiety and increase sedation. Among the many benzodiazepine medications, short-acting midazolam IV most effectively results in a short-term memory loss in addition to its sedative and anti-anxiety effects. Midazolam IV is thus considered an extremely effective pre-procedure medication in those instances where a patient will not be anesthetized or totally unconscious as it results in a semi-conscious state often referred to as twilight sleep. It is used primarily to treat preoperative anxiety, induce twilight sleep during medical procedures and, rarely, to cause seizure cessation in situations such as status epilepticus.
Preoperative anxiety is often treated with midazolam IV. The use of the medication in this way is particularly helpful if significant patient preparation is required prior to actual anesthetic induction and the beginning of the surgery. A patient treated with midazolam IV can be roused from light sedation to assist in transfers from the stretcher to the operating room table or to move into postural positions necessary for the procedure. When conscious, yet sedated, a patient is not as prone to anxiety reactions when medical equipment with which he is unfamiliar is introduced or applied. Further, the short-term memory loss caused by midazolam often results in a patient's complete amnesia of this preoperative even, particularly when its administration is followed by a complete anesthetic induction.
Midazolam IV is often used prior to and during diagnostic or treatment procedures where the patient will not undergo full anesthetic induction. It is used to maintain a patient in twilight sleep during potential uncomfortable procedures such as colonoscopies or upper endoscopies. The short-term amnesia prevents the patient from remembering any significant episodes of pain during the procedure and decreases his anxiety during the activity. He remains capable, however, of being aroused to consciousness in order to assist with postural changes or other actions necessary to complete the medical procedure. Midazolam IV or syrup is often used in small children to attain sedated cooperation in performing some medical tests and procedures.
Specific monitoring equipment, nursing care and medical supervision are required when using midazolam IV for preoperative anxiety, twilight sleep or epileptic seizures. This medication can cause significant respiratory depression, particularly when administered via this route. All patients treated with midazolam IV should be monitored for adequate respiratory effort and adequate oxygenation of the tissues with a pulse oximeter. Constant monitoring is required until the patient regains full consciousness.