The midazolam dose must be carefully individualized. In elderly and debilitated patients, lower doses are required.
The midazolam dose should further be adjusted according to the type and amount of premedication used. Excess doses or rapid IV administration may result in respiratory depression and/or arrest, particularly in elderly or debilitated patients.
For IM use, midazolam should be injected deep in a large muscle mass. IV midazolam dose should be administered only by a person trained in general anaesthesia and should be used for sedation/anxiolysis/amnesia only in the presence of personnel skilled in early detection of hypoventilation, maintenance of a patent airway and support of ventilation.
The necessary equipment and medications must be immediately available to ensure the safety of the procedures and the maintenance of respiratory and cardiovascular functions.
Midazolam injection for IV sedation prior to and during short endoscopic or short diagnostic procedures and direct current cardioversion should always be administered slowly.