Midazolam infusion can be used either alone or combined with a narcotic immediately before the procedure, with supplemental doses to maintain the desired level of sedation throughout the procedure.
For short endoscopic or short diagnostic procedures and direct current cardioversion, midazolam infusion of 1 mg/mL formulation is recommended for IV sedation to facilitate slow injection.
Midazolam infusion should be administered immediately prior to the procedure in small increments and titrated slowly until the desired sedative effect is achieved.
An initial titration with a small dose, such as 2 to 2.5 mg administered over a 2 to 3 minute period is suggested for an average healthy adult.
After waiting about 2 minutes, the dosage may be further titrated in small increments of the initial dose if necessary to the desired sedation.
Additional maintenance doses may be given in increments of 25% of the initial dose to maintain the desired level of sedation, only by slow titration.
The desired end point can usually be attained within 3 to 6 minutes, depending on the total dose administered and whether or not it is preceded by narcotic premedication.
The midazolam infusion dosage should be lowered in the elderly and debilitated, and in patients with limited pulmonary reserve.
Because the danger of underventilation or apnoea is greatest in these patients and because peak effect may take longer, increments should be smaller and the rate of injections should be slower.