Midazolam pediatric dose loading dose may be followed by a continuous IV infusion to maintain the effect. IV loading doses should not be used in neonates.
Continuous IV infusion for sedation in critical care settings is important in pediatric patients. To initiate sedation using midazolam, an IV loading dose of 0.05 to 0.2 mg/kg administered over at least 2 to 3 minutes can be used to establish the desired clinical effect.
Based on pharmacokinetic parameters and reported clinical experience, continuous IV infusions of midazolam pediatric dose should be initiated at a rate of 0.001 to 0.002 mg/kg/min (1-2 mcg/kg/min).
The rate of infusion can be increased or decreased as required, or supplemental IV midazolam pediatric dose can be administered to increase or maintain the desired effect. Frequent assessment using standard pain or sedation scales is recommended.
Drug elimination may be delayed in patients receiving erythromycin and/or other P450 enzyme inhibitors and in patients with liver dysfunction, renal dysfunction, low cardiac output (especially those requiring inotropic support), and in neonates.
Hypotension may be observed in patients who are critically ill, particularly those receiving opioids and/or when midazolam pediatric dose is rapidly administered.
When initiating an infusion with midazolam in haemodynamically compromised patients, the usual loading midazolam pediatric dose should be titrated in small increments, separated by 2 to 3 minutes, and the patient monitored for haemodynamic instability, e.g., hypotension, respiratory rate and oxygen saturation.