GasGasGas - The FRCA Primary Exam Podcast GasGasGas - Midazolam
Sep 19, 2025
Explore the fascinating world of midazolam, the go-to benzodiazepine in perioperative settings. Discover its rapid action, unique pharmacokinetics, and vital role in sedation and amnesia. Learn about dosing strategies, especially for pediatric premedication, and the potential risks for vulnerable patients. Uncover how midazolam interacts with the GABA-A receptor and reduces MAC during procedures. The conversation also delves into practical applications in critical intubations and managing alcohol withdrawal, making it essential for any anaesthetic professional.
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Midazolam Mechanism And Class
- Midazolam is an imidazol benzodiazepine that potentiates GABA-A mediated inhibition in cortex, midbrain and spinal cord.
- It also shows some kappa opioid agonism in vitro and can produce analgesia intrathecally.
Practical Uses And Dosing
- Use midazolam for induction, sedation, premedication (commonly in children) and to induce amnesia.
- Typical IV dosing is 0.07–0.1 mg/kg or practical boluses of 0.5–2 mg, and premedication commonly 0.5 mg/kg up to 15 mg.
Cardio‑Respiratory Profile
- Cardiovascular effects are mild: small drops in systolic/diastolic BP and reduced SVR, but heart rate may increase.
- Respiratory effects include reduced tidal volume, increased rate (so minute ventilation roughly preserved) but risk of apnea and reduced CO2 responsiveness.