Page 149 - 2026 SMOG

MIDAZOLAM (VERSED)
Class/Mechanism of Action
• Benzodiazepine
Short-acting benzodiazepine. Acts as an Anxiolytic/Hypnotic, anticonvulsant, and sedative.
˚ Onset of action (sedation)—IV: 1–5min, IM: 15min, IN: <10min; Duration: 15min to
6 hours (HIGH variability)
Indications
• Labeled Indications
˚ Preoperative sedation, induction, and maintenance of general anesthesia
• Off-Label Indications
˚ Anxiety/agitation, status epilepticus, conscious sedation (intranasal)
Contraindications
• Hypersensitivity to midazolam or any component of the formulation or other benzodiazepines
• Acute narrow-angle glaucoma, Acute Alcohol Intoxication
• Respiratory Insufficiency/Depression (except during mechanical ventilation)
• Should not be used in shock, coma, or acute alcohol intoxication with depression of vital signs
• Neurologic Depression (Head Trauma) unless having an active seizure
Adverse Reactions/Precautions
• No Analgesic properties (Narcotic pain control is needed for intubated patients)
• May cause respiratory depression: do not give without a stable IV line and BVM (airway control)
ready.
• Hypotension may occur more frequently in patients who have received opioid analgesics.
• Amnesia, confusion, drowsiness, slurred speech (paradoxical reactions possible: aggressiveness,
agitation, anxiety, inappropriate behavior)
• Benzodiazepine overdose can be treated with supportive measures alone.
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Sedation Procedural Sedation/Transcutaneous
Note: Best used in combination with Fentanyl Pacing/Cardioversion
• IV/IO (Push Dose) • IM
˚ 0.01–0.05mg/kg over 2min q10–15min until • IN ˚ 0.1–0.15mg/kg (max dose: 10mg)
desired sedation is achieved
• IV/IO (Continuous) ˚ 0.2mg/kg may repeat in 15min (max dose:
˚ 0.01–0.1mg/kg/hr 10mg)
Transcutaneous Seizure/Status Epilepticus
Pacing/Cardioversion/Agitation/Anxiety (Prehospital Treatment)
• IV • IM/IN
˚
˚ 0.5–2mg q5min until goal achieved or Note: Do not administer Midazolam IV to
0.2mg/kg once (max dose: 10mg)
RR <10
˚ If intubated: 1–4mg q5min until goal pediatric patients who are NOT intubated
achieved
Seizure
• IM
˚ 10mg as a single dose
• IV/IO
˚ 5mg q5min until seizure stops

2026 Standard Medical Operating Guidelines (SMOG) • 141