Midazolam (Versed), diazepam (Valium), and lo-razepam (Ativan) are benzodiazepine derivatives that are useful in anesthesia. Midazolam is the most popular of these agents for the induction of anesthesia. Its popularity is related to its aqueous solubility and to its short duration of action, which permits a prompt return of psychomotor competence. Unlike midazolam, lor-azepam and diazepam are not water soluble and must be formulated in propylene glycol; the latter is irritating to the vasculature on parenteral administration.
Benzodiazepines are useful as orally administered premedications. They are also used intravenously in doses that produce conscious sedation rather than hypnosis. Sedated patients tolerate unpleasant procedures (e.g., wound repair, bronchoscopy, angiography) while maintaining cardiorespiratory function and the ability to respond to tactile stimulation or verbal commands.
Midazolam has a shorter half-life (t1/2p = 1.3-2.2 hours) than either diazepam (t1/2p = 30 hours) or lor-azepam and is not converted in the liver to active metabolites, as is diazepam. Thus, use of midazolam results in a more rapid return to psychomotor competence. Doses may need to be lowered by at least 30% in older patients and in those premedicated with opioids or other sedative drugs.
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