A prospective study of the adverse effects of midazolam on withdrawal in critically ill children.
Fifty-three critically ill infants and children received midazolam as sedation in a regional intensive care unit. Assessment of the level of sedation was carried out at regular intervals on withdrawal of midazolam. Forty-nine patients were fully alert within 4 h of midazolam being stopped. Four patients took from 6 h to 1 week to become fully alert. Four patients had abnormal behaviour highly suggestive of midazolam withdrawal. The onset of abnormal behaviour was within 12 h of discontinuation of midazolam. The duration of the abnormal behaviour ranged from 3 h to 1 week. One child had a paradoxical reaction to midazolam. The overall incidence of adverse effects to midazolam in the patients studied was 17%. No adverse effects were observed in infants; all adverse effects were observed in children. We have shown that it is possible to prospectively study the toxicity of sedatives in critically ill infants and children.
Institute of Child Health, Alder Hey Children's Hospital, Liverpool, UK.
J
J
Hughes
A
A
Gill
H J
HJ
Leach
A J
AJ
Nunn
I
I
Billingham
J
J
Ratcliffe
R
R
Thornington
I
I
Choonara
D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008874:Midazolam / Q000009:adverse effects*; D009460:Neurologic Examination; D011446:Prospective Studies; D012307:Risk Factors; D012894:Sleep Stages / Q000187:drug effects; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology*
D008874:Midazolam