title: Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients.
abstract: OBJECTIVE
  To trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety.
  
  
  METHODS
  A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant-induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end-point of rousable drowsiness.
  
  
  RESULTS
  Sixty-two patients were enrolled. Two-thirds of the patients required only one dose of midazolam; 88% of the sample were sedated with two doses. Six and a half per cent of patients were not sedated after four doses. A Glasgow Coma Score of eight or less was prolonged in eight patients. Airway problems requiring an adjunct were present in four patients. Recent psychostimulant use was present in only 55% after full assessment.
  
  
  CONCLUSIONS
  High-dose midazolam protocols cannot be supported as universally safe. High-dose protocols for severe behavioural disturbance are not more effective, with failures occurring even after repeated dosing.
authors: Gold Coast Hospital, Southport Campus, Brisbane, Queensland, Australia. david_spain@health.qld.gov.au
authors: David
authors: D
authors: Spain
authors: Julia
authors: J
authors: Crilly
authors: Ian
authors: I
authors: Whyte
authors: Linda
authors: L
authors: Jenner
authors: Vaughan
authors: V
authors: Carr
authors: Amanda
authors: A
authors: Baker
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D010865:Pilot Projects; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D012449:Safety; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam