Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients.
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.
Spain
David
D
Gold Coast Hospital, Southport Campus, Brisbane, Queensland, Australia. david_spain@health.qld.gov.au
Crilly
Julia
J
Whyte
Ian
I
Jenner
Linda
L
Carr
Vaughan
V
Baker
Amanda
A
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
D006993:Hypnotics and Sedatives; D008874:Midazolam