• Emerg Med Australas · Apr 2008

    Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients.

    • David Spain, Julia Crilly, Ian Whyte, Linda Jenner, Vaughan Carr, and Amanda Baker.
    • Gold Coast Hospital, Southport Campus, Brisbane, Queensland, Australia. david_spain@health.qld.gov.au
    • Emerg Med Australas. 2008 Apr 1;20(2):112-20.

    ObjectivesTo trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety.MethodsA 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.ResultsSixty-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.ConclusionsHigh-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.

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