Ces manifestations disparaissent en général en 2 à 6 semaines, mais il peut parfois se prolonger sur … The combination of midazolam and small-dose ketamine provided adequate sedation and a high degree of patient comfort, as reported previously by White et al. midazolam generally recovered at a slightly slower rate. 12 years and older: 6 months to 16 years: 0.25 to 1 mg/kg orally once before the procedure Also, make sure your child's school has a supply of midazolam for your child and that there are staff members who have been trained in dealing with epileptic seizures. -Initial dose: 0.025 to 0.05 mg/kg IV injection, with evaluation for sedation. . Over 32 weeks with tracheal intubation: dose to 0.25 mg/kg/dose IV x1 if premedicated or to 0.15 mg/kg/dose IV x1 if severe systemic dz or debilitated [55 yo and older] Midazolam may sting if administered intra-nasally. La dose initiale I.V. Initially 2–2.5 mg, to be administered 5–10 minutes before procedure at a rate of approximately 2 mg/minute, increased in … Uses: La dose létale est de 150 mg/kg source: je suis infirmier . -The need for continued sedation with maintenance dosing should be carefully considered. Phone: 01932 690325 Fax: 01932 341091. 8. Less than 32 weeks with tracheal intubation: Speak with your child's doctor about changing the dose or trying a new medicine. -Maintenance dose: 25% of the dose used to reach desired sedation level -Less cooperative and/or younger (e.g., less than 6 years) patients may require oral doses up to 1 mg/kg. Recommendations: Administration advice: -Dosing should be reduced in patients receiving this drug for sedation. Midazolam is given by intramuscular or intravenous injection. -The initial dose and all subsequent doses should always be titrated slowly; administer over at least 2 minutes and allow at least an additional 2 minutes to fully evaluate the sedative effect. Adjust doses in accordance with patient’s condition; reduce less if severe pain. Safety and efficacy of oral syrup formulations have not been established in patients younger than 6 months. Monitoring: Buccolam® – remove oral syringe cap before use to avoid risk of choking. Midazolam injection can be administered via the buccal, sublingual or intranasal route. Reconstitution/preparation techniques: -Component of IV supplementation of nitrous oxide and oxygen (balanced anesthesia), Loading dose: 0.01 to 0.05 mg/kg IV via slow injection or infusion over several minutes; the dose may be repeated in 10 to 15-minute intervals until sedation is achieved. CSCI 5 to 10mg over 24 hours. Midazolam and hydroxymidazolam are present in breast milk. Please refer to, The injection preparation prescribed for adults and held by the palliative care community networks is. Indicates this medication is associated with QT prolongation, Severe Uncontrolled Distress in the last days of life, https://www.sps.nhs.uk/wp-content/uploads/2018/02/2008-NRLS-1074A-midazolam-RRR-mation-2008-12-09-v1.pdf. Comments: The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. General: -Doses should be adjusted up or down by 25% to 50% of the initial infusion rate to assure adequate sedation. -Rectal formulations: Rectal solutions should be administered with a plastic applicator fixed on the end of a syringe. -Infusion rates should be reassessed to ensure that the lowest effective dose is used, especially after the first 24 hours. Applies to the following strengths: 2 mg/mL; 5 mg/mL; 1 mg/mL; 1 mg/mL preservative-free; 5 mg/mL preservative-free; 1 mg/mL-NaCl 0.9%; 1 mg/mL-D5%; 1 mg/mL preservative-free-D5%; 0.5 mg/mL-D5%; 0.5 mg/mL preservative-free-D5%; 5 mg/inh; 1 mg/mL-NaCl 0.8%; 0.5 mg/mL-NaCl 0.9%; 2 mg/mL-NaCl 0.9%; 2 mg/mL-D5%, Patients younger than 60 years: Use: Sedation of intubated and mechanically ventilated patients during treatment in a critical care setting, Nasal: Although the total dosages of midazolam and ketamine were similar in the two studies, intraoperative recall was more frequent in the earlier study (2) , possibly because the drugs were administered by intermittent bolus injections. -The initial IV dose for sedation in adult patients may be as little as 1 mg but should not exceed 2.5 mg in a normal, healthy adult. Liao P(1), Sinclair M(2), Valverde A(1), Mosley C(3), Chalmers H(1), Mackenzie S(4), Hanna B(5). This refers to the area between the lower -IV formulations: For deeply sedated pediatric patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure. As a last resort, can be administered intra-nasally if the patient foams at the mouth. Niños de 6 meses a < 16 años de edad: 0.25—0.5 mg/kg (máximo 20 mg) en forma de una dosis única antes de la cirugía. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. Adults and Pediatrics: The volume, however, is often impractical. -The lowest effective dose should be used, and patients should be regularly assessed for sedation. 6 to 11 months: 1 mg/kg PO (Max: 20 mg/dose) as a single dose for procedural sedation; a total dose up to 0.6 mg/kg IV (Usual Max: 6 mg) may be necessary for amnesia induction; specific maximum dosage information for other routes or indications is not available; the dose required is dependent on route of administration, indication, and clinical response. Se recomienda una dosis de 0,025 a 0,05 mg/kg administrada por vía intramuscular profunda. Obese patients: 6 years to 12 years: If you miss a dose of this medicine, take it as soon as possible. Also available as pre-filled oral syringes of 2.5mg, 5mg, 7.5mg, <4hours with a 5mg dose* (*individual variation), Changing benzodiazepines - seek specialist advice if uncertain. Midazolam 2,5 mg/ml solución oral Composición Componentes Cantidad Midazolam 250 mg Jarabe simple c.s.p. Of those prescribing buccal midazolam, only 33% used a test dose in hospital. IM: 10mg to 20mg over 24 hours in a syringe pump + midazolam SC 5mg hourly, as required. Administración oral. midazolam también se puede administrar en combinación con anticolinérgicos. -Induction of general anesthesia before administration of other anesthetic agents Note: There are a number of different strengths of midazolam injection available (1mg/ml, 2mg/ml. IM ADMINISTRATION: 0.1 to 0.15 mg/kg IM once, with some patients requiring doses of 0.5 mg/kg Please refer to current edition of BNF for significant drug interactions. Selling or giving away midazolam is against the law. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. -Concomitant prescribing of these drugs should be reserved for use in patients for whom alternative treatment options are inadequate. 81 A recent study in an Israeli hospice found average doses of midazolam … -Patients should be advised to report alcohol consumption and all concurrent prescription and nonprescription medications or herbal products they are taking. -Once maintenance dose levels are attained, the dose should be decreased by 10% to 25% every few hours to determine the lowest effective infusion rate. -Preoperative sedation/anxiolysis/amnesia 24. -Extreme caution should be used in current/former preterm patients who do not have tracheal intubation. Patients on regular benzodiazepines who have developed a tolerance to their effects may require a higher dose. Some paediatric neurologists recommend a test dose, others do not. La dose de midazolam doit être réduite en cas d'administration concomitante avec un narcotique. Incremental propofol doses reduced dentist satisfaction, in contrast to their effect on patient satisfaction. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Note: Consider a reduced dose (5mg) in elderly patients and patients <50kg. Conversion of IV Midazolam. -Maintenance dose: Approximately 25% of the IM dose first used to reach optimal sedation; however, the need for continued sedation with maintenance dosing should be carefully considered. Hemodynamically compromised patients: -Sedation La dosis más efectiva suele ser la de 0.5 mg/kg aunque algunos niños pueden necesitar hasta 1 mg/kg (máximo 20 mg) hasta obtener el efecto clínico deseado. -This drug should not be administered by rapid injection in the neonatal population. Chronic and/or home use should be avoided. Also continue rescue doses of 5mg s-c prn. -Induction of general anesthesia before administration of other anesthetic agents Midazolam SC 2mg to 5mg, hourly, as required. These data indicated that the pharmacokinetics of midazolam and 1-hydroxymethylmidazolam were linear between the 7.5 and 15 mg oral dose range. -Agent for sedation/anxiolysis/amnesia prior to/during diagnostic, therapeutic/endoscopic procedures (e.g., bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures alone/in combination of with other central nervous system [CNS] depressants), Patients younger than 55 years: Note: There is no maximum dose for midazolam however the dose should be titrated carefully according to the response. Administración intravenosa: dosis de carga: 0,05-0,2 mg/kg, seguida de una perfusión continua a dosis iniciales de 0.06-0.12 mg/kg/hora (1-2 mcg/kg/minuto). -Patients should be monitored for respiratory depression and sedation. 2mg to 5mg SC/SL/buccal. Unpremedicated patients with tracheal intubation: PREMEDICATED PATIENTS WITH SEVERE SYSTEMIC DISEASE/DEBILITATION: If 3 or more doses are administered in 4 hours, seek advice. Select one or more newsletters to continue. Safety and efficacy of nasal spray formulations have not been established in patients younger than 12 years. -Doses and the duration of therapy should be limited to the minimum required. Six single-dose pharmacokinetic studies involving healthy adults yield pharmacokinetic The pack must be discarded if the solution is not clear. Supplemental IV doses may be given to increase/maintain the desired effect. Répondre à ce commentaire. est recommandée. Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients. Note: Consider a reduced dose (5mg) in elderly patients and patients <50kg. IM: 0.02 to 0.05 mg/kg IM once up to 1 hour before surgery Induction dose and recovery quality of propofol and alfaxalone with or without midazolam coinduction followed by total intravenous anesthesia in dogs. This formulation should be given IV or IM, and extravasation should be avoided. Maximum IV doses typically do not exceed 6 mg (patients 6 months to 5 years) or 10 mg (patients 6 years and older), and maximum IM doses typically do not exceed 10 mg. A survey of paediatric neurologists in 2003 revealed that 49% disagreed or strongly disagreed with giving a test dose of midazolam, 34% were neutral, and 17% agreed with giving a test dose. -Loading dose: The usual loading dosed should be increased in small increments. -The subsequent dose should not be administered if the patient has difficulty breathing OR if the patient has sedation that is not typically observed during a seizure cluster episode. Generally administered sublingually or bucally:10mg initially; repeated after 10 minutes if no effect and the patient is breathing normally. IV: 1 to 2.5 mg slow IV every 2 minutes as necessary for sedation Tratamiento inicial de crisis convulsiva >5 minutos. Do not place the syringe between the patient’s teeth as they might bite the syringe. -Loading and/or maintenance doses may be increased in some circumstances. Last updated on Feb 2, 2021. Comments: Retirar con una jeringa 50 ml de midazolam amp 5 mg/ml (contiene 250 mg de midazolam). Too low a dose could cause McGuire to "be aware of and experience air hunger," an expert said at the time. If no effect apparent 5 minutes after the second dose, seek medical help. Please check your local formulary for preferred product. CONTRAINDICATIONS: If the volume of the solution is too small, water may be added to a total volume of 10 mL. -IV and oral syrup formulations should be used only in hospital or ambulatory care settings, including health care providers' and dental offices, that provide for continuous monitoring of respiratory and cardiac function (e.g., pulse oximetry). -Total doses of 0.6 mg/kg may be used in unpremedicated, resistant patients, but the dose could prolong recovery. Midazolam injection can be administered via the buccal route. Midazolam se puede administrar como un componente sedante en anestesia combinada mediante pequeñas dosis IV intermitentes (entre 0,03 y 0,1 mg/kg) o perfusión continua IV (entre 0,03 y 0,1 mg/kg/h), normalmente en combinación con analgésicos. -IV injection doses should be administered over 2 to 3 minutes. Misuse can cause addiction, overdose, or death. 1. -Agent for sedation/anxiolysis/amnesia prior to/during diagnostic, therapeutic/endoscopic procedures (e.g., bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures alone/in combination of with other central nervous system depressants), Over 55 years: If 6 doses are required in 24 hours, seek medical review/advice. -The rate of continuous infusion may be increased or decreased (e.g., usually by 25% of the initial/subsequent rate) as necessary in premedicated non-neonates. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. -A total IV dose greater than 3.5 mg is usually not necessary. -Usual dose: 0.15 mg/kg IV once may provide sufficient anesthesia -IV formulations should be administered slowly (e.g., over 2 minutes), and the patient's sedation level should be evaluated for at least 2 minutes before administering another dose. Careful titration is however necessary. Use lower doses if not used previously and in frail elderly. -Respiratory rate and oxygen saturation Dilution with other liquids should be avoided. Use: Acute treatment of intermittent, stereotypic episodes of frequent seizure activity (e.g., acute repetitive seizures, seizure clusters) that are distinct from a patient's usual seizure pattern. PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, HIGHER-RISK SURGICAL PATIENTS, OR THOSE WHO RECEIVED CONCOMITANT NARCOTICS OR CENTRAL NERVOUS SYSTEM (CNS) DEPRESSANTS: Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. -Maximum total dose: 10 mg Patients may recognise this as an orange syringe This preparation should be administered into the buccal space. Plus la durée de prise et la dose de benzodiazépines sont importantes et plus le risque de syndrome de sevrage augmente, en particulier si l'arrêt a été brutal ou trop rapide. -Component of IV supplementation of nitrous oxide and oxygen (balanced anesthesia), Oral: -The subsequent dose should not be administered if the patient has difficulty breathing OR if the patient has sedation that is not typically observed during a seizure cluster episode. -A total IV dose over 5 mg is usually not necessary. -The initial infusion rate is usually 1 to 7 mg/hour. Comments: 12 years and older: 1 to 2.5 mg slow IV every 2 minutes as necessary for sedation -Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding. Do not use a second dose if you have trouble breathing or excessive sleepiness during a seizure cluster episode. DEBILITATED/CRITICALLY ILL PATIENTS AND/OR THOSE OVER 60 YEARS WHO RECEIVED CONCOMITANT NARCOTICS/CNS DEPRESSANTS: -Heart rate and blood pressure The dosage derived from the child's weight is the preferred and most accurate option for prescribing Epistatus Midazolam Oromucosal Liquid 10mg in 1 ml. Miloud SLIMAN Dose létale 50 % . Smaller patients and/or larger volumes may receive half of the dose in one side of the mouth, and the rest of the dose in the other side of the mouth. Dying patients unable to take oral medication, Sedative/anxiolytic in terminal haemorrhage (refer to bleeding guideline), Spasticity or skeletal muscle spasm (seek specialist advice), Persistent hiccups (refer to hiccups guideline), Anxiety/panic, for example, in severe breathlessness at end of life. Epistatus® can be prescribed by the patient’s GP for the indications listed in liaison with local palliative care specialists. ADULT PATIENTS WHO RECEIVED CONCOMITANT NARCOTICS/CNS DEPRESSANTS: Patient satisfaction increased with an increasing dosage of propofol up until 4 mg/kg/hr, reaching a peak of 78.6%. Buccolam is half the strength of Epistatus – be aware of difference in strength when prescribing. If the liquid is allowed to evaporate some of the midazolam will precipitate, exhibited as cloudiness or as white particles in the liquid. -Initial dose: 5 mg (1 spray) intranasally in 1 nostril ONCE Le midazolam accroît la létalité aiguë de la buprénorphine chez la souris - Figure 1. Midazolam can slow or stop your breathing, especially if you have recently used a narcotic (opioid) medication. -As a component of anesthesia for sedation of intubated and mechanically ventilated patients Drowsiness and sedation (may persist for several hours after administration). Other narcotics used for premedication should be administered approximately 1 hour prior to induction. -This drug does not protect against increases in intracranial pressure or heart rate/blood pressure rise associated with endotracheal intubation under light general anesthesia. Par IDE, il y a 6 ans (en réponse à zoltan): 100 ml Modo de elaboración 1. Textes législatifs et règlementaires _____ 33 Annexe 2. Anti-epileptic drugs have a long half-life, however ongoing management should be considered: If muscle spasms fail to respond to oral muscle relaxants such as baclofen, tizanadine, dantrolene or diazepam: Midazolam: 2mg to 5mg SC or 10mg in 24 hours by CSCI. -Oral syrup: Once the correct dose is measured, the oral syrup should be administered directly into the mouth. 7.2 Dose For buccal administration of midazolam, the parenteral injection formulation licensed for intravenous and intramuscular use may be employed 5. Non-neonates and children: Respiratory depression occurs in about 5% patients. La dosis i.v. Uses: -When used concomitantly with other drugs used to induce anesthesia, initial doses may be reduced by to up to 25%. Medically reviewed by Drugs.com. Do not use more than 2 doses to treat a single episode. -Doses of sedative medications in pediatric patients must be calculated on a mg/kg basis, and initial doses and all subsequent doses should always be titrated slowly. -Oral syrup: Once the correct dose is measured, the oral dispenser/syringe may be covered with a cap tip. Age of patient Dose of buccal Midazolam (1st ndand 2 doses) 0 - 2 months (in hospital only) 0.3mg/kg (max per dose 2.5mg) 3 – 6months (in hospital only) 2.5mg 7 months - <1 year 2.5mg 1 - 4 years 5mg 5 - 9 years 7.5mg 10 -17 years 10mg The dose must always be prescribed in mg and in ml 2. Parenteral: -Maximum total dose: 10 mg -Maximum dose: 10 mg/day Loading dose: 0.01 to 0.05 mg/kg IV via slow injection or infusion over several minutes; the dose may be repeated in 10 to 15-minute intervals until sedation is achieved. Dose conversions should be conservative and doses are usually rounded down (Note – check available strengths). Midazolam elimination may also be delayed in patients with liver dysfunction, low cardiac output and in new-born infants (see section 5.2). Dose: 0.3-0.35 mg/kg/dose IV x1; Info: may give incremental doses of 25% of initial dose prn to achieve complete induction, up to 0.6 mg/kg total dose in resistant pts; consider decr. -Parenteral solution: A 1 mg/mL solution may be diluted with 0.9% sodium chloride or 5% dextrose in water. recommandée est de 0,5 mg et doit être complétée par titration lente si besoin. Consult WARNINGS section for additional precautions. ( wikipedia.org ) La dose de MIDAZOLAM ACCORD varie d'un patient à l'autre. 78,79 It is also considered the first-line drug because of its ability to be easily reversed, lending itself to use in respite sedation and short-term palliative sedation. Other narcotics used for premedication should be administered approximately 1 hour prior to induction. Epistatus® is an unlicensed medication and as such has no marketing authorisation in the UK. 14 A commonly cited double-blind trial suggests a conversion of 1 mg IV lorazepam to 2 mg of IV midazolam, which is further supported using a midazolam oral bioavailability of 40% due to a significant first-pass effect. Dose and Administration The adult dose of Buccolam® (midazolam) oromucosal solution is 10 mg. Midazolam is a short-acting benzodiazepine; a single dose lasts between one and six hours. . Midazolam is one of the most common drugs administered to cancer patients near end of life, along with morphine and haloperidol. -Fentanyl, used as premedication, should be administered 5 minutes before induction. Unpremedicated patients: 0.2 to 0.3 mg/kg IV once, administered over 20 to 30 seconds -Intrathecal or epidural administration (parenteral formulations containing benzyl alcohol) Preterm and term neonates: Children younger than 12 years of age—Use and dose must be determined by your doctor. -Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic procedures or before induction of anesthesia -Doses between 0.15 and 0.35 mg/kg have been used in premedicated patients. Only 0.03% of midazolam is eliminated in its unchanged form. -Initial dose: 0.06 to 0.12 mg/kg/hr (1 to 2 mcg/kg/min) The recommended doses is usually about 0.3-0.5 mg/kg in children6,7,8,9,10,11 and 10 mg in adults 6,9. We comply with the HONcode standard for trustworthy health information -. The dosage currently used across Scotland is0.3mg (300 micrograms) per kg of body weight*. Uses: -Patients should be given approximately 30% less of the dose than in patients who did not receive premedications. Elimination of the parent drug takes place via hepatic metabolism of midazolam to hydroxylated metabolites that are conjugated and excreted in the urine. Storage requirements: -Oral syrup formulations: For deeply sedated patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure. Maintenance dose: 0.2 to 0.1 mg/kg via IV infusion per hour Fatalities have occurred after concurrent administration with higher than approved doses of olanzapine. -Initial doses of 0.15 mg/kg have been sufficient in inducing anesthesia in patients, especially in those with severe systemic disease or debilitation. -Parenteral solution: Prior to administration, this drug should be inspected for particulate matter and discoloration. -Maintenance dose: After thorough clinical evaluation, additional doses may be given in increments of 25% of the initial dose used to reach sedation. -Initial dose: 0.03 mg/kg/hr (0.5 mcg/kg/min) IV La posología y los intervalos entre las dosis varían de acuerdo con la reacción de cada paciente. If doses in excess of 30mg / 24 hours are required, seek advice from the Palliative Care team. If using the injectable solution sublingually or buccally, ensure needle is removed from syringe tip prior to administration. Unpremedicated patients: 5mg, 7.5mg and 10mg. This medicine is for use only in the nose. US Controlled Substance: Schedule IV. Using the oral syringe provided administer over a period of 2 to 3 seconds, about half of the prescribed dose to each buccal cavity (between the gums of the lower jaw and the cheek). -Initial dose: 0.06 to 0.12 mg/kg/hr (1 to 2 mcg/kg/min) Comments: Midazolam may be habit-forming. Epistatus® (5ml bottle) – the dose markings are on the syringe plunger not the syringe barrel. -Initial dose: 0.05 to 0.1 mg/kg IV injection, with evaluation for sedation. Midazolam (20 μg kg −1) and droperidol (20 μg kg −1) significantly reduced the mean hypnotic dose of propofol (mean) S.D.) -Dosing should be calculated based on the patient's ideal body weight. You and your child should always carry a supply of midazolam with you in case of an emergency. IV compatibility: 80 One report in adult palliative sedation found mean midazolam doses of 29 mg/day (median: 30 mg, range: 15–60 mg/day). Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Midazolam: Increase syringe driver dose by the equivalent of the extra doses given. -Maximum dose: 20 mg -IM dosing is intended for patients who are not receiving concomitant narcotic or central nervous system depressants; lower doses should be considered in patients older than 60 years who are receiving narcotic or CNS depressants. IM: 0.07 to 0.08 mg/kg IM once, up to 1 hour before surgery CONTINUOUS INFUSION: Une dose de 0,025 à 0,05 mg/kg administrée par voie I.M. 5 Midazolam comes in five dosage forms, including: Intravenous administration (IV midazolam) Intramuscular (midazolam injection) Intranasal (nasal spray) Buccally (between the gum and cheek) Sublingually (under the tongue) A single dose of Midazolam lasts between one and six hours, which is why it’s not an ideal sleep aid. Use: Acute treatment of intermittent, stereotypic episodes of frequent seizure activity (e.g., acute repetitive seizures, seizure clusters) that are distinct from a patient's usual seizure pattern, 60 years and older: The dose for sedation during surgery is 0.5 to 1 mg given over 2 minutes and not to exceed 2.5 mg per dose. This is available as a 10mg in 2 mL prefilled syringe. Is midazolam given to patient at end of life? -Maximum dose: 10 mg/day If the midazolam injection formulation is used, to administer the prescribed amount the Epistatus® (5ml bottle) – the bottle cap must be replaced immediately to prevent evaporation. Comments: Seizures (refer to seizuresguideline) 1. Para esta indicación, el midazolam debe administrarse IM, profunda en una gran masa muscular 20 a 60 minutos antes de la inducción de la anestesia, preferentemente por vía rectal en el … -Limitations of use: This drug should be limited to healthcare providers who are capable of monitoring and treating respiratory/cardiovascular adverse events, including respiratory and cardiac resuscitation. -Subsequent dose: 5 mg (1 spray) intranasally in the opposite nostril after 10 minutes if the patient has not responded to the initial dose If an optimal sedation level is not reached, doses may be readministered every 2 to 3 minutes, up to a maximum dose of 0.4 mg/kg. Uses: -Maximum dose: 0.6 mg/kg Maintenance dose: 0.2 to 0.1 mg/kg via IV infusion per hour -Some patients may achieve sufficient sedation with an IM dose of 1 mg if the intensity and duration of sedation is less critical. Patient advice: -Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured.
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