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Paradoxical behavior is often not recalled by the patient due to the amnesia-producing properties of the drug. In extreme situations, flumazenil can be administered to inhibit or reverse the effects of midazolam. Antipsychotic medications, such as haloperidol, have also been used for this purpose. [47] Midazolam is known to cause respiratory ...
Additionally, IV sedation is frequently administered as a concoction of several agents including those previously mentioned for induction and maintenance of anesthesia, as well as a benzodiazepine (usually midazolam, but temazepam or flunitrazepam are also used via the oral route [4]) and a narcotic/systemic analgesic such as demerol or fentanyl.
Sedation scales are used in medical situations in conjunction with a medical history in assessing the applicable degree of sedation in patients in order to avoid under-sedation (the patient risks experiencing pain or distress) and over-sedation (the patient risks side effects such as suppression of breathing, which might lead to death).
In emergency medicine, safe administration of intranasal fentanyl with a low rate of side effects and a promising pain-reducing effect was demonstrated in a prospective observational study in about 900 out-of-hospital patients. [40] In children, intranasal fentanyl is useful for the treatment of moderate and severe pain and is well tolerated. [41]
Midazolam is metabolized in the liver and is excreted through the kidneys. [9] When midazolam is used alone, it has few side effects, but can cause respiratory depression if being used together with fentanyl. [8] Fentanyl – It is a synthetic, centrally-acting opioid. It suppresses pain and sympathetic stimulation.
The most common side effects reported by patients receiving this medication are a sense of extreme "dizziness" (often short lived, a common side effect of other fast-acting synthetic phenylpiperidine narcotics such as fentanyl and alfentanil) and intense itching , often around the face.
Fentanyl provides analgesia and sedative properties; it does not have any amnestic effects. It was commonly used with midazolam for effective PSA prior to propofol and etomidate. The major complication of fentanyl is respiratory depression, which can be made worse when given with other sedative agents.
Instantaneously (from 5 to 15 sec); 4× more rapid than fentanyl 0.25 hr (15 min); up to 54 minutes until offset of effects Trefentanil: 10-25 Brifentanil: 10-25 Acetylfentanyl: 15 7-Hydroxymitragynine: 17 ~0.6 mg Furanylfentanyl: 20 Butyrfentanyl: 25 Enadoline: 25 15 μg (threshold) and 0.160 mg/kg (dissociative effects) Buprenorphine [13] 40 ...