Geller E, Halpern P, Barzelai E, Sorkine P, Lewis M C, Silbiger A, Nevo Y
Department of Anesthesia and Intensive Care, Tel Aviv Medical Center, Ichilov Hospital, Israel.
Resuscitation. 1988;16 Suppl:S31-9. doi: 10.1016/0300-9572(88)90003-2.
ICU patients often require sedation. Midazolam (M), a new imidazobenzodiazepine, features rapid onset and rapid elimination time. Flumazenil (Ro 15-1788) is a new benzodiazepine antagonist. We studied the efficacy and safety of M by continuous infusion in 28 ICU patients: 16 post major surgery, and 12 medical patients, aged 20-77 years. M was administered as a loading dose of 0.05-0.15 mg/kg per min followed by continuous infusion of 0.05-0.1 mg/kg per h titrated to maintain patients asleep but arousable. M was administered for up to 14 days in doses of 1-15 mg/h and cumulative doses of up to 1915 mg. No untoward effects were noted except for slight decreases in blood pressure following the loading dose. ACTH challenge tests performed before and 24 h or more following the start of M showed no depression of adrenal responsivity. All patients meeting weaning criteria were weaned off mechanical ventilation while still on M. In 13 patients extubation was performed immediately after M was stopped, and flumazenil (0.38 +/- 0.27 mg, i.v.) given until full awakening. Patients remained awake yet calm. Vital signs remained stable after flumazenil. Midazolam by continuous infusion appears to be a safe and effective mode of sedation in ICU patients. Flumazenil may increase the flexibility and safety of this mode of sedation.
重症监护病房（ICU）的患者常常需要进行镇静治疗。咪达唑仑（M）是一种新型的咪唑并苯二氮䓬类药物，具有起效迅速和消除时间快的特点。氟马西尼（Ro 15 - 1788）是一种新型的苯二氮䓬类拮抗剂。我们对28例ICU患者持续输注咪达唑仑，研究其有效性和安全性：其中16例为大手术后患者，12例为内科患者，年龄在20至77岁之间。咪达唑仑以0.05 - 0.15毫克/千克每分钟的负荷剂量给药，随后以0.05 - 0.1毫克/千克每小时的速度持续输注，并根据需要进行调整，以维持患者处于睡眠状态但可唤醒。咪达唑仑的给药时间长达14天，剂量为1 - 15毫克/小时，累积剂量高达1915毫克。除负荷剂量后血压略有下降外，未观察到不良影响。在开始使用咪达唑仑之前以及开始后24小时或更长时间进行的促肾上腺皮质激素（ACTH）激发试验显示，肾上腺反应性没有降低。所有符合撤机标准的患者在仍使用咪达唑仑时均成功撤机。13例患者在停止使用咪达唑仑后立即拔管，并静脉注射氟马西尼（0.38±0.27毫克）直至完全清醒。患者保持清醒且平静。使用氟马西尼后生命体征保持稳定。持续输注咪达唑仑似乎是ICU患者一种安全有效的镇静方式。氟马西尼可能会增加这种镇静方式的灵活性和安全性。
