Peter Jens-Uwe, Dieudonné Peter, Zolk Oliver
Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, 15562 Rüdersdorf, Germany.
Department of Anesthesiology, University Hospital Ulm, 89081 Ulm, Germany.
Pharmaceuticals (Basel). 2024 Apr 8;17(4):473. doi: 10.3390/ph17040473.
Midazolam, a short-acting benzodiazepine, is widely used to alleviate patient anxiety, enhance compliance, and aid in anesthesia. While its side effects are typically dose-dependent and manageable with vigilant perioperative monitoring, serious cardiorespiratory complications, including fatalities and permanent neurological impairment, have been documented. Prolonged exposure to benzodiazepines, such as midazolam, has been associated with neurological changes in infants. Despite attempts to employ therapeutic drug monitoring for optimal sedation dosing, its efficacy has been limited. Consequently, efforts are underway to identify alternative predictive markers to guide individualized dosing and mitigate adverse effects. Understanding these factors is crucial for determining midazolam's suitability for future administration, particularly after a severe adverse reaction. This article aims to elucidate the factors influencing midazolam's pharmacokinetics and pharmacodynamics, potentially leading to adverse events. Finally, a case study is presented to exemplify the complex investigation into the causative factors of midazolam-related adverse events.
咪达唑仑是一种短效苯二氮䓬类药物，广泛用于缓解患者焦虑、提高依从性及辅助麻醉。虽然其副作用通常与剂量相关，通过围手术期的密切监测可加以控制，但严重的心肺并发症，包括死亡和永久性神经损伤，已有文献记载。长期接触苯二氮䓬类药物，如咪达唑仑，与婴儿的神经变化有关。尽管尝试通过治疗药物监测来实现最佳镇静剂量，但效果有限。因此，正在努力寻找替代预测指标，以指导个体化给药并减轻不良反应。了解这些因素对于确定咪达唑仑在未来给药时的适用性至关重要，尤其是在发生严重不良反应之后。本文旨在阐明影响咪达唑仑药代动力学和药效学的因素，这些因素可能导致不良事件。最后，通过一个案例研究来说明对咪达唑仑相关不良事件病因的复杂调查。
