Midazolam

Injectable midazolam in 1 and 5 mg/ml strengths
Oklahoma State Penitentiary, the site of the state of Oklahoma's execution chamber

Benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.

- Midazolam

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Anterograde amnesia

Loss of the ability to create new memories after the event that caused amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact.

Hippocampus (brain)

This disorder is usually acquired in one of four ways: One cause is benzodiazepine drugs such as midazolam, flunitrazepam, lorazepam, temazepam, nitrazepam, triazolam, clonazepam, alprazolam, diazepam, and nimetazepam; all of these are known to have powerful amnesic effects.

WHO Model List of Essential Medicines

The WHO Model List of Essential Medicines (aka Essential Medicines List or EML ), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.

2017 marked the 40th anniversary of the WHO Model List of Essential Medicines.
A skeletal model of the chemical structure of aspirin
A skeletal model of the chemical structure of albendazole
Pure crystals of ethambutol
Two capsules of atazanavir
Bag containing one unit of fresh frozen plasma
A vial of oral cholera vaccine

Midazolam

Anesthesia

Not to be confused with Paresthesia and Anesthetic.

The anesthetic area of an operating room
A vaporizer holds a liquid anesthetic and converts it to gas for inhalation (in this case sevoflurane)
Syringes prepared with medications that are expected to be used during an operation under general anesthesia maintained by sevoflurane gas: – Propofol, a hypnotic – Ephedrine, in case of hypotension – Fentanyl, for analgesia – Atracurium, for neuromuscular blockade – Glycopyrronium bromide (here under trade name "Robinul"), reducing secretions
An anesthetic machine with integrated systems for monitoring of several vital parameters.
A patient-controlled analgesia infusion pump, configured for epidural administration of fentanyl and bupivacainefor postoperative analgesia
Anesthesia-related deaths by ASA status
Hua Tuo
Sir Humphry Davy's Researches chemical and philosophical: chiefly concerning nitrous oxide (1800), pp. 556 and 557 (right), outlining potential anesthetic properties of nitrous oxide in relieving pain during surgery.
Contemporary re-enactment of Morton's 16 October 1846, ether operation; daguerrotype by Southworth & Hawes
Morton's ether inhaler

Drugs like midazolam produce amnesia through different pathways by blocking the formation of long-term memories.

Psychomotor agitation

Symptom in various disorders and health conditions.

Signs including (enlarged liver and spleen), and symptoms (including headache, and vomiting) of acute HIV infection.

Intramuscular midazolam, lorazepam, or another benzodiazepine can be used both to sedate agitated patients and to control semi-involuntary muscle movements in cases of suspected akathisia.

Procedural sedation and analgesia

Technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient.

Patient being monitored following anesthesia

Midazolam is a benzodiazepine that acts by stimulating inhibitory GABA receptors.

Propofol

Short-acting medication that results in a decreased level of consciousness and a lack of memory for events.

A 20 ml ampoule of 1% propofol emulsion, as sold in Australia by Sandoz

Its use in these settings results in a faster recovery compared to midazolam.

Status epilepticus

Single seizure lasting more than 5 minutes or 2 or more seizures within a 5-minute period without the person returning to normal between them.

Generalized 3 Hz spike-and-wave discharges on an electroencephalogram
Diazepam that can be inserted rectally is often prescribed to caregivers of people with epilepsy. This enables treatment of multiple seizures prior to being able to seek medical care.

Possible benzodiazepines include intravenous lorazepam as well as intramuscular injections of midazolam.

Lorazepam

Benzodiazepine medication.

0.5 mg tablets of the Ativan brand of lorazepam
1987 advertisement. "In a world where certainties are few...no wonder Ativan is prescribed by so many caring clinicians."

Lorazepam is sometimes used as an alternative to midazolam in palliative sedation.

Benzodiazepine

Fusion of a benzene ring and a diazepine ring.

Structural formula of benzodiazepines.
Midazolam 1 & 5 mg/mL injections (Canada)
Temazepam (Normison) 10 mg tablets
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Benzodiazepines were ranked in this graph 7th in dependence, physical harm, and social harm.
Diazepam 2 mg and 5 mg diazepam tablets, which are commonly used in the treatment of benzodiazepine withdrawal.
Chlordiazepoxide 5 mg capsules, which are sometimes used as an alternative to diazepam for benzodiazepine withdrawal. Like diazepam it has a long elimination half-life and long-acting active metabolites.
Schematic diagram of the (α1)2(β2)2(γ2) GABAA receptor complex that depicts the five-protein subunits that form the receptor, the chloride (Cl−) ion channel pore at the center, the two GABA active binding sites at the α1 and β2 interfaces and the benzodiazepine (BZD) allosteric binding site at the α1 and γ2 interface.
Left: The 1,4-benzodiazepine ring system. Right: 5-phenyl-1H-benzo[e] [1,4]diazepin-2(3H)-one forms the skeleton of many of the most common benzodiazepine pharmaceuticals, such as diazepam (7-chloro-1-methyl substituted).
A pharmacophore model of the benzodiazepine binding site on the GABAA receptor. White sticks represent the carbon atoms of the benzodiazepine diazepam, while green represents carbon atoms of the nonbenzodiazepine CGS-9896. Red and blue sticks are oxygen and nitrogen atoms that are present in both structures. The red spheres labeled H1 and H2/A3 are, respectively, hydrogen bond donating and accepting sites in the receptor, while L1, L2, and L3 denote lipophilic binding sites.
The molecular structure of chlordiazepoxide, the first benzodiazepine. It was marketed by Hoffmann–La Roche from 1960 branded as Librium.
Xanax (alprazolam) 2 mg tri-score tablets

In the community, intravenous administration is not practical and so rectal diazepam or buccal midazolam are used, with a preference for midazolam as its administration is easier and more socially acceptable.

End-of-life care

End-of-life care (EoLC) refers to health care for a person nearing the end of their life or in the advanced stage of a terminal illness.

Global concentrations of health care resources, as depicted by the number of physicians per 10,000 individuals, by country. Data is sourced from a World Health Statistics 2010, a WHO report.

Delirium, terminal anguish, restlessness (e.g. thrashing, plucking, or twitching). Typically controlled using clonazepam or midazolam, antipsychotics such as haloperidol or levomepromazine may also be used instead of, or concomitantly with benzodiazepines. Symptoms may also sometimes be alleviated by rehydration, which may reduce the effects of some toxic drug metabolites.