Use of Intravenous Lipid Emulsion Therapy to Prevent the Undesirable Effects of Midazolam

Objective: Midazolam is a lipophilic benzodiazepine used for moderate and deep interventional sedation and sedoanalgesia in emergency departments. It may cause undesirable outcomes such as bradycardia and hypotension when used. Intravenous lipid emulsion (ILE) therapy is performed to prevent the toxic effects of local anesthetics, β-blockers and lipophilic drugs. In this study, it was aimed to evaluate the effect of ILE infusion on undesirable outcomes such as bradycardia, hypotension and respiratory depression that may occur after midazolam infusion in rats.
Material and Methods: For the study, 24 Sprague-Dawley rats with the same characteristics were randomly divided into four groups as follows: (1) 0.9% NaCl 16 mL/kg intravenously (IV), (2) midazolam 5 mg/kg IV bolus at an infusion rate of 5 mg/kg/h, (3) 16 mL ILE at an infusion rate of 16 mL/kg/min infusion, and (4) 16 mL ILE at an infusion rate of 16 mL/kg/min infusion for 4 min, then Midazolam 5 mg/kg IV bolus at an infusion rate of 5 mg/kg/h over 60 min. Vital parameters and mortality were monitored.
Results: Mean arterial pressure (MAP) and pulse rate was significantly lower in the midazolam-infused group compared to the other groups (p<0.05). In the group receiving midazolam + ILE treatment, MAP decreased at a later period and no significant difference was observed compared to the control group in the measurements after the 40th minute (p>0.05). The mortality rate of the midazolam group was 100%, and the survival rate of the other groups was 100%. A significant increase in respiratory rate was observed in the group receiving ILE treatment compared to the control group (p<0.05).
Conclusion: It has been shown that effects such as hypotension and respiratory depression that may occur after midazolam administration can be eliminated with ILE treatment and mortality can be reduced.

Keywords: Midazolam, intravenous lipid emulsion, rat