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  • Acute Benzodiazepine Withdrawal Syndrome After Midazolam Infusions in Children

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    Acute Benzodiazepine Withdrawal Syndrome After Midazolam Infusions in Children

    Hochgeladen von

    Susan
    t

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    © All Rights Reserved
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    Vol. 17, No. 3 influence of various fluid treatments on edemagenesis after pulmonary microembolism. Since we expected the Gar equa tion not to hold under these conditions. we stated in our paper the following (page 1111, lines 8-12): “Since emboli are seen in precapillary arterioles (12), the arterial resistance ‘may be preferentially elevated. Thus, P, and Pr, may be ‘overestimated in the fibrin microembolism set of experi- ments.” ) The new method of Cope et al. (3) to estimate P, in the in vivo lung may assist in more accurate estimations of arterial and venous resistances across the pulmonary circulation. The spuriously high values, however. for pulmonary artery wedge ‘pressure (WP) that were reported after fibrin microembolism in dogs (4) as well as in humans (5) make any P. estimates based on WP values inaccurate under these conditions. We attempted to avoid this pitfall by direct measurement of eft atrial pressure in the open-chest dog experiments. Some dif- {erences in filtration pressure may have been present in the heterogeneous lung circulation between the embolism and control groups, but we believe that these differences were Small because left atrial pressure was controlled at 1S mm He by volume adjustments to the left atrial balloon catheter in all experimental groups. Richard C. Schaeffer, Jr, PhD: University of Arizona, Tucson, AZ: Richard W. Carlson, MD: Wayne State University School of Medicine, Detroit, MI REFERENCES, 1. Gaar KA. Taylor AE, Owens LJ. et al: Pulmonary capillary pressure and fltauon coefficient in the sslated perfused lun. dim J Physiol 1967: 215910 2, Schaefer RC Je, Renicwicr RR, Chilton SM. et al: Effects of colondal and ersalloidal Mids on edemagenesis in normal and thromboembolized lunes in dogs. Crt Care Med 1987: 181110 3. Cope DK. Allison RC. Parmentier JL, et a Measurement of lective pulmonan capillary pressure using pulmonary artery pressure profiles after aclusion. (rt Care Mod 1986. 1416 4. Schaefer RC Jr. Chilion SM. Hadden TJ, et al Pulmonary fibrin microembolism wath Echiscarmmarus senom in dogs” El fects of synthetic thrombin inhibvior J Ippl Prod 198 sr:1824 5, Fairfax WR. Thomas F. Ome JF Jr Pulmonary artery catheter czcluson a5 an indication of pulmonar, embolus. Ches! 1984 86.270 Acute Benzodiazepine Withdrawal Syndrome After ‘Midazolam Infusions in Children To the Editor: ‘AL the Royal Liverpool Childrens Hospitals. we sedate children who are undergoing mechanical ventilation of the Jungs with midazolam (120 to 240 ugykg-h) with or without ‘morphine (20 to 40 g/kg:h) infusions. This was proved to be a satisfactory technique for the majority of our patients (1; however. recently three patients required prolonged se- dation and were difficult to control with our usual regimen 50 midazolam dose rates were increased. Afler abrupt termi: nation of sedation. we observed confused and agitated behav jor. A summary of their case details are presented below Patient 1. & &-yr-old (15-kg) boy underwent mechanical Pulmonary ventilation (MPV) for pneumonia, He was sedated With midazolam (total dose 560 mg over 7 days, mean dose Fate 220 ug/kg-h, maximal dose rate 370 ug/kg:h) and mor- Dhine infusions. Concurrent drug therapy included d-tubo- ‘curarine, cefuroxime. benzyl penicillin, and flucloxacillin, During weaning from MPV. he was difficult o sedate despite increasing doses of midazolam; 24 h after extubation and LETTERS TO THE EDITOR 301 cessation of the sedation he was hyperactive, aggressive, and ‘uncommunicative. He appeared to be having visual halluci- nations and seemed not to recognize his parents. Chlorpro- ‘mazine and chloral hydrate provided temporary sedation, but only diazepam (iv and oral) provided relief (albeit partial) of these symptoms. Diazepam was required for a further 7 days until his behavior returned to normal, Patient 2. An I1-vr-old girl (40-kg) required 14 days of MPV after an acute severe asthmatic attack, She was sedated ‘with midazolam (total 2350 mg over 14 days, mean dose rate 170 ugyke-h, masimal dose rate 375 ug/kg-h), and morphine infusions. Coincident drug therapy included vecuronium, hy-

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