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Midazolam is sometimes used for the acute management of prolonged seizures.Long-term use for the management of epilepsy is not recommended due to the significant risk of tolerance (which renders midazolam and other benzodiazepines ineffective) and the significant side effect of sedation. [21]
Midazolam is the most commonly prescribed for this use because of its strong sedative actions and fast recovery time, as well as its water solubility, which reduces pain upon injection. Diazepam and lorazepam are sometimes used. Lorazepam has particularly marked amnesic properties that may make it more effective when amnesia is the desired effect.
"Pain ladder", or analgesic ladder, was created by the World Health Organization (WHO) as a guideline for the use of drugs in the management of pain. Originally published in 1986 for the management of cancer pain , it is now widely used by medical professionals for the management of all types of pain .
The tables below contain a sample list of benzodiazepines and benzodiazepine analogs that are commonly prescribed, with their basic pharmacological characteristics, such as half-life and equivalent doses to other benzodiazepines, also listed, along with their trade names and primary uses.
A standard coinduction regimen for an adult might consist of a benzodiazepine sedative amnesic such as midazolam, followed by an opioid analgesic with further sedating properties such as fentanyl which has a fast onset, then an intravenous induction agent: propofol.
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Opioid, lidocaine and midazolam are adjuvant agents frequently administered to minimize pain during the injection of the induction agents. [ 45 ] [ 46 ] They are also used to lessen the sympathetic stress response, cough reflex during laryngoscopy or intubation , and supplement sedation by synergistic effects .
Multimodal analgesia refers to the use of multiple classes of medications in order to treat pain from different molecular mechanisms at once. Prolonged use of higher doses of opioids is associated with increased risk of tolerance and opioid use disorder, so there is a growing trend in the use of multimodal analgesia to treat pain. [4] [5] [6]