Dental treatment under sedation
The dosage of Dormikum is selected individually for the patient. In some cases, it is enough to put the patient into a light sleep to relieve anxiety and fear. In other cases, anesthesia with partial or complete loss of consciousness is required. In all cases, the patient will not feel any pain effects; with the help of Dormikum, complete pain relief is achieved. The drug relieves muscle tension, which is so undesirable during dental treatment. The anesthesiologist regulates the dose of Dormikum, which is administered intravenously, while being next to the patient during the treatment session. All vital functions of the patient (respiratory and heart rate, blood pressure level, activity of the central nervous system) are under constant monitoring. Special equipment is used for this. During treatment, the anesthesiologist may increase the dose to prolong anesthesia. For recovery from anesthesia, the antagonist drug Dormikum Anexat is used. After anesthesia, the patient wakes up either in the dental chair or in a separate room and after 30 minutes can leave the Dial-Dent clinic. It is not recommended to drive after anesthesia; take care of someone accompanying you or order a taxi.
The drug Dormikum has its own contraindications, the main of which are hypersensitivity, myasthenia gravis, 1st trimester of pregnancy, breastfeeding. The side effects that any drug potentially has, thanks to the modern equipment of the clinic, practically do not appear. All details of contraindications and side effects are discussed during the consultation. During the consultation, the anesthesiologist will clarify what medications you are taking, what chronic diseases you have, answer all questions and explain the details of dental treatment under anesthesia.
Instructions for use DORMICUM
The dose should be titrated to achieve the desired sedative effect, which is consistent with clinical need, the physical condition and age of the patient, and the drug therapy he is receiving.
In patients over 60 years of age, debilitated or chronic patients, the dose should be selected carefully, taking into account the special factors inherent in each patient.
IV sedation with
preservation of consciousness
The dose of Dormicum is selected individually; The drug should not be administered quickly or in a stream. The onset of sedation varies individually, depending on the patient’s condition and dosage regimen (rate of administration, dose size). The effect occurs approximately 2 minutes after administration, the maximum - on average after 2.4 minutes.
For adults
Dormicum should be administered intravenously slowly, at a rate of approximately 1 mg per 30 seconds.
For adults under 60 years of age
the initial dose is 2.5 mg 5-10 minutes before the start of the procedure.
If necessary, subsequent doses of 1 mg are administered. Average total doses range from 3.5 to 7.5 mg. Usually a total dose not exceeding 5 mg is sufficient.
Patients over 60 years of age, debilitated or chronically ill
the initial dose is reduced to approximately 1 mg and administered 5-10 minutes before the start of the procedure. If necessary, subsequent doses of 0.5-1 mg are administered. Because maximum effect may not be achieved as quickly in these patients, subsequent doses should be titrated very slowly and carefully. Usually a total dose not exceeding 3.5 mg is sufficient.
For children
The drug is administered intramuscularly at a dose of 0.1-0.15 mg/kg 5-30 minutes before the procedure. For patients in a state of more pronounced agitation, up to 0.5 mg/kg body weight can be administered. Usually a total dose not exceeding 10 mg is sufficient.
The initial dose of Dormikum is administered intravenously over 2-3 minutes, after which, before starting the procedure or administering a second dose, you need to wait another 2-3 minutes to assess the sedative effect. If sedation needs to be increased, the dose continues to be titrated carefully until the desired degree of sedation is achieved.
Infants and children under 5 years of age
may require larger doses than older children and adolescents.
Data for non-intubated children less than 6 months of age
limited. These children are particularly prone to airway obstruction and hypoventilation, so it is critical to titrate the dose in small increments until clinical benefit is achieved, and to monitor patients closely.
Initial dose in children from 6 months to 5 years
is 0.05-0.1 mg/kg. To achieve the desired effect, a total dose of up to 0.6 mg/kg may be required, but should not exceed 6 mg.
Initial dose in children 6 to 12 years of age
is 0.025-0.05 mg/kg, total dose - up to 0.4 mg/kg (no more than 10 mg).
Doses for children from 12 to 16 years
the same as for adults.
Anesthesia
Premedication with Dormikum shortly before the procedure has a sedative effect (inducing drowsiness and eliminating emotional stress), and also causes preoperative amnesia. Premedication is usually carried out by injecting the drug deep into the muscle 20-60 minutes before induction of anesthesia.
Dormikum can be used in combination with anticholinergic drugs.
For adults
for preoperative sedation and elimination of memory of preoperative events, 0.07-0.1 mg/kg body weight (about 5 mg) is administered to patients not included in the high-risk group (ASA class I or II, age up to 60 years).
Patients over 60 years of age, debilitated or chronically ill
the dose is individually reduced.
If the patient is not simultaneously receiving narcotic analgesics, the recommended dose of midazolam is 0.025-0.05 mg/kg, the usual dose is 2-3 mg. For patients over 70 years of age,
intramuscular administration of Dormikum should be carried out carefully, under continuous monitoring, due to the possibility of excessive drowsiness.
Children from 1 to 15 years old
prescribed in relatively higher doses (per kg of body weight) than in adults. Doses in the range of 0.08-0.2 mg/kg have proven to be effective and safe.
Introductory anesthesia
If Dormikum is administered for induction anesthesia before other anesthetics, then the individual reaction of patients varies greatly. The dose should be titrated to the desired effect according to the age and clinical condition of the patient. If Dormikum is administered before other IV drugs for induction of anesthesia, then the initial doses of each of these drugs can be significantly reduced, sometimes up to 25% of the standard initial dose. The desired level of anesthesia is achieved by titrating the dose. The induction dose of Dormikum is administered intravenously slowly, fractionally. Each repeated dose, not exceeding 5 mg, should be administered over 20-30 seconds, with intervals of 2 minutes between injections.
Adults under 60 years of age
a dose of 0.15-0.2 mg/kg is administered intravenously over 20-30 seconds, after which you should wait 2 minutes to assess the effect.
For geriatric surgical patients
who do not belong to a high-risk group (ASA class I and II), an initial dose of 0.2 mg/kg is recommended. For some debilitated patients or patients with severe concomitant diseases, a lower dose may be sufficient.
Adults under 60 years of age
who have not received premedication, the dose may be higher, up to 0.3-0.35 mg/kg body weight. It is administered intravenously over 20-30 seconds, after which you should wait 2 minutes to evaluate the effect. If necessary, to complete the induction, the drug is administered additionally in doses of about 25% of the initial one. Alternatively, liquid inhalational anesthetics can be used to complete induction. In refractory cases, the induction dose of Dormikum can reach 0.6 mg/kg, however, the recovery of consciousness after such doses may be slowed down.
Patients over 60 years old
those who have not received premedication require smaller induction doses of Dormikum;
the recommended initial dose is 0.3 mg/kg; for patients with severe concomitant pathology and weakened patients
, an induction dose of 0.2-0.25 mg/kg is sufficient, sometimes only 0.15 mg/kg.
For induction of anesthesia in children
Dormikum is not recommended because experience with its use is limited.
Maintenance anesthesia
Maintaining the desired level of switching off consciousness can be achieved either by further fractional administration of small doses (0.03-0.1 mg/kg), or by continuous intravenous infusion at a dose of 0.03-0.1 mg/kg x h, usually in combination with analgesics. Doses and intervals between administrations depend on the individual response of the patient.
Patients over 60 years of age, debilitated or chronically ill
Smaller doses are required to maintain anesthesia.
For children
patients receiving ketamine for anesthesia (ataralgesia), it is recommended to administer a dose of 0.15 to 0.20 mg/kg IM. Sufficiently deep sleep is usually achieved after 2-3 minutes.
IV sedation in intensive care
The desired sedative effect is achieved by gradually selecting the dose, followed by either a continuous infusion or fractional jet administration of the drug, depending on the clinical need, the patient’s condition, his age and the simultaneously administered drugs.
For adults
The intravenous
loading dose
is administered fractionally and slowly. Each repeated dose of 1-2.5 mg is administered over 20-30 seconds, observing 2-minute intervals between injections.
The value of the IV loading dose can vary between 0.03-0.3 mg/kg, and usually a total dose of no more than 15 mg is sufficient.
In patients with hypovolemia, vasoconstriction or hypothermia, the loading dose is reduced or not administered at all.
If Dormikum is used simultaneously with strong analgesics, the latter should be administered before it so that the dose of Dormikum can be safely titrated to the level of sedation caused by the analgesic.
Maintenance dose
may be 0.03-0.2 mg/(kg x h). In patients with hypovolemia, vasoconstriction or hypothermia, the maintenance dose is reduced. If the patient's condition allows, the degree of sedation should be regularly assessed.
For children
to achieve the desired clinical effect, the drug is administered intravenously at a dose of 0.05-0.2 mg/kg over at least 2-3 minutes (it cannot be administered quickly intravenously). After this, they switch to continuous intravenous infusion at a dose of 0.06-0.12 mg/kg (1-2 mcg/kg/min). If necessary, to enhance or maintain the desired effect, the infusion rate can be increased or decreased (usually by 25% of the initial or subsequent rate) or additional doses of Dormicum can be administered.
If Dormikum infusion is prescribed to patients with hemodynamic disorders, the usual loading dose must be titrated in small “steps”, monitoring hemodynamic parameters (hypotension). These patients are prone to respiratory depression when using Dormicum and require careful monitoring of respiratory rate and oxygen saturation.
Newborns (less than 32 weeks)
Dormikum should be administered as a continuous intravenous infusion at an initial dose of 0.03 mg/kg x hour (0.5 mcg/kg/min), and
for newborns (more than 32 weeks) -
at a dose of 0.06 mg/kg/h (1 mcg/kg/min). min). An IV loading dose is not administered to newborns; instead, the infusion is administered somewhat more rapidly in the first few hours to achieve therapeutic plasma concentrations of the drug. The infusion rate should be frequently and carefully reviewed, especially in the first 24 hours, to administer the lowest effective dose and reduce the possibility of drug accumulation.
Rules for preparing the solution
Dormikum solution in ampoules can be diluted with 0.9% sodium chloride solution, 5% and 10% dextrose solution, 5% fructose solution, Ringer's solution and Hartmann's solution in a ratio of 15 mg of midazolam per 100-1000 ml of infusion solution. These solutions remain physically and chemically stable for 24 hours at room temperature or 3 days at 5°C.
Dormikum should not be diluted with a 6% solution of macrodex in glucose or mixed with alkaline solutions.
In addition, a precipitate may form, which will dissolve upon shaking at room temperature.
