Dexmedetomidine/midazolam interaction
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Dexmedetomidine/midazolam interaction Cardiogenic shock secondary to midazolam intoxication: case report
A male neonate [age at the time of reaction onset not clearly stated] developed cardiogenic-shock secondary to midazolam intoxication following concomitant administration of midazolam and dexmedetomidine for sedation during routine care related to prematurity. The boy was admitted to the NICU for routine care related to prematurity and was started on ventilatory support. He started receiving IV Midazolam 0.2 mg/kg/h via continuous infusion in combination with dexmedetomidine 0.4 mg/kg/h [route not stated] for sedation. The dosage of midazolam was increased from 0.2 to 0.3 mg/kg/h and finally reduced to 0.15 mg/kg/h on day 0. On day 2, he was deeply sedated and therefore midazolam and dexmedetomidine administration was discontinued. However, on day 4, i.e. 2 days following midazolam discontinuation, he developed cardiogenic shock presumably because of midazolam intoxication. Although midazolam plasma concentrations were within the range of 100-400 ng/mL and the blood concentration of midazolam was 3972 ng/mL. Brain MRI revealed polycystic encephalomalacia on either side of the occipital and parietal lobes. Electroencephalography showed spikes from the temporal to the occipital region on the left side and right occipital region. Based on these abnormal findings, he was diagnosed with post-resuscitation encephalopathy. The boy was administered carbamazepine for convulsions and was subsequently discharged [outcomes not stated]. Endo M, et al. Midazolam Intoxication in a Premature Neonate. Clinical Therapeutics 42: 946-951, No. 5, May 2020. Available from: URL: http://doi.org/10.1016/ j.clinthera.2020.03.013
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