The aim of this study was to investigate how patient background influences the prolonged effect of midazolam, focusing on factors previously reported and albumin levels. A total of 196 patients aged 18 years and older were admitted to the University Hospital and Matsuyama Shimin Hospital intensive care units between January 2015 and May 2022 and received continuous midazolam infusion for at least 24 h were initially considered. Ultimately, 68 patients meeting the inclusion criteria were analyzed. We collected patient data, including background information, laboratory test values, and usage status of sedatives such as midazolam, from medical records. The primary outcome was the time required to see improvement in the Richmond Agitation–Sedation Scale score after midazolam administration. Factors influencing the duration of midazolam's effects were assessed using the Mann–Whitney U test and logistic regression analysis. The improvement in Richmond Agitation–Sedation Scale scores post-midazolam discontinuation occurred within 48 h for 52 patients (76.4%) and exceeded 48 h for 16 patients (23.5%). Risk factors identified in prior studies, and albumin levels were linked to the prolonged effect of midazolam. Multivariate logistic regression analysis indicated that albumin levels significantly affected the duration of midazolam's effects (odds ratio, 0.61; 95% confidence interval, 0.44–0.85; P < .05). In this study, the serum albumin level was identified as a new factor that enhances and prolongs the action of midazolam. Therefore, sedation in patients with low albumin levels should be performed carefully to avoid the prolongation and potentiation of midazolam action.
Yano et al. (Mon,) studied this question.