Use of midazolam in palliative care

Objective: To review the use of midazolam (a water-soluble benzodiazepine) in terminally ill patients. Design: A retrospective study of 104 patients. Results: Midazolam was used intravenously as sedation before minor procedures in three patients. Because of prolonged sedation in two patients, the following regimen is now used: 1 mg intravenously stat, followed by 1 mg/min, or 0.5mg/min in those over 65. In other situations, midazolam was used subcutaneously (SC), usually via a syringe driver. For muscle relaxation the median dose was 30mg SC/24h (27 patients; range 10-60mg). When treating terminal agitated delirium the median dose was 35mg SC/24h (61 patients; range 10-240mg). For multifocal myoclonus or as prophylaxis against fits the median dose was 30mg SC/24h (12 patients; range 15-80mg).