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Cardiovascular effects of intravenous midazolam after open heart surgery
  1. Lara Shekerdemiana,
  2. Andrew Bushb,
  3. Andrew Redingtona
  1. aRoyal Brompton Hospital / National Heart and Lung Institute (Imperial College of Science, Technology and Medicine): Department of Paediatric Cardiology, bDepartment of Paediatric Respiratory Medicine
  1. Professor A Redington, Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP.


Midazolam is the sedating agent of choice in many paediatric intensive care units, and is usually administered as a continuous intravenous infusion with or without a preceding bolus dose.

 Ten haemodynamically stable children, ventilated in the early postoperative period after cardiac surgery and receiving intravenous morphine infusions, were given an intravenous bolus followed by a continuous infusion of midazolam. Haemodynamic data were recorded before the bolus, and 15 minutes and one hour later. A bolus of midazolam lowered the cardiac output by 24.1%. Arterial blood pressure, oxygen consumption, and mixed venous oxygen content fell significantly. There was a tendency for all variables subsequently to recover towards baseline values, within one hour, during a continuous infusion.

 An intravenous bolus of midazolam causes a transient but unwanted fall in cardiac output. It is suggested that in children who are receiving intravenous opiates, its use in the early postoperative period be limited to a continuous infusion.

  • cardiac output
  • sedation
  • midazolam
  • cardiac surgery.

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