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[Dosage of midazolam]

Ã¥¿¡´Â ÀÌ·¸°Ô µÇ¾î ÀÖ½À´Ï´Ù. ¹°·Ð ¼­±¸ÀÇ ±ÇÀå·®ÀÔ´Ï´Ù. "ÃÊȸ ¿ë·®À¸·Î´Â °Ç°­ÇÑ ¼ºÀο¡°Ô´Â 2-2.5 mg (0.035-0.070mg/kg)À» °¡´ÉÇÑ ÃµÃµÈ÷ Åõ¿©ÇÏ°í °í·É ¶Ç´Â Çã¾à ȯÀÚ¿¡°Ô´Â 1-1.5 mgÀ» Åõ¿©ÇÑ´Ù. º¸´Ù °­ÇÑ ÁøÁ¤ÀÛ¿ëÀÌ ÇÊ¿äÇϸé 1-2ºÐ ±â´Ù¸° ÈÄ Á¶±Ý¾¿ Áõ·®ÇÏ¿© 0.5-1 mg¾¿ ´õ Åõ¿©ÇÒ ¼ö ÀÖ´Ù. °Ç°­ÇÑ ¼ºÀο¡°Ô´Â ÃÖ´ë ÃÑ Åõ¿©·®Àº 0.1 mg/kgÀÌ´Ù. °í·ÉȯÀÚ, Çã¾àȯÀÚ ¹× Æó¿ë·®ÀÌ ºÎÁ·ÇÑ È¯ÀÚ¿¡°Ô´Â ÃÑ Åõ¿©·®À» ¾à 30% ÀÌ»ó °¨¼Ò½ÃÅ°´Â °ÍÀÌ ÁÁ´Ù."

¿ì¸®³ª¶ó¿¡¼­´Â ¼­±¸ÀÇ ±ÇÀå·®º¸´Ù Á¶±Ý ¸¹ÀÌ Åõ¿©ÇÏ´Â °æÇâÀÔ´Ï´Ù. ÀÇÇÐÀûÀÎ ÀÌÀ¯´Â ¾ø½À´Ï´Ù. ÀÇ·áȯ°æÀÇ Æ¯¼ö¼º(ºñº¸Çè µî)¿¡ ±âÀÎÇÑ °ÍÀÔ´Ï´Ù. È­²öÇÑ °ÍÀ» ÁÁ¾ÆÇÏ´Â ¼ºÇâ°úµµ °ü°è°¡ ÀÖ½À´Ï´Ù.

³»½Ã°æ °Ë»ç Àü sedation°ú °ü·ÃµÈ ÀÀ±Þ»óȲÀº "Demerol 25 mg + midazolam 4 mg"°ú °°ÀÌ ¾à°£ ¸¹Àº ¿ë·®À» fixed dose·Î »ç¿ëÇÏ´Â °æ¿ì¿¡ ÈçÇÕ´Ï´Ù. °³Àκ°·Î Â÷º°È­µÈ Á¢±ÙÀÌ ÇÊ¿äÇÕ´Ï´Ù. ¿¬·É°ú üÁßÀ» ¹ÙÅÁÀ¸·Î midazolam dose chart¸¦ ¸¸µé¾î »ç¿ëÇÏ´Â º´¿øµµ ÀÖ½À´Ï´Ù. ÁÁÀº ¹æ¹ýÀ̶ó°í »ý°¢µË´Ï´Ù.

"³ª´Â ½ÉÀåµµ ³ª»Ú°í Æóµµ ³ª»Ú°í ü·Âµµ ¾È ÁÁ¾Æ¼­ ±×³É ³»½Ã°æÀ» ¸ø ÇÏ°Ú´Ù. È®½ÇÇÏ°Ô ¼ö¸é³»½Ã°æÀ» ÇØ ´Þ¶ó"°í ºÎŹÇÑ °í·ÉÀÇ È¯ÀÚ¿¡¼­´Â ƯÈ÷ ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. ½Ã°£ÀÌ ¸¹ÀÌ °É¸®´õ¶óµµ 1 mg Á¤µµ¸¸ Åõ¿©ÇÑ ÈÄ 2ºÐ Á¤µµ ±â´Ù·È´Ù°¡ ÇÊ¿äÇϸé 0.5 mg À» Ãß°¡ Åõ¿©ÇÏ´Â ¹æ¹ýÀ» ±ÇÇÕ´Ï´Ù. ƯÈ÷ ±íÀº sedationÀÌ µÇÁö ¾Êµµ·Ï ÁÖÀÇÇϽʽÿä. ȯÀÚ°¡ È®½ÇÇÏ°Ô ÇØ ´Þ¶ó°í ÀÇ»çÀÇ ¸¶À½ÀÌ Èçµé¸®¸é »ç°í·Î À̾îÁö±â ½±½À´Ï´Ù.

Àú´Â ȯÀÚÀÇ ¿¬·É, ü±¸, Áúȯ µîÀ» °í·ÁÇÏ¿© 1 mg, 2 mg, 3 mg ȤÀº 4 mgÀ» Åõ¿©ÇÕ´Ï´Ù. 2-3ºÐ ±â´Ù¸° ÈÄ Á¶±Ý ´õ Åõ¿©Çϱ⵵ ÇÕ´Ï´Ù. Áø´Ü ³»½Ã°æ¿¡¼­´Â ´ëºÎºÐ DemerolÀº »ç¿ëÇÏÁö ¾Ê½À´Ï´Ù. Ä¡·á³»½Ã°æ¿¡¼­´Â ´ëºÎºÐ Demerol 25 mgÀ» Åõ¿©ÇÏ°í ÀÖ½À´Ï´Ù.


[2014-10-13] 2014³â »ï¼º¼­¿ïº´¿ø ÀÇ·áÁøÀ» ´ë»óÀ¸·Î ÇÑ ÁøÁ¤ ±³À°À» ¹Þ¾Ò½À´Ï´Ù. ÀÎÁõÀ» ¾ÕµÎ°í ²À ¹Þ¾Æ¾ß ÇÏ´Â Çʼö±³À°À̾ú½À´Ï´Ù. ¾î¿ ¼ö ¾øÀÌ º» µ¿¿µ»óÀ̾úÁö¸¸, Áß¿äÇÑ Á¡À» ´Ù½Ã Çѹø ´À³¢°Ô µÈ ÁÁÀº °è±â¿´½À´Ï´Ù.

60¼¼ ¹Ì¸¸ÀÇ ¼ºÀο¡¼­ midazolamÀÇ ÃÊȸ·®Àº 2 - 2.5 mgÀÌ°í °í·ÉÀÚ, ¼è¾àȯÀÚÀÇ ÃÊȸ·®Àº 1 - 1.5 mgÀ̶ó´Â ³»¿ëÀ̾ú½À´Ï´Ù. ¿ì¸®³ª¶ó ³»½Ã°æ½Ç¿¡¼­ »ç¿ëµÇ´Â midazolam ¿ë·®À» »ý°¢Çغ¸¾Ò½À´Ï´Ù. Á¦°¡ ³»½Ã°æÀ» óÀ½ ¹è¿ï ¶§¿¡´Â "midazolam 4 mg + Demerol 50 mg"ÀÌ ¹«½¼ Ç¥ÁØó·³ »ç¿ëµÇ¾ú½À´Ï´Ù. Áö±Ý »ý°¢Çغ¸¸é ¾îó±¸´Ï ¾ø´Â °í¿ë·®ÀÔ´Ï´Ù.

³»½Ã°æ½ÇÀÇ CPRÀ̳ª »ç¸Á»ç·Ê´Â ´ëºÎºÐ ÁøÁ¤Á¦ ¿ë·®ÀÌ °úÇ߱⠶§¹®ÀÔ´Ï´Ù. ¿ì¸®°¡ initial dose¸¦ Àß ÁöŲ´Ù¸é, ÇÊ¿äÇÑ °æ¿ì¿¡¸¸ ÀûÀº ¿ë·®À» õõÈ÷ Ãß°¡ÇÑ´Ù¸é, ´ëºÎºÐÀÇ CPR, ´ëºÎºÐÀÇ »ç¸Á »ç°í¸¦ ¸·À» ¼ö ÀÖ½À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ midazolam ¿ë·®ÀÌ ¼­±¸º¸´Ù ¸¹¾Æ¾ß ÇÒ ÀÌÀ¯´Â ¾ø½À´Ï´Ù. Àü ¼¼°è Ç×¾ÏÁ¦ ¿ë·®Àº °øÅëÀÔ´Ï´Ù. Midazolam, propofol ¿ë·®µµ ¼¼°è °øÅëÀÔ´Ï´Ù. ÀÇ·á ÇöÀåÀÇ ¾î·Á¿òÀ» º¯¸íÀ¸·Î »ïÁö ¸»¾Æ¾ß ÇÕ´Ï´Ù. Áö±ÝºÎÅÍ¶óµµ midazolam, propofol¿¡ ´ëÇÑ ±³°ú¼­ÀÇ ¿ë·®°ú ¿ë¹ýÀ» ÁöÅ°´Â °ÍÀÌ ³»½Ã°æ½Ç ¾ÈÀüÀÇ Ã¹°ÉÀ½À̶ó°í »ý°¢ÇÕ´Ï´Ù. È­²öÇÏ°Ô ¸¹ÀÌ ÁÖ¸é º¸ÅëÀº ÁÁ½À´Ï´Ù. ±×·±µ¥ °¡²û ȯÀÚ Á×½À´Ï´Ù. ±×·¯´Ï È­²öÇÏ°Ô ¾²¸é ¾ÈµÇ´Â °ÍÀÔ´Ï´Ù. ¿ë·®°ú ¿ë¹ýÀ» ÁöÄÑ¾ß ÇÕ´Ï´Ù.

Midazolam°ú propofolÀÇ initial dose¸¦ Áöŵ½Ã´Ù. ÇÊ¿äÇÑ °æ¿ì¿¡´Â 1-2ºÐ ÈÄ ¼Ò·®À» Ãß°¡ÇսôÙ. ±×°Ô ¿Ã¹Ù¸¥ ¿ë¹ýÀÔ´Ï´Ù. ¿Ã¹Ù¸¥ ÁøÁ¤À» ÇսôÙ.


»ï¼º¼­¿ïº´¿ø ¸ð¹ÙÀÏ È¨ÆäÀÌÁö·ÎºÎÅÍ »ï¼º¼­¿ïº´¿ø ³»½Ã°æ½ÇÀÇ sedation guidelineÀ» ¿Å±é´Ï´Ù.

[Sedation for Endoscopy at SMC Endoscopy Unit]

1. ASA classification

Class I The patient is normal and healthy.
Class II The patient has mild systemic disease that does not limit their activities. e.g., controlled hypertension or DM without complications.
Class III The patient has moderate or severe systemic disease, which does limit their activities. e.g., stable angina or DM with complications.
Class IV The patient has severe systemic disease that is a constant potential threat to life. e.g., congestive heart failure, chronic renal failure.
Class V The patient is morbid and is at substantial risk of death within 24 hours.
Class E Emergency stats: in addition to indicating underlying ASA status (I-V), any patient undergoing an emergency procedure is indicated by the suffix "E".


2. Initial dose for upper endoscopy

Condition Body weight >= 60 kg Body weight < 60 kg
Age < 65 years Midazolam 2.5 mg Midazolam 2 mg
Age >= 65 years Midazolam 2 mg Midazolam 1.5 mg

@ Pethidine 25 mg IV may be used for selected patients with age < 70 years.


3. Initial dose for colonoscopy

Condition Body weight >= 60 kg Body weight < 60 kg
Age < 65 years Midazolam 2.5 mg + Pethidine 25 mg Midazolam 2 mg + Pethidine 25 mg
Age >= 65 years Midazolam 2 mg + Pethidine 25 mg Midazolam 1.5 mg + Pethidine 25 mg


4. Additional dose

1. Wait for at least 2-3 minutes after the initial dose.

2. If necessary, add midazolam 0.5 mg (age >= 65 years) or 1 mg (age < 65 years).

3. Interval for the next dose should be at least 1-2 minute.

4. Additional pethidine needs to be individualized (used only rarely).


5. Level of sedation

Three level system (mild/moderate/deep) is recommended for the monitoring of sedation level [ASA method]. Old system of Richmond agitation sedation scale (RASS) is not used anymore. If paradoxical response is observed, it should be recorded separately.

¡à minimal (ÃÖ¼Ò ÁøÁ¤): ¾à¹°¿¡ ÀÇÇØ ºÒ¾ÈÀÌ ÇØ¼ÒµÈ »óÅ·Π±¸µÎÁö½Ã¿¡ Á¤»óÀûÀ¸·Î ¹ÝÀÀÇÔ. ÀÎÁö±â´É°ú Á¶È­±â´ÉÀÇ ÀúÇÏ°¡ °üÂûµÉ ¼ö ÀÖÀ¸³ª ÀÚ¹ß È¯±â¿Í ½ÉÇ÷°ü°è±â´ÉÀº Á¤»óÀÓ.

¡à moderate (Áߵ ÁøÁ¤): ¾à¹°¿¡ ÀÇÇØ ÀǽÄÀÌ ÀúÇÏµÈ »óÅ·Π±¸µÎÁö½Ã³ª °¡º­¿î Á¢ÃËÀڱؿ¡ ÀǹÌÀÖ´Â ¹ÝÀÀÀ» º¸ÀÓ. ÀûÀýÇÑ ÀÚ¹ß È¯±â¸¦ º¸ÀÌ¸ç ½ÉÇ÷°ü°è ±â´ÉÀº À¯ÁöµÊ.

¡à deep (±íÀº ÁøÁ¤): ¾à¹°¿¡ ÀÇÇØ ½±°Ô ±úÁö ¾Ê´Â »óÅ·Π¹Ýº¹µÈ ÀÚ±ØÀ̳ª ÀǵµÀûÀÎ ÅëÁõ Àڱؿ¡ ´Ü¼ø ȸÇÇ ¹ÝÀÀ Á¤µµ¸¸ º¸ÀÓ. ÀûÀýÇÑ ±âµµÀ¯Áö¿Í ÀÚ¹ß È¯±â¸¦ À§ÇÑ º¸Á¶°¡ ÇÊ¿äÇÒ ¼ö ÀÖÀ¸³ª, ½ÉÇ÷°ü°è ±â´ÉÀº ´ëºÎºÐ À¯ÁöµÊ.


¡à paradoxical response : ¾à¹°¿¡ Åõ¿© ÈÄ ¿ÀÈ÷·Á ÈïºÐ°ú ºÒ¾ÈÀ» º¸À̸ç, ±¸µÎÁö½Ã³ª Àڱؿ¡ ÅëÁ¦µÇÁö ¾Ê´Â ¸ð¼øµÈ ¹ÝÀÀÀ» º¸ÀÓ.

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