Skip to main content

Benzodiazepines and Barbiturates

  • Chapter
  • First Online:
Sedation and Analgesia for the Pediatric Intensivist

Abstract

Benzodiazepines and barbiturates are used for procedural sedation either as a single agent or in combination with other medications. This chapter discusses the mechanism of action, dosing, clinical effects, and uses of these sedative agents, although barbiturates are falling out of favor in the sedation community due to the ready availability of other short-acting sedatives such as propofol. Ultra-short acting barbiturates like Methohexital can still be useful for procedural sedation in patients where propofol is contraindicated, such as those with allergy to propfol, eggs, and soy and patients with an underlying mitochondrial disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Baldwa NM, Padvi AV, Dave NM, Garasia MB. Atomised intranasal midazolam spray as premedication in pediatric patients: comparison between two doses of 0.2 and 0.3 mg/kg. J Anesth. 2012;26(3):346–50.

    Article  Google Scholar 

  2. Calligaris L, Davide Z, Alessandra M, De Bortoli R, Chiaretti A, Barbi E. Concentrated midazolam for intranasal administration: a pilot study. Pediatr Emerg Care. 2011;27(3):245–7.

    Article  Google Scholar 

  3. Lugo RA, Fishbein M, Nahata MC, Lininger B. Complication of intranasal midazolam. Pediatrics. 1993;92(4):638.

    CAS  Google Scholar 

  4. Lam C, Udin RD, Malamed SF, Good DL, Forrest JL. Midazolam premedication in children: a pilot study comparing intramuscular and intranasal administration. Anesth Prog. 2005;52(2):56–61.

    Article  Google Scholar 

  5. Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256–9.

    Article  Google Scholar 

  6. Gershanik J, Boecler B, Ensley H, McCloskey S, George W. The gasping syndrome and benzyl alcohol poisoning. N Engl J Med. 1982;307(22):1384–8.

    Article  CAS  Google Scholar 

  7. Duerden EG, Guo T, Dodbiba L, et al. Midazolam dose correlates with abnormal hippocampal growth and neurodevelopmental outcome in preterm infants. Ann Neurol. 2016;79(4):548–59.

    Article  CAS  Google Scholar 

  8. Bellolio MF, Puls HA, Anderson JL, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. BMJ Open. 2016;6(6):e011384.

    Article  Google Scholar 

  9. Mancuso CE, Tanzi MG, Gabay M et al. Paradoxical reactions to benzodiazepines: literature review and treatment options. Pharmacotherapy. 2004;24(9):1177–85. https://doi.org/10.1592/phco.24.13.1177.38089.

    Google Scholar 

  10. Sharbaf Shoar N, Saadabadi A. Flumazenil. Treasure Island: StatPearls; 2019.

    Google Scholar 

  11. Chun TH, Amanullah S, Karishma-Bahl D, Machan JT, Andrada ER, Lewander WJ. Comparison of methohexital and pentobarbital as sedative agents for pediatric emergency department patients for computed tomography. Pediatr Emerg Care. 2009;25(10):648–50.

    Article  Google Scholar 

  12. Jones NE, Kelleman MS, Simon HK, et al. Evaluation of methohexital as an alternative to propofol in a high volume outpatient pediatric sedation service. Am J Emerg Med. 2017;35(8):1101–5.

    Article  Google Scholar 

  13. Mason KP, Zurakowski D, Connor L, et al. Infant sedation for MR imaging and CT: oral versus intravenous pentobarbital. Radiology. 2004;233(3):723–8.

    Article  Google Scholar 

  14. Mallory MD, Baxter AL, Kost SI, Pediatric Sedation Research C. Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth. 2009;19(6):601–11.

    Article  Google Scholar 

  15. Baxter AL, Mallory MD, Spandorfer PR, et al. Etomidate versus pentobarbital for computed tomography sedations: report from the Pediatric Sedation Research Consortium. Pediatr Emerg Care. 2007;23(10):690–5.

    Article  Google Scholar 

  16. Mason KP, Zurakowski D, Karian VE, Connor L, Fontaine PJ, Burrows PE. Sedatives used in pediatric imaging: comparison of IV pentobarbital with IV pentobarbital with midazolam added. AJR Am J Roentgenol. 2001;177(2):427–30.

    Article  CAS  Google Scholar 

  17. Kaila R, Chen X, Kannikeswaran N. Postdischarge adverse events related to sedation for diagnostic imaging in children. Pediatr Emerg Care. 2012;28(8):796–801.

    Article  Google Scholar 

  18. Katzung BG, Trevor AJ. Basic & clinical pharmacology. 13th ed. New York: McGraw-Hill; 2015.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mudit Mathur .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mathur, M., Malik, M.T. (2021). Benzodiazepines and Barbiturates. In: Kamat, P.P., Berkenbosch, J.W. (eds) Sedation and Analgesia for the Pediatric Intensivist. Springer, Cham. https://doi.org/10.1007/978-3-030-52555-2_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52555-2_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52554-5

  • Online ISBN: 978-3-030-52555-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics