镇静术在早期食管癌、胃癌及癌前病变内镜治疗中的应用

目的探讨异丙酚复合小剂量咪达唑仑行镇静术于早期食管癌、胃癌及癌前病变内镜治疗中的应用及安全性。方法48例早期食管癌、胃癌及癌前病变在内镜下行黏膜切除术及氩离子凝固术患者,ASAⅠ、Ⅱ级,均静脉应用异丙酚复合小剂量咪达唑仑行镇静术。进镜前静脉缓慢注射咪达唑仑0.07mg/kg,待患者入睡后进镜,先行治疗前病变观察、染色等操作,继之静脉缓慢注射异丙酚1.5~2.0mg/kg,1min后即可开始治疗,术中根据治疗需要追加异丙酚0.5~1.0mg/kg。治疗过程中持续监测平均动脉压(MAP)、心率、脉搏、血氧饱和度(SpO2),并观察患者镇静程度及术中反应(呼吸、咳嗽、屏气、体动反应等)。术后记录治疗时间、异丙酚用药量、睁眼时间、清醒时间及患者感受。结果治疗过程中镇静程度评分4~5分43例(90%),呛咳反应3例(6%),体动反应2例(4%)。MAP、心率、SpO2基本平稳,组内比较差异均无显著性(均为P>0.05)。平均治疗时间35min,平均异丙酚用药量(25±7)ml。均于停药后2~3min内睁眼,10min内完全清醒;术后均无不适主诉,对治疗过程无任何记忆。结论异丙酚复合小剂量咪达唑仑行镇静术用于早期食管癌、胃癌及癌前病变的内镜治疗安全有效。     

咪唑安定清醒镇静用于纤支镜检查及最佳剂量的探讨

目的：研究度冷丁50mg配伍不同剂量的咪唑安定用于支纤维的镇静作用及对呼吸循环的影响，并探讨其最佳剂量。方法：120例拟行支纤镜检患者（ASAI－Ⅱ级），随机分为对照组、度冷丁50mg 咪唑安定0.04mg/kg、度冷丁50mg 咪唑安定0.06mg/kg三组，观察其镇静分级，检查过程中的感受情况、遗忘程度，检查后的满意度，并记录检查中脑电图双频指数分析（BIS值）、血压、脉搏血氧饱和率及心电图的变化。结果：与对照组相比，度冷丁50mg 咪唑安定0.06mg/kg组的效果明显优于未用药组和度冷丁50mg 咪唑安定0.04mg/kg组，其镇静程度明显，遗忘程度高，对呼吸循环功能影响较小。结论：度冷丁50mg 咪唑安定0.06mg/kg用于清醒镇静支纤维镜检是完全有效的，且为最佳剂量。     

异丙酚、咪唑安定和冬眠合剂用于ICU镇静效果对比观察

目的观察异丙酚、咪唑安定和冬眠合剂用于ICU患者的镇静效果。方法ICU50例机械通气患者随机分为3组，其中包括异丙酚组24例，咪唑安定组18例，冬眠合剂组8例。所有患者均行深静脉穿刺。伴疼痛和／或手术后病人均同时加用镇痛剂。异丙酚组：先静注异丙酚1．5mg／kg行镇静诱导（高龄及危重患者酌减），然后改用输液泵持续静注1～5mg·kg^-1·h^-1；咪唑安定组：先静注咪唑安定0．2mg／kg行镇静诱导，再以0．05～0．15mg·kg^-1·h^-1用输液泵持续静注：冬眠合剂组：先静注氯丙嗪、异丙嗪各50mg，再以氯丙嗪、异丙嗪各50mg，哌替啶100mg用5％葡萄糖250ml稀释，用输液泵以5～30ml／h的速度持续静脉泵入。结果药物达Ramsay分级所需时间：异丙酚组（26．9±8．1）s、咪唑安定组（71．6±11．2）s和冬眠合剂组（40．8±11．5）min比较有显著性差异（P〈0．05）；3组用药后HR，R，SpO2，PaO2，PaCO2有明显改善（P〈0．05），但当异丙酚组滴速〉10mg·kg^-1·h^-1时易致低血压，冬眠合剂组需多次调整剂量方能达效果。停药后神志恢复时间，异丙酚组（35±10）min，咪唑安定组（59±30）min，冬眠合剂组（6．7±2．4）h，组间差异有统计学意义（P〈0．01）。异丙酚组和咪唑安定纽用药前后肝肾功能、血小板、白细胞未见明显异常，冬眠合剂组用药后2例出现肝功能轻度升高。结论异丙酚、咪唑安定用于ICU镇静是安全有效的，异丙酚苏醒快，但维持费用高。     

咪唑安定在内镜操作中的镇静作用及护理支持

目的 探讨咪唑安定（Dormicum)在内镜操作中的镇静作用及护理支持。方法 对40例接受内镜操作的患，随机分为4组，运用咪唑安定后，观察镇静分级、遗忘程度、患满意度及心率、血氧饱和度的变化。结果 与对照组相比，用药组患的满意度明显提高（P＜0．05）。第4组的镇静程度、遗忘程度明显优于第2、第3组（P＜0．05）。对照组检查开始1min血压显升高（P＜0．05），同时伴有心率显加快（P＜0．05）。第4组氧饱和度在用药后2min-5min有所下降（1％－2％），内镜操作开始后即回升。结论 应用咪唑安定0.05mg/kg可显改善内镜操作时患的耐受性，具有较好的安全性，且护理支持中心电监护、供氧、建立静脉通路、镇静观察等至关重要。     

异丙酚与咪唑安定对严重创伤病人镇静效临床比较

目的：比较异丙酚，咪唑安定对创伤病人镇静的安全与效能的临床效果。方法：82例创伤病人随机分3组：M组用咪唑安定0．1mg/kg/h，最大0．35mg/kg/h连续静注；P组用异丙酚1．5mg/kg/h，最大6mg/kg/h连续静注；MP组用咪唑安定0．1－0．2mg/kg/h和异丙酚1．5－3mg/kg/h连续静注，结果；三组按计划均达到同等有效的镇静效果（P＞0．05），血流动力学参数无差别（P＞0．05），病人清醒时间P组，MP组比M组明显缩短（P＜0．05）。结论：咪唑安定，异丙酚对创伤病人镇静是安全的，但咪唑安定清醒时间稍长。     

咪唑安定在机械通气病人镇静中的临床观察

目的：探讨咪唑安定在ICU机械通气中的镇静效果、血流动力学变化及不良反应。方法：选择60例需机械通气病人。无意识障碍，无严重心肝肾功能障碍。随机分为两组。以异丙酚做对照，咪唑安定组（Ⅰ组）以0．1mg/kg为诱导量，以0．03—0．2mg/kg/h速率持续输注；异丙酚组（Ⅱ组）以1mg／kg为诱导量，以1．0—2．5mg/kg/h速率持续输注。观察两组对呼吸循环的影响，镇静期间Ramsay评分及苏醒时间、用药剂量的差异。结果：两组镇静Ramsay评分满意，血流动力学无显著差异，Ⅰ组部分病人出现耐药，有镇静延迟现象；Ⅱ组苏醒迅速．可尽早拔管。结论：两组对机械通气患者镇静效果、血流动力学变化无显著差异。对中长期镇静病人，宜选择咪唑安定为镇静药。     

咪唑安定在呼吸机应用中的镇静抗焦虑作用

目的:观察咪唑安定在呼吸机应用过程中的镇静、抗焦虑作用。方法:20例在呼吸机应用过程中出现焦虑、恐惧、烦躁不安(Ramsay镇静评分1级)患者,首先静脉注射咪唑安定,负荷量0.03～0.3 mg/Kg,然后给予维持量0.02-0.2 mg/Kg·h-1,用0.9％氯化钠稀释后持续静脉泵人。结果:24小时内16例病人Ramsay镇静评分达到2-4级,有效率为80.00％。结论:咪唑安定对呼吸机应用过程中的焦虑、恐惧、烦躁不安有镇静、抗焦虑作用,并且能改善心率、呼吸频率和SaO2。     

静脉注射丁丙诺啡-咪唑安定用于硬膜外麻醉的临床观察

目的：观察静脉注射丁丙诺啡-咪唑安定辅助硬膜外麻醉时的镇静、消除内脏牵拉反应效果和对呼吸、循环的影响。方法：硬膜外麻醉下行下腹部手术患者40例,随机分为B组20例（丁丙诺啡0.15mg＋咪唑安定4mg）和F组20例（芬太尼0.1mg＋咪唑安定4mg）;均于手术开始前5min分别静脉缓慢注射上述药物剂量的3/4或全量。观察并记录用药时和用药后5,15,30min平均动脉压、心率、脉搏、血氧饱和度、呼吸频率及患者镇静程度和术中发生的牵拉反应。结果：B组的镇静、消除内脏牵拉反应的作用明显强于F组（P〈0.05）;两组对循环及呼吸均无明显影响（P〉0.05）。结论：丁丙诺啡-咪唑安定能安全地辅助于硬膜外麻醉,能有效的增强镇静和消除内脏牵拉反应,对呼吸和循环无明显影响。     

咪唑安定清醒镇静用于胃镜检查剂量与年龄相关性的探讨

目的探讨咪唑安定清醒镇静用于胃镜检查所需的剂量与年龄、性别的相关性,并观察其镇静效果及对呼吸循环的影响.方法210例胃镜检查患者,先给予咪唑安定0.02mg/kg,以后追加0.01mg/kg至OAA/S评分达3分止.记录所需咪唑定安剂量,并记录检查过程中MAP,HR,SpO2和BIS的变化及检查后患者的遗忘度、满意度.结果咪唑安定用于胃镜检查是安全有效的,其所需剂量与年龄呈明显负相关(男性γ=-0.784,女性γ=-0.762,P＜0.01),而与性别无相关性.结论咪唑安定清醒镇静用于胃镜检查所需剂量与年龄成负相关.     

注药式气管导管在术后ICU病人机械通气中的应用

目的 采用注药式气管导管对术后机械通气的ICU病人行气道表面麻醉，观察机械通气过程中病人对气管导管的耐受情况。方法 选择34例胸腹部手术、术后行机械通气12h以上的病人，随机分为两组，每组17例。对照组（C组）：经注药式气管导管气管内注射生理盐水；治疗组（T组）：经注药式气管导管气管内注射2％利多卡因。观察病人在机械通气12h内气管导管的耐受情况和镇静药物咪唑安定、芬太尼的给药次数及使用量的变化。结果 治疗组病人在机械通气12h内呛咳反应、高血压和心动过速的发生次数显著低于对照组（P〈0．05）；治疗组病人在机械通气12h内咪唑安定和芬太尼给药次数和使用量显著低于对照组（P〈0．05）。结论 使用注药式气管导管进行气道表面麻醉可以显著减轻气管导管引起的不适反应，减少ICU病人的镇静药物用量。     

Reversal of midazolam sedation with flumazenil.

OBJECTIVE: To demonstrate the efficacy of flumazenil in reversing the sedative action of midazolam in ventilated intensive care patients. DESIGN: Prospective, double-blind randomized study. SETTING: ICU of a tertiary, university-affiliated teaching hospital. PATIENTS: Thirty ICU patients requiring artificial ventilation for greater than 12 hrs were studied. INTERVENTIONS: All patients received a midazolam infusion for sedation. Twenty-nine patients received supplementary narcotics. At the end of the sedation period, either flumazenil or placebo was administered to all the patients in a double-blind, randomized fashion, and the effects were observed. MEASUREMENTS AND MAIN RESULTS: Sedation levels were measured hourly during the infusion; at the end of the infusion; and at 5, 15, 30, 60, and 120 mins after cessation of the midazolam infusion. Midazolam concentrations in serum were measured at the time of cessation of the midazolam infusion and at 30, 60, and 120 mins later. Reversal of sedation was observed in 14 of 15 patients who received flumazenil, and resedation occurred in seven of these patients. Reversal was not seen in any of the patients who received placebo. Midazolam serum concentrations were similar in both groups. CONCLUSION: Flumazenil in a dose of 0.15 mg is a safe drug that reverses the sedative effect of midazolam.     

Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam

BACKGROUND AND STUDY AIMS: Adequate sedation of the patient is required for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The anesthetic propofol, with its shorter half-life, affording better control, offers an alternative to the benzodiazepine midazolam. The aim of this randomized, controlled, unblinded study was to compare prospectively the quality of sedation under propofol and midazolam in patients undergoing ERCP. PATIENTS AND METHODS: A total of 80 patients were randomized to sedation with propofol alone (n = 40) or midazolam alone (n = 40). Blood pressure, pulse, and oxygen saturation were measured. Midazolam was given by the endoscopist and titrated to the patients' response during ERCP, to a maximum dose of 15 mg per patient. In the propofol group an anesthetist was present to administer the propofol and to observe the patient. Standardized testing procedures (Steward score, Trieger test) were used to determine the length of postendoscopy recovery time. Efficacy of sedation was assessed by investigators and patients, using scoring systems. RESULTS: Complete ERCP and adequate sedation was possible in 80% of patients (32 out of 40) with midazolam, and in 97.5% of patients (39 out of 40) with propofol (P<0.01). The average propofol induction dose was 1.24 mg/kg body weight, with maintenance requiring a mean dose of 9 mg/kg body weight per hour, or the equivalent of 354 mg in total. The average dose of midazolam administered was 0.12 mg/kg body weight; the total dose averaged 8 mg. Recovery time in the propofol patients was significantly shorter (P<0.01). The investigators (P<0.01) and the patients (P<0.05) both judged the quality of sedation to be better in the propofol group. There were no differences in blood pressure, pulse, or oxygen saturation between the two groups. One patient in the propofol group (79 years old) suffered a protracted apneic phase accompanied by hypotension that was managed by manual ventilation and drug therapy, and led to no complications. CONCLUSIONS: Propofol proves to be an excellent sedative for ERCP and shows a shorter recovery time than midazolam. Because of the narrow therapeutic window, we recommend close patient monitoring.     

The effect of midazolam on the normal sphincter of Oddi: a controlled study.

BACKGROUND AND STUDY AIMS: Midazolam HCl (Versed) is often used for intravenous conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP) and is increasingly used in endoscopic sphincter of Oddi (SO) manometry. The effect of medications on SO motility should be fully characterized if they are to be used during SO manometry. There has been controversy as to whether midazolam influences SO motility. The aim of this study was to determine the effect of midazolam on the normal SO. PATIENTS AND METHODS: The study population consisted of 60 patients presenting with recurrent abdominal pain who were found to have SO basal pressure of less than 40 mmHg on SO manometry. ERCP was performed in the standard fashion using a pneumohydraulic capillary perfused triple-lumen catheter system in a stationary pull-through method from the pancreatic and common bile ducts. In the test group 30 patients received 2 mg midazolam intravenously while the 30 patients in the control group received intravenous saline. SO manometry was performed, with recording of the basal pressure, phasic pressure, phasic amplitude, phasic frequency and ductal pressure before and 3 min after the intravenous infusion. The changes in basal, phasic and duct pressure as well as phasic frequency before and after the administration of saline and midazolam were compared. RESULTS: Midazolam causes a small but statistically significant reduction in basal and peak SO pressure (4 and 19 mmHg respectively), compared with saline. Diagnostic concordance (normal vs. abnormal) between the basal sphincter pressure before and after midazolam was seen in 100 % of patients. Midazolam does not significantly affect phasic amplitude, phasic frequency or duct pressure. CONCLUSIONS: Midazolam does not have a clinically significant influence on the accuracy of SO manometry in identifying normal sphincteric motility.     

无痛胃镜下治疗食管静脉曲张疗效观察

目的探讨无痛胃镜两种方式——清醒镇静和静脉麻醉下治疗食管静脉曲张或出血的可行性。方法 2004年11月2008年5月,根据病情或患者要求,对13例患者行清醒镇静即静脉推注咪达唑仑＋芬太尼,30例行静脉麻醉即静脉推注咪达唑仑＋丙泊酚。43例患者中36例行套扎治疗,7例行1%乙氧硬化醇注射治疗。结果 43例均成功完成治疗,急诊止血率100%（11/11）,治疗后4周复查,显效24例,占55.8%,有效17例,占39.5%,无效2例,总有效率95.3%。静脉麻醉组术后遗忘度100%,清醒镇静组插镜过咽和治疗过程中发生恶心分别为76.9%、46.1%。两组患者在治疗过程中及治疗后均未发生大出血。结论无痛胃镜下行食管静脉曲张治疗安全、疗效确切,以硬化剂注射治疗者应采用静脉麻醉。     

Midazolam in patients receiving anticancer chemotherapy and antiemetics

Benzodiazepines lessen anxiety and improve comfort in cancer patients. Midazolam is an effective benzodiazepine with a rapid onset and short duration of action, properties that could permit its use in outpatient areas or in short but stressful situations. Two consecutive trials were undertaken to study midazolam as an adjunct in patients receiving anticancer chemotherapy. Each studied midazolam given as a short infusion 30 min prior to chemotherapy at dose levels ranging from 0.01 to 0.05 mg/kg. Trial I determined the safety, sedation, and dose of midazolam in patients receiving chemotherapy of low to moderate emetic potential. Twenty-two patients were entered. No significant respiratory depression or oxygen desaturation was observed. At the optimal dose level (0.04 mg/kg), sedation began a median of 3 min following administration and continued for a median of 38 min. Sixty-four percent of patients experienced mild sedation. Trial II studied the same doses of midazolam when used in combination with intravenous metoclopramide and dexamethasone in patients receiving cisplatin≥100 mg/m². Nineteen patients were entered; 79% experienced mild sedation. At the 0.04-mg/kg dose level, sedation began a median of 18 min following administration and continued for a median of 170 min. Midazolam can be given safely to patients receiving chemotherapy with and without concomitant antiemetics. The predictability and duration of its sedative effects suggest it can be used in outpatients.     

Midazolam use in the emergency department

Midazolam is a new imidazobenzodiazepine derivative that is two to three times as potent as diazepam, is water-soluble, has a rapid onset and short duration of action, and produces a profound amnestic effect. These properties make it an extremely useful drug for outpatient sedation. We performed retrospective review of midazolam use in a general emergency department over a one-year period. Midazolam was used in 120 patients, 71 men and 49 women, with an average age of 46 years. The average dose given was 3.4 mg, with a range of 1 to 10 mg. In 69 of the cases (57%) other drugs were administered, most commonly an opiate. There were only four adverse reactions. One patient developed urinary retention, one patient vomited, and two patients were somnolent for a prolonged period of time. There were no serious cardiovascular or respiratory problems. We conclude that midazolam is a safe drug to use in the emergency department. Close monitoring of the patient and the availability of airway support equipment are mandatory.     

Continuous infusion of lorazepam versus medazolam in patients in the intensive care unit: sedation with lorazepam is easier to manage and is more cost-effective.

OBJECTIVE: To evaluate the effectiveness of lorazepam and midazolam for long-term sedation of critically ill, mechanically ventilated patients. DESIGN: Double-blind, randomized, controlled study. SETTING: Medical intensive care unit in a university teaching hospital. PATIENTS: Sixty-four evaluable adult patients admitted to the intensive care department requiring mechanical ventilation for >3 days. INTERVENTIONS: Patients were randomized to receive blinded solutions of either lorazepam or midazolam by continuous infusion. The lowest dose that achieved an adequate sedation was infused. The maximum dose allowed for each drug was 60 mg/hr for midazolam and 4 mg/hr for lorazepam. Sedation was assessed initially and at least every 8 hrs thereafter on a seven-point scale if the sedation was adequate and every 2 hrs if it was not. MEASUREMENTS AND MAIN RESULTS: Measurements included the score on the sedation scale, the time between determination of the desired level of sedation and the achievement of that level, and plasma concentrations. It is significantly easier to reach a desired level of sedation with lorazepam than with midazolam. No difference in recovery was found in the 24 hrs after discontinuation of therapy. The fact that there are many factors influencing midazolam pharmacokinetics may explain the more difficult management of desired sedation levels. The equipotent dose of 10 mg of midazolam proved to be 0.7 mg of lorazepam in long-term sedation. The average cost for therapy with midazolam was approximately ten times more than that with lorazepam. CONCLUSIONS: Lorazepam is a useful alternative to midazolam for the long-term sedation of patients in the medical intensive care unit and provides easier management of the sedation level. Sedation with lorazepam offers a significant cost-savings.     

Midazolam use in the emergency department

Midazolam is the first water-soluble benzodiazepine. As with other benzodiazepines it has amnestic, sedative, hypnotic, anxiolytic, and anticonvulsant properties. Midazolam is about two to four times more potent than diazepam. Midazolam has been extensively used for a variety of outpatient procedures, but there has been no documentation of its safety in emergency department patients. The authors retrospectively reviewed all patients receiving midazolam during a 2-year period at the University of Cincinnati Center for Emergency Care. The study population consisted of 389 patients (men 56%; women 44%) with an average age of 33.3 years. Midazolam was used intravenously for sedation before a wide variety of painful procedures and for agitation control. The average dose was 3.86 mg, with a range of 0.5 mg to 20.0 mg. The majority of patients (79.2%) received narcotics or sedative/hypnotic agents in addition to midazolam. There was an overall complication rate of 1.0%. Two patients (0.5%) developed clinically significant respiratory depression after midazolam use. Both patients had also received fentanyl citrate and the respiratory depression was reversed with naloxone. Two patients (0.5%) receiving several other drugs developed short periods of hypotension. There were no apparent long term sequelae. The authors conclude that midazolam can be safely used in the emergency department setting. Careful dosing and titration to the desired clinical effects is mandatory. Patients should be closely monitored to maximize safety.     

A cost analysis of enterally administered lorazepam in the pediatric intensive care unit

OBJECTIVE: To determine the cost savings of replacing intravenous midazolam with enterally administered lorazepam in mechanically ventilated children who require long-term continuous sedation. DESIGN: Retrospective review of patients treated according to a preestablished pediatric intensive care unit (ICU) sedation protocol. SETTING: Twenty-six-bed pediatric ICU in a tertiary care children's hospital. PATIENTS: The records of 30 mechanically ventilated children were analyzed. The median age was 1.5 yrs and the median weight was 8.0 kg. Patients required continuous sedation for a total of 16 days (median). INTERVENTIONS: According to our pediatric ICU sedation protocol, midazolam infusion was continued until the hourly midazolam requirement was stable for at least 24 hrs. Thereafter, patients with a nasojejunal tube who were likely to require a minimum of three additional days of continuous sedation were transitioned from intravenous midazolam to enterally administered lorazepam. The goal in transitioning therapy was to titrate the lorazepam dose and reduce midazolam administration while maintaining an unchanged level of sedation. MEASUREMENTS AND MAIN RESULTS: The rate of midazolam administration was significantly (p<.05) reduced beginning on day 1 of lorazepam treatment. Midazolam was successfully discontinued in 24 (80%) patients in 3 days (median), and adequate and appropriate sedation was maintained with lorazepam monotherapy. Six patients in whom midazolam could not be discontinued experienced a 52% reduction in the rate of midazolam administration as a result of adding lorazepam. Total projected midazolam utilization was defined as the sum of midazolam administration before initiating lorazepam and the projected midazolam requirement after initiating lorazepam. Projected midazolam cost was calculated as the product of total projected midazolam utilization and midazolam acquisition cost. Actual expenditures for both midazolam and lorazepam were subtracted from the projected midazolam cost to calculate the estimated cost savings. Overall, midazolam utilization (in milligrams) was reduced by 46.7+/-27.6% (median 52). Total projected midazolam cost for the 30 patients was $90,771. The actual cost of midazolam and lorazepam combined was $47,867, resulting in a cost savings of $42,904. CONCLUSIONS: Transitioning from intravenous midazolam to enterally administered lorazepam in critically ill children who require long-term sedation results in significant cost savings. The oral formulation of lorazepam was convenient to use, inexpensive, and effective in maintaining a continuous and appropriate level of sedation once midazolam was discontinued.     

Ketamine and midazolam kinetics during continuous hemodiafiltration in patients with multiple organ dysfunction syndrome

OBJECTIVE: To assess the effect of continuous hemodiafiltration (CHDF) on ketamine and midazolam kinetics in multiple organ dysfunction syndrome (MODS). DESIGN AND SETTING: Consecutive clinical study in a general intensive care unit of a university hospital. PATIENTS: Twelve adult patients with MODS requiring CHDF. MEASUREMENTS AND RESULTS: A total of 68 samples were collected during CHDF for ketamine, norketamine, and midazolam assays. The clearance values for ketamine and norketamine were 10.8 +/- 6.6 and 10.9 +/- 11.5 ml/min and their daily extractions were 21.4 +/- 7.1 and 10.2 +/- 11.5 mg/day, respectively. Midazolam was not eliminated through the filter during CHDF. There were no changes in Ramsay Sedation Score or Glasgow Coma Scale during CHDF. CONCLUSIONS: Small fractions of ketamine and norketamine were eliminated during CHDF in MODS. Midazolam was not eliminated during CHDF. CHDF did not affect the sedation using ketamine and midazolam even in MODS patients.