Benzodiazepines provide anxiolysis and amnesia but not anesthesia. They can be used alone as a sedative, or in conjunction with a narcotic or local anesthetic for a painful procedure. Midazolam (Versed) is a short-acting benzodiazepine that has an onset of action within 5 min and a duration of action of 30 to 45 min. Midazolam is safe and effective for use in the ED in children undergoing laceration repair, fracture reduction, and other painful procedures. 10 Adverse effects include respiratory depression and paradoxical inconsolability.11 Anecdotally, this latter effect appears to happen with increased frequency in children with attention deficit hyperactivity disorder, and is reversible with flumazenil.
Diazepam is a longer-acting benzodiazepine that has been used extensively as a sedative for children and has amnestic properties. Diazepam can be used for extended diagnostic procedures and for muscle relaxation for orthopedic reductions. It has been largely replaced by midazolam.
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