One concept to reduce the adverse effects of opioids is the use of very small doses of opioid antagonists. 25 – 28 The rationale is that agents such as naloxone (Narcan) have a biphasic effect whereby very low doses reduce the incidence of opioid adverse effects and may augment the analgesic effect. 25 , 28 Much of the data are limited to the inpatient setting with intravenous administration of the opioid antagonist. 25 – 27 Concomitant administration of intravenous naloxone with morphine infusions has been studied, but the results have been mixed. 25 – 27 More research is needed before this treatment is implemented as part of routine practice.
Pediatrics and Neonates : In pediatric patients aged 1 year and older, the pharmacokinetic properties following a single dose of midazolam reported in 10 separate studies of midazolam are similar to those in adults. Weight-normalized clearance is similar or higher ( to L/hr/kg) than in adults and the terminal elimination half-life ( to hours) is similar to or shorter than in adults. The pharmacokinetic properties during and following continuous intravenous infusion in pediatric patients in the operating room as an adjunct to general anesthesia and in the intensive care environment are similar to those in adults.