Precautions needed with parenteral benzodiazepines

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Although benzodiazepines are the drugs of first choice for emergency therapy, they do carry a risk of respiratory depression, hypotension and cardio-respiratory collapse. In a well-controlled study in anaesthetic practice, for example, diazepam 10 mg was given intravenously to 15 patients and resulted in a drop in blood pressure of 10 mmHg or more in eight patients, a mean 28% decrease in ventilation, and a 23% decrease in tidal volume. The effects on cardiorespiratory function are as great (or even greater) with midazolam or lorazepam. In the occasional patient, the cardio-respiratory effects can be extremely severe, and for this reason it is essential that no patient given parenteral benzodiazepine should be left unattended. After parenteral benzodiazepine administration (buccally, intra-nasally, rectally, IM or IV) pulse, respiration, blood pressure, and (where possible) oxygen saturation should be frequently monitored, until the patient has recovered full consciousness. Resuscitation is occasionally needed, and deaths have occurred owing to lax post-administration care.

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