What is the role of lorazepam in emergency department (ED) sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Lorazepam is a water-soluble benzodiazepine. The dose range in adults is usually 1-4 mg. The initial pediatric dose is 0.1 mg/kg. It is an intermediate-acting benzodiazepine; its effects begin within 3-5 minutes and peak at 20-30 minutes. The effects of lorazepam generally last 1-4 hours.

Lorazepam has a few advantages over midazolam: first, metabolism occurs by means of conjugation, which makes it more suitable than other benzodiazepines for use in the presence of renal or hepatic failure. Second, lorazepam does not have any active metabolites. Thus, it can be given as a continuous intravenous infusion (0.03-0.1 mg/kg/h) with less concern for adverse effects than an intravenous midazolam drip. For this reason, it is the preferred agent for continuous administration.

Lorazepam's utility in the ED could be for longer-term sedation; for example, patients undergoing mechanical ventilation. [1]


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