Gastric POCUS, 3-Part Episode

Benzodiazepines have hypnotic, sedative, anxiolytic, amnestic and anticonvulsant properties. Midazolam is metabolized by the cytochrome P450 system in the liver, specifically the CYP3A4 and CYP3A5 enzymes to several metabolites. These metabolites are cleared by the renal and hepatic system. Thus, if patients possess chronic renal and/or hepatic disease, the metabolites may cause prolonged sedation effects. Midazolam is redistributed to adipose tissue and thus patients who are obese have a prolonged elimination half-life. Chronic alcohol use without hepatic impairment increases metabolism of midazolam. Liver cirrhosis decreases the plasma clearance of midazolam due to decreased metabolism and leads to longer duration of action and potentially more profound sedation.