ativan vs versed - Forum

Surgical student

ativan vs versed - Ärzteforum

Post#1 »

I'm currently on a BICU (burn unit) rotation with a few medical residents on it as well (I am a surgical intern). I have a question that was posed to me by one of my medical colleagues.

In the unit that I'm in, we frequently sedate intubated patients with ativan (or propofol). The question is, why not versed? It is popular in the MICU....

I've noticed that we usually use ativan. Is this just my attendings' preference, or is there a reason. I have been under the impression that versed is faster acting than ativan and would be a good choice if we had to check the patient's responsiveness once in a while (besides using propofol of course).


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Surgeon

Re: ativan vs versed - Ärzteforum

Post#2 »

The question is, why not versed?

I would guess that cost is a factor. Also, versed has a shorter half life, which makes it very useful for procedures such as colonoscopy. This is less important in the typical ICU patient on the vent.

Critical

Re: ativan vs versed - Ärzteforum

Post#3 »

In our SICU we use Ativan because it is cheaper than Versed especially if the patient will require sedation for a long period of time. (Ativan 40mg/10cc vial costs $72, Versed 50mg/10cc vial costs $304.) In those patients in whom we need to check their responsiveness we prefer Propofol. We tend to use versed in patients who will be on sedation for less than a few days or for procedures on the floor where we do not have a protocol for conscious sedation with Propofol.

Surgical student

Re: ativan vs versed - Ärzteforum

Post#4 »

After my first post on this subject, I went off to a lecture on sedation in the ICU so I will now regurgitate what I have just learned. There other reason for preferring lorezepam (Ativan) over midazolam (Versed) besides cost.

The reason midazolam is shorter acting is that it is more lipophilic than lorezepam. Therefore there is more potential for peripheral accumulation of the drug. The intermediate metabolites of midazolam have sedative properties. Therefore with infusions greater than 24 hours a prolongation of the clinical effects of the drug will result.

Compared with midazolam, lorazepam is longer acting, causes less hypotension, causes an equally effective anterograde amnesia, is lower in cost, and with prolonged administration produces more rapid awakening.

Therefore midazolam or propofol are the preferred agents only for the short term (<24 hrs) treatment of anziety in the critically ill adult. Lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult.

The other interesting tidbit is that Wyeth-Ayerst the only makers of a parenteral form of lorazepam announced last week that they will be raising their price of lorazepam. They apparently realized that they had a lock on the market.

Grandpa Phil

Re: ativan vs versed - Ärzteforum

Post#5 »

Versed is midazolam, a.k.a Dormicum east of the Atlantic.

Hans

Re: ativan vs versed - Ärzteforum

Post#6 »

Midazolam has been implicated in late respiratory arrests after apparent full recovery. There seems to be a small group of patients in which this may happen quite unpredictably.

Grandpa Phil

Re: ativan vs versed - Ärzteforum

Post#7 »

Using Romazicon (Flumazenil) for reversal of midazolam in quite a bit higher doses than orginally recommended seems to have decreased late respiratory arrests to vanishingly small numbers.

Chirurgia

Re: ativan vs versed - Ärzteforum

Post#8 »

When I was rotating in the burn unit, my favorite was ketalar, which i give IV(1 mg/kbw) for fast procedures that I can do in 20 minutes or IM (3-5 mg/kbw) for procedures that i would need to complete in 40 minutes. The half life is short enough to be safe but i heard that propofol has even a shorter half life but you have to give this by continuous IV drip which is quite difficult if you are both the surgeon and the anesthesiologist. I have not much experience with midazolam because it most of the time causes reflex anxiety if you don't give adequate premeds and it takes too long to wash off you wrote.

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A Doctor

Re: ativan vs versed - Ärzteforum

Post#9 »

Versed is too short acting. Wears off in a half hour. Ativan lasts for hours.

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surgery

Re: ativan vs versed - Ärzteforum

Post#10 »

Thanks to all of you who have responded to my question about ativan vs. versed in the ICU setting (or should I say lorazepam vs. midazolam)

If I have left out important parts of the discussion, please write to me.

Also if you have time, help out some of the residents studying for USMLE III, we have sample questions for the USMLE III but only letter answers are provided without explanations, perhaps you can lend an expert opinion.

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