Midazolam questions remain

Unintended 'serious harm' fears over protocol

- JACQUI DEEVOY

NG163 was a covid protocol used to treat those presenting with respiratory issues.

But evidence from more than 100 families could show this protocol has resulted in the untimely and unnecessary death of loved ones - and is reminiscent of the abolished Liverpool Care Pathway.

And when the National Institute for Health and Care Excellence (NICE) guideline NG163 was reviewed in early 2020 by a panel of nine doctors and two professors, they did raise concerns.

Yet, the protocol - which recommended the combined use of midazolam and morphine that both suppress the respiratory system was approved.

After studying the guideline, the medics familiar with palliative medicine said they were 'concerned that uncritical use of NG163 may create unintended risks for people with suspected or actual covid-19 infection' and suggested that the flawed guideline should not be implemented.

The new guideline was rebranded NG191 in March 2021, and on November 30, 2023, the recommendation to use midazolam on covid patients was dropped completely.

In a letter published on April 20, 2020, the eminent experts, led by Professor Emeritus, Sam H Ahmedzai, said that, 'while NG163 states, "Note that symptoms can change and patients can deteriorate rapidly in a few hours or less," there is no counterpoint that most patients without the preconditions above will eventually recover.'

They also stated that, while there was plenty of detail on dosing covid patients with powerful medications, there was no advice on monitoring the patients, nor on weaning them off the drugs.

Another major concern of the panel about NG163 was that the protocol stated: 'Sedation and opioid use should not be withheld because of a fear of causing respiratory depression.'