In  experience, midazolam is woefully underused in multiple contexts, because it is viewed as a procedural sedation agent in the category of propofol. This study suggests that it is a great agent for sedation of the agitated patient. However, its short half-life means that it should probably be coadministered with another agent, such as haloperidol 5 mg.Even if Intravenous route is not possible than Nasal administration can be dne when an intravenous needle or jugular or femoral catheter may also be placed.

                 Agitated patients often require sedation, but what is the best medication? Investigators conducted a prospective observational study in which all patients in one emergency department who required intramuscular sedation for agitation were treated with a particular agent during a 3-week period; after 15 weeks, five agents (haloperidol 5 mg, haloperidol 10 mg, ziprasidone 20 mg, olanzapine 10 mg, and midazolam 5 mg) had been used and average patient responses were compared.

                 Results from 737 encounters revealed midazolam to be the best agent, with 71% of patients adequately sedated at 15 minutes, versus 40% for haloperidol 5 mg, 42% for haloperidol 10 mg, 52% for ziprasidone, and 61% for olanzapine. However, 40% of the midazolam patients required an additional medication to achieve or maintain sedation, versus 33%, 20%, 24%, and 21%, respectively, for the other agents.