Diazepam (Burns — Procedural Anxiolysis)

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride conductance to produce anxiolysis, sedation, and skeletal-muscle relaxation.

Prescribing in practice

• Combined with opioids used for burns analgesia, diazepam causes additive respiratory depression and sedation, so monitoring and resuscitation facilities must be available.
• It has a long half-life with active metabolites, so accumulation and prolonged sedation are likely with repeated dosing, especially in the elderly and the frail.
• It provides anxiolysis and sedation but no analgesia, so adequate pain relief must be given separately.

Monitoring

Monitor conscious level, respiratory rate, and oxygen saturation during and after procedural sedation.

Counselling the patient

• This medicine reduces anxiety and helps relax muscles around the procedure but does not relieve pain.
• Do not drive or operate machinery and avoid alcohol while drowsiness persists.

Evidence & guidelines

Benzodiazepines such as diazepam are standard agents for procedural anxiolysis; combined use with opioids is a recognised cause of respiratory depression.