Continuous midazolam/atracurium infusions for the management of increased intracranial pressure.

Maintaining the pressure/volume balance in the brain is a challenging goal for the neuroscience team caring for patients with traumatic brain insults. Often, standard therapies are not effective in controlling increased intracranial pressure (ICP). Four severe traumatic brain injury patients given continuous infusions of midazolam and atracurium showed control of otherwise unstable ICPs. Midazolam and atracurium infusions are now considered an acceptable form of therapeutic intervention for our patients requiring such treatment. Intensive nursing care considerations for patients using the combined pharmacologic therapy are essential.