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Degradation of benzodiazepines after 120 days of EMS deployment

机译：部署EMS 120天后苯二氮卓类药物的降解

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Introduction. EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures. Objective. To describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units. Methods. Study boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May-August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95%CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT). Results. 192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95%CI) of diazepam was 97.0% (95.7-98.2%) and of midazolam was 99.0% (97.7-100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6-99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7-92.3%]). Mean MKT was 31.6°C (95%CI 27.1-36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam. Conclusions. Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.
机译：介绍。 EMS治疗癫痫持续状态可改善结局，但鉴于潜在的高环境温度暴露，尚不清楚最适合EMS使用的苯二氮卓类药物。目的。要描述地西epa，劳拉西m和咪达唑仑的降解与温度的关系以及在有源EMS装置上储存120天以上的时间。方法。装有地西epa，劳拉西m和咪达唑仑小瓶的研究箱于2011年5月至8月分配到美国西南部2个EMS系统中的4个处于活动状态的EMS单元中。该盒子每分钟记录一次温度，并按当地机构以EMS单位存储政策。每隔30天从每个盒子中取出两个药瓶的小瓶，并进行高效液相色谱法测定药物浓度。将浓度分析为初始标记浓度的平均值（和95％CI），它是时间和平均动力学温度（MKT）的函数。结果。收集了192个样本（每个城市在4个时间点从4个单位中的每个样本抽取2个样本）。 120天后，地西epa的平均相对浓度（95％CI）为97.0％（95.7-98.2％），咪达唑仑为99.0％（97.7-100.2％）。劳拉西m在60天（95.6％[91.6-99.5％]）上有中等降解，在90天（90.3％[85.2-95.4％]）和120天（86.5％[80.7-92.3％]）上有明显降解。平均MKT为31.6°C（95％CI 27.1-36.1）。 MKT的增加与劳拉西greater的更大降解有关，但与咪达唑仑或地西epa无关。结论。在高温环境中，在120天的EMS部署期间，咪达唑仑和地西epa的降解几乎没有。劳拉西m在120天内经历了显着降解，并且似乎对更高的MKT暴露特别敏感。

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