Midazolam is an imidazobenzodiazepine used as a premedicant, sedative, and anesthetic induction agent. It has a unique chemical structure that distinguishes it from other benzodiazepines, contributing to its pharmacologic and pharmacokinetic properties. Midazolam is water-soluble in its acid form but highly lipid-soluble in vivo. It has a rapid onset of action and high metabolic clearance compared to other benzodiazepines. Midazolam produces reliable hypnosis, amnesia, and antianxiety effects when administered orally, intramuscularly, or intravenously. It is used in the perioperative period for premedication, anesthesia induction and maintenance, and sedation for diagnostic and therapeutic procedures. Midazolam is preferable to diazepam in many clinical situations due to its rapid, nonpainful induction and lack of venous irritation. Compared to thiopental, midazolam is not as rapid acting nor predictable in hypnotic effect. It will not replace thiopental as an induction agent. Advantages of midazolam over thiopental include its more versatile pharmacologic properties as a benzodiazepine compared to a barbiturate, such as amnestic and anxiolytic properties. Midazolam should be a useful addition to the formulary.Midazolam is an imidazobenzodiazepine used as a premedicant, sedative, and anesthetic induction agent. It has a unique chemical structure that distinguishes it from other benzodiazepines, contributing to its pharmacologic and pharmacokinetic properties. Midazolam is water-soluble in its acid form but highly lipid-soluble in vivo. It has a rapid onset of action and high metabolic clearance compared to other benzodiazepines. Midazolam produces reliable hypnosis, amnesia, and antianxiety effects when administered orally, intramuscularly, or intravenously. It is used in the perioperative period for premedication, anesthesia induction and maintenance, and sedation for diagnostic and therapeutic procedures. Midazolam is preferable to diazepam in many clinical situations due to its rapid, nonpainful induction and lack of venous irritation. Compared to thiopental, midazolam is not as rapid acting nor predictable in hypnotic effect. It will not replace thiopental as an induction agent. Advantages of midazolam over thiopental include its more versatile pharmacologic properties as a benzodiazepine compared to a barbiturate, such as amnestic and anxiolytic properties. Midazolam should be a useful addition to the formulary.