J Anaesthesiol Clin Pharmacol. 2016 Jul-Sep;32(3):353-8. doi: 10.4103/0970-9185.168205.

Comparison of preanesthetic sedation in pediatric patients with oral and intranasal midazolam.

Journal of anaesthesiology, clinical pharmacology

Purvashree Vijay Deshmukh, Sadhana Sudhir Kulkarni, Mukund Kachru Parchandekar, Sneha Purshottam Sikchi

PMID: 27625485 PMCID: PMC5009843 DOI: 10.4103/0970-9185.168205

Abstract

BACKGROUND AND AIMS: Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children.

MATERIAL AND METHODS: With randomization, Group O (30 children): Received oral midazolam syrup 0.5 mg/kg and Group IN (30 children): Received intranasal midazolam spray 0.2 mg/kg. Every child was observed for acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug. Data were analyzed using Student's t-test, standard error of the difference between two means and Chi-square test.

RESULTS: In Group O and IN, 15/30 children (50%) and 7/30 children (23%) accepted drug easily (P < 0.05); 4/22 children (18%) in Group O and 11/20 children (55%) in Group IN cried after drug administration (P < 0.05). In both the groups, sedation at 20 min after premedication (Group O [80%] 24/30 vs. Group IN [77%] 23/30), parental separation and acceptance to mask were comparable (P > 0.05); 12/30 children (40%) in Group IN showed transient nasal irritation.

CONCLUSION: Oral midazolam and intranasal midazolam spray produce similar anxiolysis and sedation, but acceptance of drug and response to drug administration is better with oral route.

Keywords: Children; intranasal spray; midazolam; oral; preanesthetic sedation

References

1. Anesthesiology. 1985 Nov;63(5):528-31 - PubMed
2. Can J Anaesth. 1993 Aug;40(8):726-9 - PubMed
3. Anesth Analg. 2001 Jul;93(1):98-105 - PubMed
4. Anesthesiology. 1995 Jan;82(1):2-5 - PubMed
5. Pediatrics. 1993 Oct;92(4):638 - PubMed
6. Anesthesiology. 1988 Dec;69(6):972-5 - PubMed
7. Pharmazie. 2001 Dec;56(12):963-6 - PubMed
8. J Dent Child (Chic). 2004 May-Aug;71(2):126-30 - PubMed
9. Anesth Analg. 1970 Nov-Dec;49(6):924-34 - PubMed
10. Anesthesiology. 2000 Sep;93(3):676-84 - PubMed
11. Anesthesiology. 1990 Nov;73(5):831-4 - PubMed
12. Paediatr Anaesth. 2002 Oct;12(8):685-9 - PubMed
13. Br J Anaesth. 1999 Jul;83(1):16-28 - PubMed
14. Br J Clin Pharmacol. 2002 May;53(5):501-7 - PubMed
15. Br J Anaesth. 1998 Dec;81(6):865-9 - PubMed
16. Can J Anaesth. 1992 Jul;39(6):545-50 - PubMed
17. Arch Pediatr Adolesc Med. 1996 Dec;150(12):1238-45 - PubMed
18. Br J Anaesth. 2008 May;100(5):631-6 - PubMed
19. Ann Emerg Med. 1994 Dec;24(6):1074-9 - PubMed
20. Anesth Analg. 1999 Jul;89(1):75-9 - PubMed
21. Anesth Analg. 2004 Dec;99(6):1648-54, table of contents - PubMed
22. J Oral Maxillofac Surg. 1994 Aug;52(8):840-3; discussion 844 - PubMed
23. Anesthesiology. 2011 Mar;114(3):495-511 - PubMed
24. Anesthesiology. 1998 Nov;89(5):1147-56; discussion 9A-10A - PubMed
25. Anaesth Intensive Care. 1992 Feb;20(1):9-14 - PubMed
26. Can J Anaesth. 1987 May;34(3 ( Pt 1)):259-73 - PubMed
27. Anesth Analg. 2002 Jan;94(1):31-6, table of contents - PubMed
28. Pediatrics. 2000 Jan;105(1 Pt 1):73-8 - PubMed
29. Pediatr Emerg Care. 2008 May;24(5):300-3 - PubMed

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