The median effective dose of nasal midazolam for endoscopic examination in pediatric patients

Abstract

Midazolam, a benzodiazepine, was recently included in the basic drug scheme of the Mexican health system. Midazolam shares anxiolytic, sedative, hypnotic, muscle relaxant, amnesic, and anticonvulsant activity with other benzodiazepines; however, it has a short period of action and is stable in water, making it possible to administer midazolam nasally. Midazolam is already used nasally in children as a preanesthetic; however, its use as a single drug to induce conscious sedation in children undergoing endoscopic examination has not been studied. Thus this study was designed to calculate the median effective dose (ED 50) of midazolam in 86 children who underwent endoscopy. Results showed that the ED 50 was 0.30 ± 0.05 mg/kg, with a range of 0.20 mg/kg to 0.50 mg/kg. The degree of sedation was significant ( P > 0.001) with this dose compared with baseline. Immediate adverse events occurred in 7 patients (8%) and included profound sedation in 4 patients, cyanosis in 2, and respiratory distress in 1.