Administration Of Midazolam Research Articles

Intranasal Midazolam Premedication for Digital Image-Assisted Fundus Examination in Preterm Neonates.

We aimed to evaluate the feasibility and tolerability of fundus examination in preterm newborns after implementing a premedication with intranasal midazolam as a quality improvement project in a neonatal intensive care unit (NICU). Prospective examination of all fundus examinations between January and June 2022, before 0 (T0) and after 1 (T1), 15 (T15), and 60 (T60) minutes from intranasal midazolam administration. The EDIN (Echelle de Douleur et Incomfort du Nouveau-né [newborn pain and discomfort score-in French]) pain score was calculated and various physiologic parameters were recorded. Data were analyzed with repeated measures ANOVA (analysis of variance). A total of 36 fundus examinations were performed in 27 noninvasively ventilated patients. The mean EDIN score went from 0.8 ± 1 at T0 to 0.72 ± 1.05 at T1, then to 0.22 ± 0.59 at T15, and to 0 ± 0 at T60 (p < 0.001). Thus, it remained below the threshold of 5, which is associated with significant pain. The mean heart rate decreased from 164 ± 16 at T0, to 161 ± 16 at T1, then to 154 ± 14 at T15, and to 153 ± 12 at T60 (p < 0.001). There was no significant change in the oxygen saturation/inspired oxygen fraction ratio across the four time points (p = 0.202) and the mean arterial pressure was similar before and after the administration of midazolam (60 ± 10 vs. 59 ± 10, p = 0.571). Intranasal midazolam provides good comfort and normal physiological parameters; therefore, the implementation of a NICU protocol to improve quality of retinal examinations seems feasible and well tolerated. · Fundus examinations did not cause pain after premedication with intranasal midazolam.. · No respiratory or circulatory adverse effect was reported.. · Implementing such a premedication protocol in the NICU seems feasible, helpful, and well tolerated..

Randomized Controlled Clinical Trial to Examine the Efficacy of Oral Midazolam in Post Operative Pain Reduction in Patients Undergoing Laparoscopic Cholecystectomy

Background: Stressful conditions like surgery and anesthesia trigger neuroendocrine pathway activation, which can have dangerous hemodynamic effects on the patient. One method for minimizing these hemodynamic consequences is maintaining an optimum level of anesthesia. Another option is giving patients a pharmaceutical formulation that modifies how anesthetic agents react. Objective: The current study sought to determine if preoperative oral midazolam could reduce postoperative pain scores and the occurrence of Rescue Analgesia in patients undergoing laparoscopic cholecystectomy. Methods: This is a single-blinded randomized controlled study conducted at the Surgery department of Jinnah Medical College Hospital, Korangi Karachi, on patients undergoing laparoscopic cholecystectomy. Through simple random sampling, participants were divided into two study groups, control (n=32) and 7.5mg receiving preoperative oral midazolam-intervention group. After surgery, the VAS pain score in both group participants was measured at 2, 8, 12, and 24 hours. The frequency of rescue analgesia and duration of hospital stay was also observed. Standard deviation, mean, chi-square test, and T-test was performed to determine the variation in both groups by using SPSS version 26. The P value ≤0.005 was measured significant. Results: No significant difference in the postoperative pain score after oral administration of midazolam in the intervention group compared to the control group at 2, 12, and 24 hrs intervals. Except at 8-hour intervals, a significant change of 0.004 was observed in both study groups. A significant variation of 0.008 was observed in the duration of hospital stay in the intervention group when compared with the control group. Lastly, in the present study, no significant difference in the frequency of rescue analgesics was observed in both study groups. Practical implication: This study will help out to determine the right dosage of oral midazolam which might effectively be used in managing post-operative pain in laparoscopic cholecystectomy patients. Conclusion: Orally administeredmidazolam was not efficient in lowering the pain score in patients undergoing laparoscopic cholecystectomy. Keywords: Midazolam, Post-operative pain, Laparoscopic cholecystectomy, Local anesthetics

Time-of-day dependent effects of midazolam administration on myocardial injury in non-cardiac surgery.

Animal studies have shown that midazolam can increase vulnerability to cardiac ischemia, potentially via circadian-mediated mechanisms. We hypothesized that perioperative midazolam administration is associated with an increased incidence of myocardial injury in patients undergoing non-cardiac surgery (MINS) and that circadian biology may underlie this relationship. We analyzed intraoperative data from the Multicenter Perioperative Outcomes Group for the occurrence of MINS across 50 institutions from 2014 to 2019. The primary outcome was the occurrence of MINS. MINS was defined as having at least one troponin-I lab value ≥0.03 ng/ml from anesthesia start to 72 h after anesthesia end. To account for bias, propensity scores and inverse probability of treatment weighting were applied. A total of 1,773,118 cases were available for analysis. Of these subjects, 951,345 (53.7%) received midazolam perioperatively, and 16,404 (0.93%) met criteria for perioperative MINS. There was no association between perioperative midazolam administration and risk of MINS in the study population as a whole (odds ratio (OR) 0.98, confidence interval (CI) [0.94, 1.01]). However, we found a strong association between midazolam administration and risk of MINS when surgery occurred overnight (OR 3.52, CI [3.10, 4.00]) or when surgery occurred in ASA 1 or 2 patients (OR 1.25, CI [1.13, 1.39]). Perioperative midazolam administration may not pose a significant risk for MINS occurrence. However, midazolam administration at night and in healthier patients could increase MINS, which warrants further clinical investigation with an emphasis on circadian biology.

Effects of Chronic Oral Administration of Midazolam on Memory and Circadian Rhythms in Rats.

Studies have shown the ability of benzodiazepine drugs to cause memory loss in animals and humans. Midazolam is a benzodiazepine commonly administered intravenously during surgical procedures because it reacts rapidly, causes anterograde amnesia, and has few side effects. It has also been used in palliative medicine where, among others, an oral route has been employed for chronic administration of the drug. The current study evaluated the effects of chronic orally administered midazolam on spatial working memory and procedural memory in control and experimental female rats over a three-week experimental period utilizing the Morris water maze. Sample and test run times to a submerged platform in the maze were recorded daily. In addition, activity wheels attached to each cage were employed to monitor daily circadian activity of the animals. Spatial working memory was not impaired in either group. However, procedural memory amnesia occurred in animals receiving the drug indicative of a consolidation or retrieval problem. Concerning circadian rhythms, a phase-shift was noted in experimental animals possibly indicating that time of day of drug administration is important. The findings of the present study could shed insight into altered reactions observed in humans who have received midazolam as a component of treatment in palliative medicine.

The IN-MIDAZ study – Intranasal midazolam in aborting seizures – An epilepsy monitoring unit based randomized controlled trial for efficacy

ObjectiveTo compare efficacy and safety of Intranasal and Intramuscular routes of midazolam administration in terminating seizures. MethodThis was an open label Randomized controlled trial (RCT). People with drug resistant epilepsy (DRE) undergoing Video Electroencephalogram (VEEG) monitoring, were randomized in a 1:1 ratio to receive either Intranasal (IN) or Intramuscular (IM) midazolam, for prolonged seizures: longer than 5 min for focal, and longer than 2 min for focal to bilateral tonic-clonic. Outcome assessor was blinded to the allocation arm. Primary outcome was time to electrographic seizure termination after administration of midazolam. All adverse events in both the groups were noted. ResultA total of 1108 seizures were recorded in 130 subjects, of which 110 (65 seizures in 23 subjects in IN group; 45 seizures in 18 subjects in IM group) seizures required midazolam administration and were included in final analysis. Mean time to electrographic seizure termination after midazolam administration was 45.1 ± 23.8 s in the IM group and 90.4 ± 59.0 s in the IN group (p = 0.0014); mean time to clinical seizure termination was 53.9 ± 25.8 s in IM group and 104.3 ± 66.4 s in the IN group (p = 0.002). Local side effects were more in IN group; hypotension as serious adverse event was noted in the IM group. SignificanceThough mean time to electrographic and clinical seizure termination was significantly lesser in Intramuscular group for both adults and pediatric population, it was still under 2 min in the Intranasal midazolam group.IN midazolam is a useful option for terminating seizures.

Evaluation of the Efficacy of Nasal Sedation Midazolam Compared with Dexmedetomidine in the Management of Uncooperative Children with Down Syndrome during Dental Treatment.

Objective This study aimed to compare the intranasal administration of midazolam and dexmedetomidine in uncooperative children with Down syndrome. Materials and Methods The sample consisted of 20 children with Down syndrome aged 5 to 11 years who were divided equally into two groups: Group 1 (experimental) nasal dexmedetomidine and Group 2 (control) nasal midazolam. The efficacy of both the drugs was evaluated according to Ohio State University Behavioral Rating Scale (OSUBRS), University of Michigan scale (UMSS), and Houpt general behavior scale. Results Both substances have been effective in the management of children with Down syndrome. There were no statistically significant differences for Ohio State University Behavioral Rating Scale (OSUBRS) (P value = 0.631), University of Michigan scale (UMSS) (P value = 0.739), and Houpt general behavior scale (P value = 0.481). Conclusion Both midazolam and dexmedetomidine nasal can be used to sedate children with Down syndrome.

Midazolam Prevents the Adverse Outcome of Neonatal Asphyxia.

Birth asphyxia (BA) is the most frequent cause of neonatal death as well as central nervous system (CNS) injury. BA is often associated with neonatal seizures, which only poorly respond to anti-seizure medications and may contribute to the adverse neurodevelopmental outcome. Using a non-invasive rat model of BA, we have recently reported that the potent benzodiazepine, midazolam, prevents neonatal seizures in ~50% of rat pups. In addition to its anti-seizure effect, midazolam exerts anti-inflammatory actions, which is highly relevant for therapeutic intervention following BA. The 2 major aims of the present study were to examine (1) whether midazolam reduces the adverse outcome of BA, and (2) whether this effect is different in rats that did or did not exhibit neonatal seizures after drug treatment. Behavioral and cognitive tests were performed over 14months after asphyxia, followed by immunohistochemical analyses. All vehicle-treated rats had seizures after asphyxia and developed behavioral and cognitive abnormalities, neuroinflammation in gray and white matter, neurodegeneration in the hippocampus and thalamus, and hippocampal mossy fiber sprouting in subsequent months. Administration of midazolam (1 mg/kg i.p.) directly after asphyxia prevented post-asphyctic seizures in ~50% of the rats and resulted in the prevention or decrease of neuroinflammation and the behavioral, cognitive, and neurodegenerative consequences of asphyxia. Except for neurodegeneration in the thalamus, seizures did not seem to contribute to the adverse outcome of asphyxia. The disease-modifying effect of midazolam identified here strongly suggests that this drug provides a valuable option for improving the treatment and outcome of BA. ANN NEUROL 2023;93:226-243.

The Reversal of Empathy-Induced Hypernociception in Male Mice by Intra-Amygdala Administration of Midazolam and Cannabidiol Depends on 5-HT3 Receptors.

Introduction: Empathy is a fundamental prosocial behavior. It has been defined as perception, awareness, and understanding of others' emotional states, including painful processes. Mice living in pairs with conspecific chronic suffering from constriction injury exhibit pain hypersensitivity mediated by the amygdaloid complex. Nevertheless, the underlying mechanisms in the amygdala responsible for this response remain to be determined. This study investigated if the anxiolytic benzodiazepine midazolam (MDZ) and cannabidiol (CBD), a phytocannabinoid with multiple molecular targets, would attenuate this behavioral change. We also investigated if serotonergic and γ-aminobutyric acid (GABA)ergic mechanisms in the amygdala are involved in this effect. Materials and Methods: Male Swiss mice were housed in pairs for 28 days. The pairs were divided into two groups on the 14th day: cagemate nerve constriction and cagemate sham. On the 24th day, cagemates underwent a stereotaxic surgery and, on the 28th day, were evaluated on the writhing test. Results: The results showed that living with chronic pain leads to hypernociception in the cagemate and increases the expression of 5-HT3 receptor (5-HT3R) and glutamic acid decarboxylase 67 within the amygdala. MDZ (3.0 and 30 nmol) and CBD (30 and 60 nmol) attenuated the hypernociceptive behavior. The 5-HT3R antagonist ondansetron (0.3 nmol) prevented the antinociceptive effects of MDZ and CBD. Conclusion: These findings indicate that 5-HT3R and GABAergic mechanisms within the amygdala are involved in the pain hypersensitivity induced by the empathy for pain model. They also suggest that MDZ and CBD could be a new potential therapy to alleviate emotional pain disorders.

Dexmedetomidine for sedation during epicardial ablation for ventricular tachycardia: a single-center experience.

Epicardial approach to ventricular tachycardia (VT) ablation is mainly performed under general anesthesia (GA). Although catheter manipulation and ablation in the epicardial space could be painful, GA lowers blood pressure and may interfere with arrhythmia induction and mapping, and the use of muscle relaxants precludes identification of the phrenic nerve (PN). Moreover, an anesthesiologist's presence is required during GA for the whole procedure, which may not always be possible. Therefore, we evaluated the feasibility and safety of epicardial VT ablations performed under conscious sedation using dexmedetomidine in our center. Between January 2018 and January 2022, all patients who underwent epicardial VT ablation under continuous dexmedetomidine infusion were prospectively included in the study. All patients received premedication 30min before the epicardial puncture with paracetamol (acetaminophen 10mg/ml) 1000mg and ketorolac 30mg. Sedation protocol included an intravenous bolus of midazolam hydrochloride (0.03-0.05mg/kg) followed by continuous infusion of dexmedetomidine (0.2-0.7 mcg/kg/h). In addition, an intravenous fentanyl citrate bolus (0.7-1.4 mcg/kg) was given for short-term analgesia, followed by a second dose repeated after 30 to 45min. Sedation-related complications were defined in case of respiratory failure, severe hypotension, and bradycardia requiring treatment. Sixty-nine patients underwent epicardial or endo-epi VT ablation under conscious sedation and were included in the analysis. The mean age was 65.4 ± 12.1years; forty-six patients were males (66.6%). All patients had drug-refractory recurrent VT. Forty-seven patients (68.1%) had non-ischemic cardiomyopathy (NICM), 13 patients (18.9%) had ischemic-cardiomyopathy (ICM), and 9 patients (13%) had myocarditis. Standard percutaneous sub-xiphoid access was attempted in all patients. Non-inducibility of any VT was achieved in 82.6% (9/9 myocarditis, 10/13 ICM, 38/47 NICM, n = 57/69 patients), inducibility of non-clinical VT in 13% (3/13 ICM, 6/38 NICM, n = 9/69 patients), and failure in 4.3% (3/38 NICM, n = 3/69 patients). Although we observed procedural-related complications in five patients (7.2%), one transient PN palsy, two pericarditis, and two vascular complications, those were not related to the conscious sedation protocol. No respiratory failure, severe hypotension, or bradycardia requiring treatment has been observed among the patients. Prompt availability of anesthesiology support remains crucial for complex procedures such as epicardial VT ablation. Continuous infusion of dexmedetomidine and administration of midazolam and fentanyl seem to be a safe and effective sedation protocol in patients undergoing epicardial VT ablation.

Nebulized vs. oral midazolam as a sedative premedication in pediatric anesthesia: A randomized controlled double-blinded study

ABSTRACT Objective This study was carried out to compare different routes of midazolam administration (nebulized vs. oral) to achieve a satisfactory level of sedation, RAMSAY Sedation Score (RSS) of 4, within 30 minutes of midazolam administration in pediatric operative patients. Methods After approval of the ethical committee in Kasr Al-ainy university hospital and obtaining written consent from parents/legal guardians; Seventy-two pediatric patients scheduled for general and urological surgical operations under general anesthesia were included in this randomized double-blinded study. Patients were randomly assigned into one of the two equal groups. Group N: 36 children received nebulized midazolam 0.2 mg/kg in 3 ml normal saline plus 5 ml clear juice 30 min before undergoing general anesthesia (GA). Group O: 36 children received oral midazolam 0.5 mg/kg in 5 ml clear juice plus nebulizer of 3 ml normal saline 30 min before undergoing general anesthesia. Results We found no statistical difference between nebulized and oral midazolam regarding drug acceptance, peri-operative (sedation scores, hemodynamics, and side effects); P-value >0.05 for all values. Conclusion Nebulized midazolam is a good alternative to oral midazolam as a sedative premedication in pediatrics.

Comparison between Diazepam and Midazolam as Premedicant to Reduce Anxiety in Patients underwent Elective Surgery Under General Anaesthesia

Background: The majority of patients admitted to hospital for elective surgery experience anxiety preoperatively which can adversely influence the surgical procedure as well as the patient’s recovery. Reduction of anxiety and fear at preoperative period in patients of elective surgery is essential for surgical preparation. Benzodiazepines are the most commonly used drugs for this purpose. The purpose of the study to evaluate the comparative efficacy of Diazepam and Midazolam regarding onset, duration and degree of antianxiety, sedation and amnesia during surgery under general anaesthesia. Materials and methods: The study was carried out in series of 60 consequetive, unselected patients, aged 18-60 years, admitted for the elective surgery under General Anaesthesia, in Combined Military Hospital (CMH) Chattogram during the period September 2019 to February 2020. Patients receiving diazepam or midazolam as preoperative medication were taken. Anxiety was scored using VAS, sedation was scored by using Ramsay Sedation scale and anterograde amnesia by asking preoperative events after 24 hours. Results: While evaluating mean anxiety reduction only, mean reduction is greater in the diazepam group compared to that of midazolam. Desired sedation level was less achieved with midazolam. In the diazepam group, greater number of patients could not recall preoperative events. Conclusion: The standard administration of diazepam before procedure provides patients with a moderate reduction of periprocedural anxiety. Routinely, administration of midazolam has a limited effects on the reduction of anxiety. Additionally, premedication of midazolam is associated with a high incidence of adverse effects. Therefore, this study does not support the routine use of midazolam as premedication to reduce anxiety. IAHS Medical Journal Vol 5(1), June 2022; 65-69

Comparison of midazolam versus captopril in patients with uncomplicated hypertensive urgency in emergency ward: Double-blind randomized clinical trial.

The urgency of uncomplicated blood pressure (BP) is known as a sudden rise in BP. The aim of this study was to evaluate the intravascular administration of midazolam as an emergency care to control BP against captopril in patients with uncomplicated hypertension (HTN). The present study was a double-blind parallel randomized clinical trial (RCT) study that was performed on patients with urgent HTN referred to Imam Hossein Hospital in Shahroud, Iran, in 2018. Patients with BP higher than 180/110 mmHg and with healthy vital organs were selected randomly and allocated into three groups of 43 participants. All patients' BP in both arms, and after a period of 10 minutes in the left arm, was checked and after administering the medication was checked again for 4 times of 15 minutes till 1 hour complete. There were significant differences between systolic (P = 0.024), diastolic (P = 0.001), and mean BP (P = 0.009) in the midazolam group before and after treatment. The group of midazolam and captopril showed the greatest reduction of BP before, in the middle, and after carrying out the treatment methods. As such, systolic, diastolic, and mean BP showed 23.5% (P = 0.047), 17.4% (P = 0.021), and 20.5% (P = 0.031) reduction, respectively. Midazolam can be used as an effective and low-risk drug for lowering BP. Midazolam also has a faster effect on lowering BP.

Short-term administration of Polypodium leucotomos extract does not inhibit CYP3A4-mediated metabolism of midazolam in healthy subjects: an open-label, two-period, fixed-sequence study.

The extract of Polypodium leucotomos is used as a dietary supplement for its ultraviolet radiation-protective properties. Polypodium leucotomos extract reportedly inhibits CYP3A, which is important for drug metabolism in vitro in human microsomes and in vivo in rats. Inthis study, we explored the inhibitory effect of the P. leucotomos extract on CYP3A4-mediated midazolam metabolism in humans. This open-label, two-period, fixed-sequence study was performed on six healthy, Japanese, male volunteers. During period 1 (control), midazolam (1 mg) was orally administered. After a wash-out period of at least 5 days, period 2 was initiated. Subjects ingested P. leucotomos extract (240 mg) once in the morning and once at noon on the day before midazolam administration, and once the next morning (thrice overall). Midazolam was administered as in period 1. Blood samples were regularly collected for 8 hours after drug administration, and serum midazolam concentration was determined by ultra-fast liquid chromatography-tandem mass spectrometry. The pharmacokinetic parameters of midazolam were calculated and compared between the two periods. The area under the concentration-time curve was 19.18 ± 3.65 ng h/ml, maximum serum concentration was 7.81 ± 1.25 ng/ml, and half-life was 2.32 ± 0.35 hours during period 2. These parameters did not differ from those recorded in period 1 (area under the concentration-time curve: 18.74 ± 2.97 ng h/ml, maximum serum concentration: 8.78 ± 1.67 ng/ml, half-life: 2.52 ± 0.52 h). Therefore, short-term oral administration of P. leucotomos extract did not cause food-drug interactions mediated by CYP3A4 inhibition in humans.

PB2341: MIDAZOLAM AND LOCAL ANAESTHESIA CO-ADMINISTRATION GIVES BETTER PAIN CONTROL DURING THE BONE MARROW ASPIRATION AND BIOPSY PROCEDURE

Background: During the bone marrow aspiration and biopsy (BMAB) procedure, patients report pain of varying intensity ranging from complete absence of pain to severe pain. There is limited literature on the patient and procedure related factors associated with the pain. Furthermore, evidence-based guidelines on the best method of pain management during BMAB are lacking. The use of local anaesthesia(LA) only is still widespread although it does not abolish the pain of BMAB. Conscious sedation, other pharmacological agents and non-pharmacological interventions are used to a variable extent. Midazolam is the most commonly used benzodiazepine for conscious sedation and may be used in conjunction with local anaesthesia, other systemic pharmacological agents or as a single agent. Our centre introduced universal midazolam sedation unless there is a contraindication to its use, 4 years ago. Aims: To assess the impact of the universal use of intravenous midazolam premedication for the BMAB procedure compared to the use of local anaesthesia only and to determine the patient- and procedure-related factors associated with the patient-reported pain. Methods: A retrospective cross-sectional study was performed on adult patients who had a BMAB in a day procedure operating theatre over the period from 1st July 2018 to 30th March 2019. Patient demographics, the body mass index (BMI), indications, diagnosis, the number of times the patient had the BMAB procedure and the experience of the operator were documented. A numerical rating scale pain assessment tool and questionnaire were used in interviews conducted by the principal investigator. Further data were extracted from the National Health Laboratory Service laboratory information system, patients’ hospital files and the operating theatre records. Results: A total of 182 BMAB procedures were included in the study; 155 procedures performed with midazolam premedication and 27 performed using local anaesthesia only. Pain was reported in all procedures performed under local anaesthesia and only in 29.1% of procedures performed with midazolam administration. Our study showed no influence of age, sex, race, level of educations, indication, diagnosis, experience of the operator on pain. Patients who had previous BMAB experienced less pain. Midazolam dose showed negative correlation with pain. Summary/Conclusion: Local anaesthesia only is not enough to abolish pain of BMAB. Midazolam conscious sedation used with local anaesthesia consistently reduces the reported pain to acceptable levels. Patients with previous experience of BMAB under midazolam premedication reported less pain. The universal use of midazolam conscious sedation for BMAB under carefully controlled circumstances is strongly recommended.

The Efficacy and Complications of Deep Sedation in Pediatric Dental Patients: A Retrospective Cohort Study.

Background Dental anxiety in children is a common problem. Currently, many of dental procedures are performed under sedation. Different methods of sedation have been employed for this purpose. Compared to adults, children usually need a deeper sedation level. The aim of this retrospective study is to assess the efficacy and complication of deep sedation in pediatric dental patients. Method This study was performed on 250 ASA (American Society of Anesthesiologists) I, II children undergoing deep sedation during the dental procedures. After the administration of oral midazolam as premedication, the monitoring process started. The patients that received the sedation dose of propofol and oxygen through nasal cannula during the procedure were carefully monitored for the purpose of evaluating hemodynamic and respiratory complications. The mean procedure and recovery time, postoperative nausea and vomiting (PONV), and success rate were further studied. Result The average age of the patients was 3.7. 32% of the patients were females, and 68% of them were males. Laryngospasm that occurred in 5 cases was resolved immediately by using positive pressure ventilation. Mild hypoxia was observed in 17 cases which were immediately managed by a bag-valve-mask ventilation. No cases of hemodynamic complications and PONV were reported. The mean length of the procedure was 57 minutes, and the mean length of recovery was 16 minutes. The success rate of this method was estimated to be 99.6%. Conclusion Deep sedation with propofol is a suitable technique with a high success rate for dental procedures in children. It was also concluded that in pediatric dental procedures, the presence of a skilled anesthetist and the implementation of a close monitoring process are required.

Comparison of intranasal dexmedetomidine and midazolam as premedication on haemodynamic stability

Background: Premedication in pediatric population helps to produce a relaxed state with reduced anxiety and increased. These pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic medication in children. Fear of unpleasant and painful procedures, separation from parents and unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in unpremeditated patients. Because of this premedication should be an integral part of paediatric anaesthetic practice. Aims and Objectives: To evaluate the Intranasal administration of Midazolam and Dexmedetomidine as Premedication on Haemodynamic Stability among Paediatric Patients. Material &amp; Methods: This Comparative study was carried out at Department of Anaesthesiology, P K DAS Institute of Medical Sciences, Vaniamkulam, Ottapalam Kerala, India . A total of 70 Paediatric Patients of both sex age group between 1- 5 year from the routine surgical list of our Hospital were included in the study. The children were divided into two groups i.e. 35 in each based on the premedication received and by random allotted numbers.

Effect of intramuscular midazolam premedication on patient satisfaction in women undergoing general anaesthesia: a randomised control trial

ObjectiveTo determine the effect of premedication with intramuscular midazolam on patient satisfaction in women undergoing general anaesthesia.Trial design, setting and participantsDouble-blind, parallel randomised control trial at a tertiary care medical...

Effects of Midazolam on Food Intake in Budgerigars (Melopsittacus undulatus).

Currently, drug-induced stimulation of appetite is not commonly performed in hyporexic or anorexic companion psittacine birds. Instead, to prevent a catabolic state and weight loss, supplemental feedings are routinely performed by crop gavage. However, crop gavage is not without complications and is stressful to the patient and labor intensive. The objective of this study was to evaluate the effect of midazolam on food intake in healthy budgerigars. In a randomized, blinded, controlled study, change in food intake after intramuscular administration of midazolam (1 mg/kg) or a placebo-control treatment (0.9% saline) was evaluated in 12 healthy adult budgerigars (Melopsittacus undulatus). Food intake was quantified for 1 hour before and after drug administration. Birds were monitored for feeding behavior as well as signs of sedation. After midazolam administration, a median 6-fold (1.1-28) increase in food intake was recorded. In 3 of 6 (50%) birds, the food intake increase after midazolam administration was >10-fold (median 17-fold [10-28]), whereas in the remaining 3 birds, food intake increased by only 1.7-fold (1.1-1.8). The median amount of food ingested (16.7 g/kg [3.2-43.2 g/kg]) was significantly higher after midazolam administration compared with the control group (1.9 g/kg [0.0-19.7 g/kg], P = .015). The median time birds spent displaying feeding behavior after the midazolam injection was 18% (0-43%), compared with 1% (0-20%) in the control group after saline injection. Five of 6 (83%) birds showed signs consistent with mild sedation after midazolam administration. This study demonstrates that midazolam is an appetite stimulant in budgerigars. Future studies are needed to evaluate whether midazolam's effects on food intake are dose dependent and whether the duration of effect exceeds 1 hour.

Prevalence and characteristics of disinhibition during bronchoscopy with midazolam.

Disinhibition is sometimes experienced during bronchoscopy with sedation. However, data on disinhibition during bronchoscopy are scarce. We examined the prevalence and characteristics of disinhibition during bronchoscopy with midazolam. This retrospective study analyzed consecutive patients who underwent bronchoscopy between November 2019 and December 2020. The severity of disinhibition was defined as follows: mild, disinhibition sometimes requiring restraints by assistants; moderate, disinhibition always requiring restraints by assistants; and severe, disinhibition requiring antagonization of sedation by flumazenil to continue bronchoscopy. Among 251 eligible patients who were sedated using midazolam, 36 (14.3%; 95% confidence interval [CI], 10.5%-19.2%), 42 (16.7%; 95% CI, 12.6%-21.8%), and 7 (2.8%; 95% CI, 1.4%-5.6%) experienced mild, moderate, and severe disinhibition, respectively. Depression (odds ratio [OR] 2.77; 95% CI, 1.20-6.41), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) (OR 10.23; 95% CI, 1.02-103.01, referred to brushing/bronchial washing/observation), and increased administration of midazolam (OR 1.20; 95% CI, 1.02-1.42, per 1-mg increase) were independently associated with moderate-to-severe disinhibition. Patients experiencing moderate disinhibition reported significantly better scores for discomfort during bronchoscopy. Besides the maximum systolic and diastolic blood pressures during bronchoscopy, the changes in hemodynamic and respiratory statuses during bronchoscopy or complications did not significantly differ between patients experiencing moderate-to-severe disinhibition and those experiencing none-to-mild disinhibition. Moderate-to-severe disinhibition occurred in 19.5% of patients during bronchoscopy with midazolam. We should focus on disinhibition when patients have depression or are planning to undergo EBUS-TBNA, and sparing the administration of midazolam might reduce the occurrence of disinhibition. UMIN000038571.

Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review.

Objective: The objective of this study was to evaluate the efficacy and safety of intranasal midazolam as part of a paediatric sedation and analgesic procedure during the suturing of traumatic lacerations in paediatric emergency departments. Methodology: A systematic review of clinical trials was completed in July 2021. The databases consulted were PUBMED, SCOPUS, WEB OF SCIENCE, NICE and Virtual Health Library. Eligibility criteria: randomised and nonrandomised clinical trials. Two independent, blinded reviewers performed the selection and data extraction. The participants were 746 children, of whom, 377 received intranasal midazolam. All of the children were admitted to an emergency department for traumatic lacerations that required suturing. The quality of the articles was evaluated with the Jadad scale. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Nine studies were included in the review. The intranasal administration of midazolam in healthy children produces anxiolysis and minimal/moderate sedation without serious side effects. Although there are combinations of parenteral drugs that produce deeper sedation, they also have greater adverse effects. No significant differences in the initiation of sedation and the suture procedure were found between the intranasal route and the parenteral route. Conclusions: The use of intranasal midazolam in healthy children produces sufficiently intense and long-lasting sedation to allow for the suturing of traumatic lacerations that do not present other complications; therefore, this drug can be used effectively in paediatric emergency departments.