Midazolam For Premedication In Children Research Articles

A Comparative Evaluation of Intranasal Ketamine and Intranasal Midazolam for Premedication in Children

A Comparative Evaluation of Intranasal Ketamine and Intranasal Midazolam for Premedication in Children

Comparative evaluation of transnasal dexmedetomidine and transnasal midazolam for premedication in children undergoing anesthesia: A double‑blind randomized clinical trial

Comparative evaluation of transnasal dexmedetomidine and transnasal midazolam for premedication in children undergoing anesthesia: A double‑blind randomized clinical trial

A Comparative Evaluation of Intranasal Dexmedetomidine and Intranasal Midazolam for Premedication in Children

A Comparative Evaluation of Intranasal Dexmedetomidine and Intranasal Midazolam for Premedication in Children

“Comparative evaluation of intranasal dexmedetomidine and intranasal midazolam for premedication in children undergoing anesthesia”: A 1-year double-blind randomized controlled trial

Introduction: Children undergoing surgical procedures can experience significant anxiety and distress during perioperative period. Use of sedative premedication helps to reduce anxiety and facilitate a smooth induction of anesthesia. Midazolam is the most commonly used premedication agent with adverse effects such as behavioral changes, hiccups, and paradoxical hyperactive reactions. Dexmedetomidine, a highly selective α-2 agonist, has sedative properties. Aims and Objectives: The aim and objective of this study was to compare the efficacy of intranasal dexmedetomidine and intranasal midazolam for premedication in pediatric age group for parental separation anxiety and acceptance of anesthesia mask. Materials and Methods: This study included 60 American Society of Anesthesiologists I–II patients aged 1–10 years undergoing lower abdominal and lower limb surgeries under caudal epidural anesthesia. Ethical committee's clearance and informed consent were obtained. Patients were allocated into two groups by a computer-generated randomization table to receive 0.2 mg/kg intranasal midazolam in Group M and 1 μg/kg dexmedetomidine in Group D intranasally using 1 ml tuberculin syringe. The Parental Separation Anxiety Scale (PSAS) and Mask Acceptance Scale (MAS) were assessed by an anesthesiologist blinded to the drug given. Heart rate and oxygen saturation were monitored till the end of the procedure. Results: Demographic data were comparable in both groups (P > 0.05). Mean PSAS was 1.2 ± 0.40 in dexmedetomidine group and 1.6 ± 0.56 in midazolam group (P = 0.003). Mean mask acceptance score (MAS) at the time of induction was 1.7 ± 0.59 in dexmedetomidine group and 2.1 ± 0.58 in midazolam group (P = 0.02). Conclusion: Intranasal dexmedetomidine 1 μg/kg is an effective alternative for premedication in children undergoing anesthesia and it results in better parent separation and better mask acceptance at the time of induction when compared to intranasal midazolam 0.2 mg/kg without much side effects or complications.

English

INTRODUCTION: Magnetic Resonance Imaging (MRI) causes a great amount of anxiety to both parents and child. Fear of unpleasant procedures and separation from parents may result in lasting and untoward psychological consequences in children. So sedation and anxiolysis is required for children undergoing even for minor diagnostic procedures. OBJECTIVES: The objectives of our study was to compare safety, onset of sedation, degree of sedation produced by intranasal and sublingual administration of midazolam for premedication in children of 4-10 years undergoing MRI. MATERIALS AND METHODS: In this prospective randomized double blind study, the intranasal and sublingual administration of midazolam in pediatric patients who were to undergo MRI was evaluated in 60 children who were aged between 4-10 years with ASA physical status I and II by using a newer midazolam spray. The patients were divided into two groups of 30 patients each and they received Midazolam 0.3 mg/kg. Either intranasally or sublingually in a randomized manner. The heart rate, oxygen saturation (SPO2), respiratory rate and the degree of sedation before and at 3 minutes intervals, recovery score, MRI image quality were recorded and compared. RESULTS: The respiratory rate, heart rate and the oxygen saturation was found from the baseline in both the groups (p >0.05). A sedation score of >3 (approx.) was achieved in both the groups within 10 minutes of drug administration. The recovery score did not differ significantly between the two groups (p >0.05). CONCLUSION: Both the intranasal and sublingual administration of Midazolam as sedative is safe and equally effective in pediatric patients.

Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double‐blinded randomized controlled trial

This prospective, randomized, double-blind study was designed to evaluate the use of intranasally administered dexmedetomidine vs intranasal midazolam as a premedication in children undergoing complete dental rehabilitation. Seventy-two children of American Society of Anesthesiology classification (ASA) physical status (I & II), aged 3-6 years, were randomly assigned to one of two equal groups. Group M received intranasal midazolam (0.2 mg·kg(-1)), and group D received intranasal dexmedetomidine (1 μg·kg(-1)). The patients' sedation status, mask acceptance, and hemodynamic parameters were recorded by an observer until anesthesia induction. Recovery conditions, postoperative pain, and postoperative agitation were also recorded. The median onset of sedation was significantly shorter in group M 15 (10-25) min than in group D 25 (20-40) min (P = 0.001). Compared with the children in group M, those in group D were significantly more sedated when they were separated from their parents (77.8% vs 44.4%, respectively) (P = 0.002). Satisfactory compliance with mask application was 58.3% in group M vs 80.6% in group D (P = 0.035). The incidences of postoperative agitation and shivering were significantly lower in Group D compared with group M. Thirteen children (36.1%) in group M, showed signs of nasal irritation with teary eyes, and none of these signs was seen in the children in group D (P = 0.000). There were no incidences of bradycardia, hypotension, in either of the groups during study observation. Intranasal dexmedetomidine (1 μg·kg(-1)) is an effective and safe alternative for premedication in children; it resulted in superior sedation in comparison to 0.2 mg·kg(-1) intranasal midazolam. However, it has relatively prolonged onset of action.

Comparison of intravenous infusion of dexmedetomidine and midazolam for premedication in children

Objective To compare the efficacy of intravenous infusion of dexmedetomidine and midazolam for premedication in children.Methods Ninety-two ASA Ⅰ or Ⅱ children (46 cases aged 1-3 yr and 46 cases aged 4-6 yr) scheduled for elective general or urologic surgeries,were enrolled in this study.The children were randomly divided into 2 groups (n =46 each):midazolam group (group M) and dexmedetomidine group (group D).The children accompanied by their parents were admitted to the anesthesia preparation room at about 20 min before induction of anesthesia,and midazolam 0.1 mg/kg or dexmedetomidine 1 μg/kg was infused intravenously over 10 min.Anesthesia was induced with proporol-rocuroniume-remifentanil,and maintained with sevoflurane-remifentanil-rocuroniume.Modified Yale Preoperative Anxiety Scale (mYPAS) score,sedation score,HR,mean arterial pressure (MAP),respiratory rate (RR) and SpO2 were recorded before premedication (T1),before separation from their parents (T2) and when entering the operating room (T3).The incidence of sleep (a sedation score of 4) was recorded at T2,3.The end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiring rescue analgesic,and adverse effects were also retorded.Results Compared to that at T1,the mYPAS score was significantly decreased at T2,3,and the sedation score was significantly increased at T2,3 in both groups ( P ＜ 0.05),HR at T2 and MAP at T2,3 were significantly decreased in group D,and HR at T3 was significantly increased in group M ( P ＜ 0.05 ).Compared to group M,the sedation scores and the incidence of sleep were significantly increased at T2,3,and the HR was significantly decreased at T2 in group D ( P ＜ 0.05).There was no significant difference in the mYPAS score,RR,MAP,SpO2,end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiting rescue analgesic,and incidence of adverse effects between D and M groups ( P ＞ 0.05).Conclusion The sedative efficacy of iv dexmedetomidine is superior to that of iv midazolam when infused for premedication in children,but it exerts much influence on hemodynamics,and the changes in hemodynamics should be noted. Key words: Dexmedetomidine; Midazolam; Child; Premedication

Comparison of intranasal dexmedetomidine and midazolam for premedication in children

Comparison of intranasal dexmedetomidine and midazolam for premedication in children

A study to determine the effectiveness of rectally administered Midazolam for premedication in children.

This prospective double blind and randomized study was undertaken to evaluate the efficacy of rectally administered midazolam for premedication of paediatric patients. 100 ASA grade I and II children in the age group of 5-10 years were randomly allocated to two groups of 50 patients each. Group I (midazolam group) received 0.3mg/kg midazolam rectally and group II (saline group) received 5 ml of normal saline rectally.The results of the study showed that midazolam in the dosage of 0.3mg/kg given rectally was acceptable to children, produced satisfactory sedation, provided easy separation of children from parents, maintained stable cardio respiratory status preoperatively as well as postoperatively and produced smooth emergence from anaesthesia but with delayed recovery.

Comparative study between mask nebulisation and oral administration of midazolam for premedication in children

Comparative study between mask nebulisation and oral administration of midazolam for premedication in children

Evaluation of relatively low dose of oral transmucosal ketamine premedication in children: a comparison with oral midazolam

Oral Transmucosal ketamine (lollipop) has been shown to be an effective, harmless preoperative medication for children. However, its efficacy was not compared with commonly used premedication drugs. We, therefore, compared the efficacy of oral transmucosal ketamine with oral midazolam for premedication in children. Fifty-five children (2-6 years of age) were randomized to receive orally either a lollipop containing 50 mg of ketamine (the group K; n = 27) or syrup containing 0.5 mg.kg(-1) of midazolam (the group M; n = 28) before minor surgery. A five points-sedation score (1 = asleep to 5 = agitated; scores 2 and 3 were defined as 'effective') on arrival in the operating room and a three points-acceptance score of separation from the parents and a three points-mask cooperation score at induction of anesthesia (1 = easy to 3 = markedly resistant; score 3 was defined as 'poor') were used. Sedation scores in group K were significantly higher than those in group M (P = 0.012), and the incidence of 'effective' in sedation was significantly lower in group K than in group M (P = 0.036). The incidence of 'poor' at separation from the parents and for mask cooperation was significantly higher in group K than in group M (P = 0.017, P = 0.019, respectively). These results indicate that a relatively low dose of oral transmucosal ketamine premedication provides no benefits over oral midazolam in children.

A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children

A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children

A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children

A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children

Comparison of Intranasal, Oral, and Rectal Midazolam for Premedication in Children

Comparison of Intranasal, Oral, and Rectal Midazolam for Premedication in Children

Midazolam for premedication in children: Nasal vs. rectal administration

The authors compared the acceptance and efficacy of rectal and nasal administration of midazolam (MDZ) for premedication. Ninety-five ASA I and II paediatric patients (8 months to 12 years) scheduled for elective surgery were randomly allocated to two groups. Group R received 0.3 mg kg−1 of rectal midazolam (in 5 mL saline). Group N received 0.2 mg kg−1 of nasal midazolam (5 mg ml−1). Both groups were divided in two subgroups according to age (group RA (≤6 years, n=33), group RB (>6 years, n=18), group NA (≤6 years, n=28), group NB (>6 years, n=16)). At the time of premedication, tolerance to the administration was confirmed. Twenty min after rectal or 10 min after nasal administration the quality of sedation was recorded. The nasal midazolam, in commonly used dosages, induced a sedation similar to that following rectal administration with a shorter delay of onset. Nasal administration was more often painful than rectal administration. Swallowing (nasal midazolam) and concerns about modesty (rectal midazolam) were more frequent in older children. Because of its poor tolerance, nasal premedication should be reversed for cases where there is no alternative. Rectal premedication should be avoided in older children.

The pharmacokinetics of rectal midazolam for premedication in children.

The pharmacokinetics of rectal midazolam for premedication in children.