Midazolam In Children Research Articles

Plasma Concentrations of Midazolam in Children Following Intranasal Administration

Nasally administered midazolam appears to be a useful method for rapidly sedating children prior to the induction of anesthesia. We determined the peak plasma concentrations after intranasal administration of midazolam and compared this to plasma concentrations achieved after intravenously administered midazolam in 18 children between the ages of 14 months and 5 yr, who underwent elective closure of an asymptomatic atrial septal or ventricular septal defect. Preanesthetic medication was at the discretion of the attending anesthesiologist. Induction of anesthesia was with halothane in N2O and O2 via mask, and tracheal intubation was performed after the administration of fentanyl or sufentanil plus pancuronium. Anesthesia was maintained with these agents, and augmented with halothane or isoflurane. As soon as arterial access was established, the patient received 0.1 mg/kg of either intranasal or intravenous midazolam. Midazolam concentrations were measured by gas chromatography-mass spectrometry. Intranasal midazolam achieved its peak plasma concentration of 72.2 +/- 27.3 ng/ml in 10.2 +/- 2 min. Ten minutes after the administration of midazolam, the mean plasma concentration in the intranasal midazolam group was 57% of the concentrations in the group receiving midazolam intravenously. These results confirm the clinical impression that intranasal administration of midazolam rapidly achieves sedative plasma concentrations in children.

Oral Midazolam Preanesthetic Medication in Pediatric Outpatients

A need exists for a safe and effective oral preanesthetic medication for use in children undergoing elective surgical procedures. We evaluated the effectiveness of three different doses of oral midazolam when administered in combination with atropine prior to ambulatory surgery. In this randomized, double-blind, placebo-controlled study, 124 children, ages 1-10 yr, received midazolam, 0.25, 0.50, or 0.75 mg.kg-1 po, and atropine, 0.03 mg.kg-1 po, mixed with apple juice, or a placebo (containing the midazolam vehicle, atropine, and apple juice). A blinded observer noted the child's level of sedation, the quality of separation from parents, and the degree of cooperation with an inhalation induction of anesthesia. Picture-recall was used to assess the amnesic effect of midazolam in children over 5 yr of age. Midazolam 0.75 mg.kg-1 produced significant sedation at 30 min. After procedures lasting an average of 106-113 min, recovery was not prolonged by the oral midazolam-atropine combination. We concluded that oral midazolam 0.5-0.75 mg.kg-1 is an effective preanesthetic medication for pediatric outpatients.

Discussion: Preanesthetic Medication With Rectal Midazolam in Children Undergoing Dental Extractions

Discussion: Preanesthetic Medication With Rectal Midazolam in Children Undergoing Dental Extractions

Preanesthetic medication with rectal midazolam in children undergoing dental extractions

Three different dosages (0.25, 0.35, and 0.45 mg/kg) of rectally administered midazolam were compared with each other and with placebo for preanesthetic medication in children undergoing dental extractions. Eighty patients between the ages of 2 and 10 years were randomly allocated into four groups in this double-blind study. The results from this trial show that 30 minutes after rectal administration of all doses of midazolam, good anxiolysis, sedation, and cooperation were obtained in most patients. A high prevalence (23%) of disinhibition reactions was observed, particularly in the 0.45 mg/kg group. For this reason, 0.25 or 0.35 mg/kg appears to be the dose of choice when rectal midazolam is used for premedication in children.

Acute Benzodiazepine Withdrawal After Midazolam in Children

Acute Benzodiazepine Withdrawal After Midazolam in Children

Pharmacokinetics of Intravenous (IV) and Intranasal (IN) Midazolam in Children

Pharmacokinetics of Intravenous (IV) and Intranasal (IN) Midazolam in Children

Midazolam in paediatric anaesthesia.

Midazolam was given intravenously to 100 children over the age of 8 years to induce anaesthesia and a similar control group was anaesthetised with diazepam. The actions of midazolam in children were found to be similar to those of diazepam. Midazolam acted more quickly in children than has been reported in adults. The effects on the circulation and respiration, and the incidence of postoperative amnesia were similar in children to that which has been reported in adults. The incidence of postoperative vomiting after midazolam was 1% in the recovery room and 32% during the first two postoperative days. Laboratory investigations did not demonstrate any adverse effects. Midazolam has a considerable advantage over diazepam being water soluble and injectable safely without dilution. This clinical trial suggests that midazolam is a satisfactory induction agent for children.