DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20193409

Oral versus intramuscular midazolam for paediatric preanaesthetic medication

Kiran R. Vyawahare, Heena D. Pahuja, Sushma T. Pande

Abstract


Background: The need for effective preanesthetic medication in children is obvious and midazolam has proven to be one reliable choice. The aim of the present study was to compare the efficacy, acceptability and reliability of the oral and intramuscular routes of administration of midazolam towards paediatric preanesthetic medication at various doses.

Methods: Hundred eligible patients in the age group of 1 to 10 years undergoing ambulatory or routine planned, minor or major surgery during study period were allocated to one of the four groups of 25 participants each, formed on the basis of premedication they received. Haemodynamic parameters, level of sedation and anxiety and induction score were noted before premedication and after each 15 minutes interval for next 45 minutes in all the four groups. Postoperative assessment included sleep level, anterograde amnesia, picture recall and occurrence of complications.

Results: The sedative and anxiolytic effects were observed to be maximum at 45 minutes after premedication in all the four groups and better sedation, anxiolysis and quality of induction were achieved with higher doses for both oral as well as intramuscular routes. Postoperatively, the sleep level did not increase with higher dose and 64% patients were awake with 0.75 mg/kg oral midazolam. The sleep level was more with higher dose with the Intramuscular route, with 60% patients feeling drowsy with 0.1mg/kg dose. 0.75 mg/kg dose showed better anterograde amnesia (64%) than 0.5 mg/kg (28%), while it was present in 64% participants premedicated with 0.8 mg/kg intramuscular does and 72% in 0.1 mg/kg intramuscular dose.

Conclusions: Intramuscular midazolam at 0.1 mg/kg dose seems to be the ideal dose and route for paediatric preanesthetic medication, with oral midazolam at 0.75 mg/kg to be considered an effective and acceptable alternative.

 


Keywords


Intramuscular, Midazolam, Oral, Preanesthetic medication

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References


Kain ZN, Caldwell-Andrews AA. Preoperative psychological preparation of the child for surgery: an update. Anesthesiol Clin North Am. 2005;23(4):597-614.

Williams JG, Jones JR. Psychophysiological responses to anesthesia and operation. JAMA. 1968;203(6):415-7.

Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. AMA Am J dis child. 1953;86(5):587-91.

Mitchell V, Grange C, Black A, Train J. A comparison of midazolam with trimeprazine as an oral premedicant for children. Anaesth. 1997;52(5):416-21.

Pacifici GM. Clinical pharmacology of midazolam in neonates and children: effect of disease- a review. Int J Pediatr. 2014.

Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: a comparison of intranasal dexmedetomidine versus oral midazolam. Saudi J Anaesth. 2011;5(4):387.

American Society of Anaesthesiologists (ASA) Physical Status Classification System. Available at: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed 15 May 2019.

Rita L, Seleny Fl, Mazurek A, Rabins Sy. Intramuscular Midazolam for Pediatric Preanesthetic SedationA Double-blind Controlled Study with Morphine. Anesthesiol J Am Soc Anesthesiol. 1985;63(5):528-30.

Taylor MB, Vine PR, Hatch DJ. Intramuscular midazolam premedication in small children: A comparison with papaveretum and hyoscine. Anaesth. 1986;41(1):21-6.

Wilton NC. Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiol. 1988;69:972-5.

Feld LH, Urquhart ML, Feaster WW, White PF. Premedication in children: oral versus intramuscular midazolam. Anaesthesiol. 1988;69(3A):445.

McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E, Lerman J. Premedication of children with oral midazolam. Canadian J Anaesth. 1992;39(6):545-50.

Riva J, Lejbusiewicz G, Papa M, Lauber C, Kohn W, Da Fonte Ma, et al. Oral premedication with midazolam in paediatric anaesthesia. Effects on sedation and gastric contents. Pediatric Anesthesia. 1997;7(3):191-6.

Feld LH, Negus JB, White PF. Oral midazolam preanesthetic medication in pediatric outpatients. Anesthesiol. 1990;73(5):831-4.

Karl HW, Keifer AT, Rosenberger JL, Larach MG, Ruffle JM. Comparison of the safety and efficacy of intranasal midazolam or sufentanil for preinduction of anesthesia in pediatric patients. Anesthesiol. 1992;76(2):209-15.

Unlugenc H, Guler T, Gunes Y, Isik G. Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Euro J Anaesthesiol. 2003;20(8):668-73.