Related Experiment Videos
[Oral and rectal premedication of children with midazolam]]
B Pohl1, F Schmicker, R Hofmockel
1Klinik und Poliklinik für Anästhesiologie und Intensivmedizin, Universität Rostock.
Insights
Reduced doses of midazolam administered orally or rectally provided effective premedication in children undergoing surgery. This approach led to significant cardiovascular changes, but these were not clinically relevant and side effects were minimal.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Care
Background:
- Premedication in pediatric anesthesia remains a challenge, requiring both pharmacological agents and psychological support.
- Effective premedication is crucial for managing anxiety and ensuring a smooth perioperative experience for children.
Purpose of the Study:
- To evaluate the efficacy and safety of reduced oral and rectal midazolam doses for premedication in children.
- To assess the impact of midazolam premedication on cardiovascular parameters and respiratory function in pediatric patients.
Main Methods:
- A randomized study involving 329 children (aged 1-14) undergoing minor surgical procedures.
- Children received either oral (0.4 mg/kg BW) or rectal (0.3 mg/kg BW) midazolam, with premedication effects assessed using the Lindgren classification.
- Cardiovascular and respiratory parameters, including oxygen saturation, were monitored throughout the observation period.
Main Results:
- Reduced doses of midazolam, lower than typically cited, yielded very good premedication effects.
- Significant decreases in mean arterial blood pressure and heart rate were observed, attributed to anxiolysis and premedication, but were not clinically significant.
- No significant respiratory changes were detected based on oxygen saturation measurements.
- Reported side effects, such as singultus, salivation, and ataxia, were mild and posed no danger.
Conclusions:
- Low-dose oral and rectal midazolam are effective and safe for pediatric premedication in minor surgical settings.
- The observed cardiovascular changes are transient and not clinically relevant, supporting the use of these reduced dosages.
- Midazolam premedication at these reduced doses offers a favorable safety profile with minimal side effects in children.
Abstract:
Premedication in children continues to be a problem in anaesthesiology. Apart from the application of premedication drugs, a strongly committed anaesthetist and sound psychological work are decisive prerequisites for adequate premedication. In this randomized study, 329 children aged between 1 and 14 who were scheduled for small surgical procedures were examined. Based on the results of a preliminary trial using different dosages of midazolam, the children were premedicated either orally with 0.4 mg/kg BW midazolam or with 0.3 mg/kg BW midazolam as a rectal solution and the premedication effect was recorded according to the classification of Lindgren. These reduced doses of midazolam, which were much lower than those described in the literature, led to very good premedication effects, too. Regarding cardiovascular behaviour, an increasing anxiolysis and the effect of premedication led to a significant decline in mean arterial blood pressure and heart frequency. The circulatory changes that occurred were at no time clinically relevant in any child, and therefore no treatment was needed. Based on the measured oxygen saturation, no significant respiratory changes were seen during the observation period. The frequency and extent of the registered side-effects were classified as slight. Side-effects such as singultus, salivation and ataxia/gesticulations were of no danger during the entire perioperative period.