Oral premedication with fentanyl may be a safe and effective alternative to oral midazolam

Area of Science:

• Pediatric Anesthesiology
• Pharmacology
• Clinical Trials

Background:

• Oral midazolam is frequently used for pediatric premedication but often has an unacceptable taste.
• The palatability of oral midazolam can be a barrier to effective pre-anesthetic medication in children.

Purpose of the Study:

• To compare the efficacy and safety of oral fentanyl versus oral midazolam for pediatric premedication.
• To evaluate oral fentanyl as an alternative to oral midazolam in children undergoing surgery.

Main Methods:

• A randomized open-label study involving 51 children aged 12-107 months.
• Children received either oral midazolam (5 mg) or oral fentanyl (0.1 mg) 30 minutes prior to surgery.
• Excitation-sedation levels were assessed pre- and post-anesthesia.

Main Results:

• No significant differences in preoperative sedation scores were observed between the fentanyl and midazolam groups.
• No major adverse events were reported in either treatment group.
• Postoperative vomiting occurred in 18.5% of patients receiving oral fentanyl, compared to 0% in the midazolam group.

Conclusions:

• Oral fentanyl administered 30 minutes before surgery is a feasible premedication option for children aged 1-8 years.
• Fentanyl may be considered as an alternative to midazolam, particularly when taste is a concern.
• Further research may explore strategies to mitigate postoperative nausea and vomiting associated with oral fentanyl.