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Oral high-dose midazolam premedication for infants and children undergoing cardiovascular surgery

Tatsuhiko Masue1, Hiroyuki Shimonaka, Izumi Fukao

  • 1Department of Anesthesiology, Gifu Prefectural Hospital, Noishiki, Gifu, Japan. masue@cc.gifu-u.ac.jp

Paediatric Anaesthesia
|October 11, 2003
PubMed

Insights

Oral midazolam at 1.5 mg x kg(-1) provides superior sedation for pediatric cardiovascular surgery patients compared to standard doses. This higher dose is safe and effective for preanesthetic medication in this vulnerable population.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Cardiovascular Surgery

Background:

  • Premedication is crucial for managing anxiety and ensuring cooperation in pediatric patients undergoing surgery.
  • Standard midazolam doses (0.5-1.0 mg x kg(-1)) may not always provide adequate sedation for infants and children with congenital heart disease.
  • Assessing alternative dosing strategies for oral midazolam is important for improving preanesthetic care.

Purpose of the Study:

  • To evaluate the safety and efficacy of a higher dose of oral midazolam (1.5 mg x kg(-1)) as preanesthetic medication.
  • To compare the effectiveness of oral midazolam 1.5 mg x kg(-1) against standard doses (0.5-1.0 mg x kg(-1)).
  • To determine if oral midazolam 1.5 mg x kg(-1) is a suitable alternative for pediatric patients with congenital heart disease undergoing cardiovascular surgery.

Main Methods:

  • A study involving 193 infants and children (4 months to 2 years) undergoing cardiovascular surgery.
  • Patients received oral midazolam at doses of 0.5, 1.0, or 1.5 mg x kg(-1).
  • Sedation levels were assessed using a 5-point scale, and vital signs (BP, HR, SpO2) were monitored before and after medication.

Main Results:

  • The 1.5 mg x kg(-1) oral midazolam group exhibited significantly better sedation, with only 4% becoming agitated compared to 14% (1.0 mg x kg(-1)) and 26% (0.5 mg x kg(-1)).
  • Ninety percent of patients receiving 1.5 mg x kg(-1) achieved satisfactory sedation within 30 minutes, versus 68% (1.0 mg x kg(-1)) and 35% (0.5 mg x kg(-1)).
  • No significant adverse effects on blood pressure, heart rate, or oxygen saturation were observed, and no serious complications like seizure-like activity or apnea occurred.

Conclusions:

  • Oral midazolam at 1.5 mg x kg(-1) is an excellent and safe option for preanesthetic medication.
  • This higher dose effectively improves sedation quality in infants and children undergoing cardiovascular surgery.
  • The findings support the use of oral midazolam 1.5 mg x kg(-1) for preanesthetic medication in this pediatric surgical population.
Abstract

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