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Oral midazolam in children: effect of time and adjunctive therapy
B C Weldon1, M F Watcha, P F White
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
Insights
Oral midazolam (0.5 mg/kg) administered 30-45 minutes before anesthesia induction effectively sedates children and improves cooperation for mask induction. Atropine and meperidine did not enhance midazolam
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
Background:
- Preanesthetic medication aims to reduce anxiety and facilitate induction.
- Oral midazolam is a commonly used anxiolytic and sedative agent in pediatric patients.
Purpose of the Study:
- To evaluate the optimal timing for oral midazolam administration.
- To assess the impact of concomitant atropine and/or meperidine on oral midazolam's perioperative effects in children.
Main Methods:
- A randomized, double-blind study involving 154 healthy children aged 1-8 years.
- Six oral preanesthetic medication regimens were compared, including placebo, midazolam, atropine, meperidine, and combinations.
- Children received medications 20-60 minutes before anesthesia induction, with sedative effects and separation anxiety assessed.
Main Results:
- The peak sedative effect of oral midazolam was observed 30 minutes post-administration.
- Children receiving midazolam showed significantly better separation from parents (95% satisfactory scores within 45 min) and cooperation during mask induction (83% vs 56%).
- Atropine and meperidine did not significantly improve midazolam's effectiveness; no adverse effects on vital signs or recovery time were noted.
Conclusions:
- Oral midazolam (0.5 mg/kg) is a safe and effective preanesthetic agent for children, optimizing sedation and cooperation.
- Administering oral midazolam 30-45 minutes before anesthesia induction is recommended for pediatric ambulatory surgery.
- Concomitant use of atropine or meperidine does not appear to enhance the benefits of oral midazolam in this setting.
Abstract:
The purpose of this study was to determine the influence of timing and concomitant administration of atropine and/or meperidine on the perioperative effects of oral midazolam in children. In 154 healthy children, 1-8 yr old, we studied six oral preanesthetic medication regimens according to a randomized, double-blind protocol. Group A (placebo) received 5 mL of apple juice. The other five groups received medication with apple juice to a total volume of 5 mL, 20-60 min before induction of anesthesia. Group B received atropine (0.02 mg/kg); group C received midazolam (0.5 mg/kg); group D received midazolam (0.5 mg/kg) and atropine (0.02 mg/kg); group E received meperidine (1.5 mg/kg) and atropine (0.02 mg/kg); and group F received meperidine (1.5 mg/kg), atropine (0.02 mg/kg), and midazolam (0.5 mg/kg). The sedative effect of midazolam was maximal 30 min after oral administration. Ninety-five percent of the children who were separated from their parents within 45 min after oral midazolam administration (with or without atropine) had satisfactory separation scores (vs 66% of those separated after 45 min; P less than 0.02). Midazolam-treated patients were more cooperative with a mask induction of anesthesia compared with non-midazolam-treated children (83% vs 56%). Neither atropine nor meperidine appeared to significantly improve the effectiveness of oral midazolam. No preoperative changes in heart rate, respiratory rate, or hemoglobin oxygen saturation were noted in any of the treatment groups. Finally, oral midazolam did not prolong recovery even after outpatient procedures lasting less than 30 min. In conclusion, midazolam (0.5 mg/kg) given orally 30-45 min before induction of anesthesia is safe and effective without delaying recovery after ambulatory surgery.