Injectable midazolam as oral premedicant in pediatric neurosurgery

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Premedication in pediatric patients undergoing neurosurgery is crucial for managing anxiety and ensuring procedural safety.
• Injectable midazolam is commonly used for sedation, but its oral administration as a premedicant requires evaluation for efficacy and safety in this specific population.
• Assessing patient acceptability and potential side effects of oral midazolam is essential for clinical practice.

Purpose of the Study:

• To evaluate the acceptability, efficacy, and safety of injectable midazolam administered orally as a premedicant in children undergoing elective neurosurgical operations.
• To determine the optimal dosage of oral midazolam for pediatric neurosurgical patients.
• To compare the effects of different doses of oral midazolam against a placebo.

Main Methods:

• A randomized, double-blind, placebo-controlled study involving 100 pediatric patients (6 months to 6 years) undergoing elective neurosurgery.
• Patients were assigned to receive placebo or oral midazolam at doses of 0.50, 0.75, or 1.0 mg/kg, 45 minutes prior to separation from parents.
• Data collected included patient acceptability, reaction to separation, sedation scores, vital signs, anesthesia duration, recovery conditions, and side effects.

Main Results:

• Oral midazolam was found to be acceptable, with minimal vomiting or rejection after ingestion.
• Midazolam premedication improved the reaction to parental separation and reduced anxiety in the operating room compared to placebo.
• The 0.75 mg/kg dose demonstrated optimal efficacy and safety, with fewer complications and no delayed recovery, unlike the 1.0 mg/kg dose.

Conclusions:

• Injectable midazolam is an acceptable, effective, and safe oral premedicant for pediatric neurosurgical patients at a dose of 0.75 mg/kg.
• Lower doses (0.50 mg/kg) were less effective, while higher doses (1.0 mg/kg) did not offer additional benefits and potentially delayed recovery.
• The 0.75 mg/kg oral midazolam dose provides a favorable balance of efficacy, safety, and acceptable recovery characteristics in this pediatric population.