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[Oral premedication with midazolam in children]
G Molter1, P Altmayer, G Castor
1Klinik für Anästhesiologie und Intensivmedizin, Universitätskliniken des Saarlandes.
Insights
Oral midazolam is a safe and effective premedication for pediatric surgery, offering mild sedation and positive behavioral outcomes. This method is preferred over intramuscular or rectal administration for children undergoing elective procedures.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Context:
- Preoperative anxiety and distress are common in pediatric patients undergoing surgery.
- Traditional premedication methods like intramuscular injections can be painful and traumatic.
- Alternative, less invasive premedication strategies are needed to improve the pediatric surgical experience.
Purpose:
- To evaluate the efficacy and safety of oral midazolam as a premedication in children undergoing elective urological surgery.
- To assess the sedative, behavioral, and emotional effects of oral midazolam in pediatric patients.
- To compare the physiological and side effect profiles of oral midazolam premedication.
Summary:
- A study involving 100 children (6 months-10 years) found oral midazolam (0.4 mg/kg) resulted in mild to no preoperative sedation in 76-84% of patients.
- Preoperative behavior was cooperative or passive in 67-88%, with 70-84% exhibiting indifferent or euphoric states.
- Postoperatively, significant sedation was observed (57-89%), with minimal alterations in circulatory parameters and rare side effects (hiccough, vomiting, laryngospasm, stridor).
Impact:
- Oral midazolam provides a favorable alternative to intramuscular or rectal premedication, reducing patient distress.
- This approach can lead to a more positive preoperative experience for children and their families.
- The findings support the recommendation of oral midazolam for routine premedication in pediatric surgical patients.
Abstract:
One hundred children aged between 6 months and 10 years undergoing elective urological surgery, received 0.4 mg/kg midazolam orally about 20 minutes prior to the arrival in the operation theatre. The physiological state of the children was estimated and recorded pre- and postoperatively at defined, comparable and representative circumstances by a specially developed design. In the preoperative period orally administered midazolam had only a mild or non sedative effect in 76-84% of the children, 67-88% of the small patients behaved cooperatively or passively and 70-84% showed an indifferent or euphoric state of mind. Postoperatively 57-89% of the children were markedly sedated; therefore, the estimation of behaviour and state of mind was of minor significance. The circulatory parameters were altered only minimally. Systolic blood pressure and heart rate changed slightly but significantly compared to the preoperative values the day before surgery: a preoperative increase to a maximum immediately after the insertion of the venous cannula and a postoperative maximum after recovery. Side effects were rare (hiccough 5%, vomitus 4%, laryngospasm 1%, stridor 1%). Our results suggest that oral premedication with midazolam in children can be recommended to avoid traumatic or unpleasant alterations resulting from intramuscular injections or rectal applications. Therefore, we prefer this kind of premedication in paediatric patients.