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Paradoxical reactions to rectal midazolam as premedication in children
J A Roelofse1, D H Stegmann, J Hartshorne
1Department of Anaesthesia, Faculty of Dentistry, University of Stellenbosch, Republic of South Africa.
Insights
Rectal midazolam effectively sedated children undergoing dental surgery. Higher doses of midazolam (0.25-0.45 mg/kg) significantly improved anxiolysis and sedation levels without impacting vital signs.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Premedication in pediatric anesthesia aims to reduce anxiety and facilitate induction.
- Midazolam is a commonly used sedative agent for pediatric premedication.
- Rectal administration offers a non-invasive route for administering medication to young children.
Purpose of the Study:
- To evaluate the efficacy and safety of different doses of rectal midazolam as premedication in children undergoing oral surgery.
- To determine the relationship between midazolam dosage and the levels of anxiolysis and sedation.
Main Methods:
- Eighty healthy children aged 2-7 years were randomly assigned to four groups.
- Three groups received rectal midazolam at doses of 0.25, 0.35, or 0.45 mg/kg.
- One group received a placebo (saline) 30 minutes prior to general anesthesia induction.
- Systolic and diastolic blood pressures, respiration, and pulse rates were monitored pre- and post-sedation.
Main Results:
- No statistically significant differences were observed in systolic blood pressure, diastolic blood pressure, respiration rate, or pulse rate between the groups.
- A statistically significant association was found between midazolam dosage and the levels of anxiolysis and sedation (p < 0.0001).
- Higher doses of rectal midazolam correlated with increased anxiolysis and sedation.
Conclusions:
- Rectal midazolam is a safe premedication option for pediatric oral surgery, with no significant adverse effects on vital signs.
- The dosage of rectal midazolam is directly related to its effectiveness in achieving desired levels of anxiolysis and sedation in children.
- Optimizing midazolam dosage can enhance the pre-anesthetic experience for pediatric patients.
Abstract:
Eighty healthy children, between the ages of 2 and 7 years, who were to undergo oral surgical procedures under general anaesthesia, were allocated randomly to 4 groups. Three groups received rectal midazolam, and the other group a placebo (saline) as premedication 30 min prior to induction of anaesthesia. Group A children received midazolam 0.25 mg/kg, Group B 0.35 mg/kg and Group C 0.45 mg/kg. No statistically significant difference was found between the treatment groups as to the effect on systolic- (p = 0.6920) and diastolic (p = 0.8701) blood pressures, respiration (p = 0.0505) and pulse (p = 0.6192) rates at either pre- or post-sedation levels. However, the results indicate that levels of anxiolysis and sedation were significantly associated with midazolam dosage (p less than 0.0001).