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Premedication with midazolam nasal spray: an alternative to oral midazolam in children

Ravi K Verma1, Anil Paswan1, Anisa De1

  • 1Department of Anesthesia, Banaras Hindu University (BHU), Varanasi, India.

Anesthesiology and Pain Medicine
|June 7, 2014
PubMed

Insights

Nasal midazolam spray offers better sedation and easier anesthesia induction in children compared to oral midazolam. While oral administration was more accepted, the nasal spray demonstrated superior efficacy in achieving sedation and facilitating general anesthesia.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Clinical Trials

Background:

  • Midazolam, a water-soluble benzodiazepine, is commonly administered intravenously and orally.
  • A nasal spray formulation of midazolam has recently become available for clinical use.

Purpose of the Study:

  • To compare the efficacy of oral midazolam versus midazolam nasal spray for pediatric premedication.
  • To assess patient acceptability, sedation scores, and ease of general anesthesia induction.

Main Methods:

  • A randomized controlled trial involving 60 healthy children (2-6 years) undergoing elective surgery.
  • Children received either oral midazolam (mixed in honey) or a commercial midazolam nasal spray.
  • Outcomes included patient acceptance, sedation levels, ease of induction, and recovery parameters.

Main Results:

  • Children showed better acceptance of oral midazolam compared to the nasal spray.
  • The nasal spray group achieved higher satisfactory sedation scores at 10 and 20 minutes.
  • Nasal midazolam spray resulted in better ease of anesthesia induction, shorter recovery times, and improved post-anesthesia recovery scores.

Conclusions:

  • Midazolam nasal spray is an acceptable and effective alternative to oral midazolam for pediatric premedication.
  • The nasal spray offers significant advantages in terms of sedation efficacy and anesthesia induction.
Abstract

Keywords:
AnesthesiaMidazolamNasal SpraysPremedication

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