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Intramuscular compared to intravenous midazolam for paediatric sedation: A study on cardiopulmonary safety and

Mohammad-Reza Ghane, Hamid-Reza Javadzadeh, Sadrollah Mahmoudi

  • 1Department of Paediatrics' Diseases, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.

African Journal of Paediatric Surgery : AJPS
|July 23, 2014
PubMed

Insights

Both intramuscular (IM) and intravenous (IV) midazolam are effective and safe for pediatric procedural sedation in emergency departments (ED). IV midazolam acts faster, but IM is a viable option when IV access is difficult.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Clinical Anesthesiology

Background:

  • Sedation in pediatric emergency departments (ED) is a complex issue.
  • Midazolam, a benzodiazepine, is frequently used for procedural sedation in children.
  • Comparing intramuscular (IM) and intravenous (IV) midazolam administration is crucial for optimizing pediatric sedation protocols.

Purpose of the Study:

  • To compare the effectiveness and safety of intramuscular (IM) versus intravenous (IV) midazolam for procedural sedation in pediatric patients.
  • To evaluate sedation, cooperation, and irritation scores.
  • To assess the safety profile, including vital signs and oxygen saturation.

Main Methods:

  • A cohort study involving 30 children in each of two matched groups.
  • Group 1 received intramuscular midazolam (0.3 mg/kg).
  • Group 2 received intravenous midazolam (0.15 mg/kg).
  • Effectiveness was assessed via sedation, irritation, and cooperation scores every 15 minutes for 60 minutes.
  • Safety was monitored through vital signs and oxygen saturation.

Main Results:

  • All patients achieved complete sedation after the initial dose.
  • The overall complication rate was 68.3%, with euphoria being the most common (58.3%), showing no significant difference between groups (P = 0.396).
  • Intravenous midazolam resulted in faster sedation onset compared to intramuscular administration (P > 0.001).
  • Significant changes in vital signs and oxygen saturation were observed within and between groups (P < 0.05).

Conclusions:

  • Both IM and IV midazolam are effective and safe for pediatric sedation in the ED.
  • While IV midazolam provides quicker sedation, IM midazolam is a practical alternative for patients with limited IV access.
  • Close monitoring for potential psychological side-effects is recommended for all sedated pediatric patients.
Abstract

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