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Physician Self-Reported Practice Patterns: Midazolam for Minor Procedures in Pediatric Patients
Zola Trotter1, Cherisse Mecham2, Bikash Bhattarai1
1Valleywise Health Medical Center, Phoenix, AZ, USA.
Clinical Pediatrics
|December 5, 2022
Summary
Physician practices vary widely in midazolam dosing and monitoring for pediatric procedures. Developing guidelines for intranasal and oral midazolam use could standardize care and enhance patient safety.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Practice Guidelines
Background:
- Minimal sedation using midazolam is common for pediatric procedures.
- Lack of established guidelines for intranasal (INM) and oral midazolam (POM) use creates practice variability.
Purpose of the Study:
- To investigate self-reported physician practices regarding midazolam administration for minor pediatric procedures.
- To identify variations in dosing, monitoring, and pre-procedure considerations.
Main Methods:
- A survey was developed and approved by the Academy of Pediatrics Section on Emergency Medicine (APP-SOEM).
- The survey was electronically distributed to physicians, gathering data on INM and POM dosing, NPO status, cardiopulmonary monitoring, and discharge criteria.
- A 47% response rate (218/465) was achieved.
Main Results:
- Significant variation exists in therapeutic and maximum INM and POM doses.
- Physician use of cardiopulmonary monitors during midazolam sedation was inconsistent (42% never used monitors).
- Most physicians (80%) did not consider NPO status, with alertness being the primary discharge criterion.
Conclusions:
- This nationwide survey reveals considerable practice variation among physicians in midazolam dosing and monitoring for pediatric procedures.
- Implementing standardized practice guidelines for minimal sedation with midazolam is recommended to improve patient care and physician consistency.
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