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Published on: November 14, 2018

Comparison of Discharge Readiness in Pediatric Patients: Oral Versus Intranasal Preoperative Midazolam Administration

Mohammad Naem1, Jobayer Hossain2, Janna Hamideh1

  • 1University of Central Florida College of Medicine, Orlando, Florida, USA.

Paediatric Anaesthesia
|July 15, 2026
PubMed

Insights

Age, not the route of midazolam administration, impacts pediatric recovery time after tympanostomy. This study found age is the key factor influencing post-anesthesia care unit (PACU) length of stay, not oral versus intranasal midazolam.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Clinical Outcomes Research

Background:

  • Midazolam is frequently used orally or intranasally for preoperative anxiety in pediatric tympanostomy procedures.
  • Existing research suggests route-dependent recovery differences, but the impact on post-anesthesia care unit (PACU) length of stay is not well-established.

Purpose of the Study:

  • To investigate whether the route of midazolam administration (oral vs. intranasal) influences PACU length of stay in pediatric patients undergoing tympanostomy.
  • To identify independent predictors of PACU length of stay in this patient population.

Main Methods:

  • Retrospective chart review of 463 pediatric patients (6 months to 10 years) undergoing tympanostomy.
  • Patients received either oral (0.5 mg/kg) or intranasal (0.2 mg/kg) midazolam.
  • PACU length of stay analyzed using age-adjusted ANCOVA, with logistic regression for predictor evaluation.

Main Results:

  • Unadjusted analysis showed intranasal midazolam associated with shorter PACU stay (39.7 vs. 42.9 min).
  • Patients receiving intranasal midazolam were significantly younger (31.5 vs. 37.8 months).
  • After age adjustment, age was the sole predictor of PACU length of stay; route association became non-significant (p=0.15).

Conclusions:

  • Pediatric patient age, not the midazolam administration route, is the primary determinant of PACU discharge readiness after tympanostomy.
  • Observed recovery differences between oral and intranasal midazolam may be due to age-related confounding.
  • Further prospective, age-stratified research is recommended to refine pediatric sedation guidelines.
Abstract

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