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Conscious sedation with high-dose midazolam for pediatric gastrointestinal endoscopy
D A Gremse1, S Kumar, A I Sacks
1Division of Pediatric Gastroenterology and Nutrition, University of South Alabama College of Medicine, Mobile, USA.
Insights
Higher doses of midazolam (greater than 0.3 mg/kg) are safe and effective for sedating children undergoing gastrointestinal endoscopy. This study found no significant differences in side effects or sedation efficacy compared to lower doses.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacology
Background:
- Midazolam is a common sedative for pediatric gastrointestinal endoscopy.
- Current recommended intravenous midazolam dosage for children is up to 0.3 mg/kg.
- The study investigated the potential for using higher midazolam doses.
Purpose of the Study:
- To evaluate the safety and efficacy of higher intravenous midazolam doses (> 0.3 mg/kg) for pediatric endoscopy.
- To compare outcomes between children receiving higher and lower midazolam doses.
Main Methods:
- Retrospective review of 116 pediatric patients (1-18 years) undergoing endoscopy.
- Comparison of sedation efficacy and side effects between two groups: midazolam doses >= 0.3 mg/kg (n=45) and < 0.3 mg/kg (n=71).
- All patients received meperidine (approx. 1 mg/kg).
Main Results:
- No significant differences were observed in blood pressure, pulse rate, respiratory rate, or oxygen saturation between groups.
- The degree and duration of sedation were similar across both dosage groups.
- Incidence of side effects like hypotension, hypoxia, and vomiting did not differ significantly.
Conclusions:
- Intravenous midazolam doses exceeding 0.3 mg/kg are suitable for conscious sedation in pediatric endoscopy.
- Higher doses of midazolam can be safely administered to children for this procedure.
- The findings support the use of adjusted midazolam dosages based on clinical need.
Background:
Midazolam is used frequently to sedate children for gastrointestinal endoscopy. The sedative dosage of intravenous midazolam commonly reported in children is up to 0.3 mg/kg. We hypothesized that larger doses of midazolam could be used for pediatric endoscopy.
Methods:
We retrospectively reviewed the medical records of 116 pediatric patients (aged 1 year to 18 years) who had endoscopy. The efficacy and side effects of sedation in 45 patients who received midazolam doses of > or = 0.3 mg/kg were compared with the same effects in 71 children who received < 0.3 mg/kg.
Results:
All patients received approximately 1 mg/kg meperidine (up to 50 mg) intravenously. The blood pressure, pulse rate, respiratory rate, oxygen saturation, degree and duration of sedation, and incidence of side effects such as hypotension, hypoxia, or vomiting were similar in both groups.
Conclusions:
Intravenous doses of midazolam > 0.3 mg/kg can be used for conscious sedation in children.