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Evaluation of intranasal midazolam in children undergoing esophagogastroduodenoscopy
M Fishbein1, R A Lugo, J Woodland
1Department of Pediatrics, Columbus Children's Hospital, Ohio, USA.
Insights
Intranasal midazolam effectively reduces children's anxiety during parental separation before procedures. However, the benefits may be limited by discomfort from nasal drug administration.
Area of Science:
- Pediatric Sedation
- Anesthesiology
- Gastroenterology
Background:
- Conscious sedation for pediatric esophagogastroduodenoscopy (EGD) often involves intravenous midazolam and opioids.
- Children experience significant pre-procedure anxiety, particularly during separation and venipuncture.
- Intranasal midazolam offers a noninvasive alternative for pre-procedural sedation.
Purpose of the Study:
- To evaluate the efficacy of intranasal midazolam in reducing anxiety during parental separation and venipuncture in children undergoing EGD.
- To assess the adequacy of sedation provided by intranasal midazolam during EGD procedures.
Main Methods:
- Prospective, randomized, double-blind study involving 40 children (2-12 years) undergoing EGD.
- Group I received intranasal placebo followed by IV midazolam and meperidine.
- Group II received intranasal midazolam followed by IV placebo and meperidine.
Main Results:
- Intranasal midazolam significantly decreased negative behaviors associated with parental separation (p < 0.05).
- No significant differences in negative behaviors were observed during venipuncture or EGD between groups.
- Increased negative behaviors were noted during the administration of intranasal agents (midazolam or placebo).
Conclusions:
- Intranasal midazolam is effective in mitigating separation anxiety in pediatric patients undergoing EGD.
- While providing adequate sedation for the procedure, intranasal drug delivery may cause discomfort, potentially offsetting its benefits.
Background:
Intravenous midazolam and opioids are used to produce conscious sedation in children undergoing esophagogastroduodenoscopy (EGD). However, children may experience significant fear and anxiety before receiving these medications, especially during separation from parents and during venipuncture. Intranasal administration of midazolam represents a noninvasive method of sedating children before anxiety-producing events. The objective of this study was to determine whether premedication with intranasal midazolam reduces stress and anxiety of separation from parents and of undergoing venipuncture, while maintaining adequate sedation during EGD.
Methods:
This was a prospective, randomized, double-blind study in 40 children, aged 2 to 12 years, who were undergoing EGD. Patients in group I were premedicated with intranasal placebo (0.9% NaCl) followed 10 minutes later by intravenous midazolam (0.05 mg/kg) and intravenous meperidine (1 mg/ kg). Patients in group II were premedicated with intranasal midazolam (0.2 mg/kg) followed by intravenous placebo (0.9% NaCl) and intravenous meperidine (1 mg/kg). Anxiolysis and sedation were scored by a blinded observer, who identified minor and major negative behaviors during four observation periods: intranasal drug administration, separation from parents, venipuncture, and EGD.
Results:
Premedication with intranasal midazolam significantly reduced negative behaviors during separation from parents (p < 0.05); however, no difference between regimens was noted during venipuncture or EGD. Negative behaviors appeared to increase during administration of intranasal midazolam or placebo.
Conclusions:
Premedication with intranasal midazolam is effective in reducing negative behaviors during separation from parents, while it maintains sedation during the endoscopic procedure. The benefits of intranasal administration may be negated, however, by irritation, and discomfort caused by intranasal drug delivery.