Sublingual midazolam premedication in children: a dose response study

Area of Science:

• Anesthesiology
• Pediatric Medicine
• Pharmacology

Background:

• Premedication is crucial for managing pediatric anxiety and facilitating anesthesia induction.
• Sublingual administration offers a non-invasive alternative to oral or intravenous routes for pediatric medications.

Purpose of the Study:

• To assess the efficacy of varying sublingual midazolam doses for pediatric premedication.
• To determine the optimal dose for achieving satisfactory sedation and improving mask acceptance in children undergoing day surgery.

Main Methods:

• A prospective, double-blind, placebo-controlled trial involving 102 children (12-129 months).
• Children received placebo or sublingual midazolam at doses of 0.25, 0.5, or 0.75 mg/kg, mixed with grape syrup.
• Sedation levels and mask induction acceptance were evaluated 15 minutes post-administration.

Main Results:

• Satisfactory sedation was observed in 28% (0.25 mg/kg), 52% (0.5 mg/kg), and 64% (0.75 mg/kg) of midazolam recipients, versus 0% for placebo.
• Higher midazolam doses (0.5 and 0.75 mg/kg) led to significantly better mask induction acceptance compared to the placebo and 0.25 mg/kg groups.

Conclusions:

• Sublingual midazolam is an effective premedication strategy in pediatric day surgery.
• Doses of 0.5 mg/kg and 0.75 mg/kg provide optimal sedation and facilitate mask induction in children.