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[Premedication with intranasal midazolam in children of various ages]
R Vivarelli1, F Zanotti, D Battaglia
1Servizio II di Anestesia e Rianimazione, Azienda Ospedaliera Arcispedale S. Anna, Ferrara.
Insights
Nasal midazolam (mdz) is effective for pediatric premedication, especially in infants. This study compared nasal mdz to oral diazepam (dz), finding nasal mdz superior in younger children for sedation and anxiety.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Care
Background:
- Premedication is crucial for managing pediatric anxiety and sedation before surgery.
- Comparing different routes of administration for common sedatives is essential for optimizing patient care.
- Midazolam (mdz) and diazepam (dz) are frequently used sedatives in pediatric populations.
Purpose of the Study:
- To compare the efficacy of nasal midazolam (mdz) versus oral diazepam (dz) for premedication in pediatric surgical patients.
- To evaluate the impact of age on the effectiveness of different premedication routes.
- To assess sedation, anxiety, and collaboration levels during anesthesia induction.
Main Methods:
- A comparative study involving 248 pediatric patients undergoing surgery, divided into three age groups.
- Patients received either nasal midazolam (0.2 mg/kg) or oral diazepam (0.2 mg/kg) as premedication.
- Key parameters assessed included treatment acceptance, sedation level, anxiety, and collaboration during anesthesia induction.
Main Results:
- Nasal midazolam acceptance was high across age groups (59% in <2 yrs, 62% in pre-school, 97% in school-age).
- Significant differences favoring nasal midazolam were observed in younger age groups (under 2 years and pre-school) for all studied parameters.
- No significant differences were found between the two premedication methods in the school-age group.
Conclusions:
- Nasal midazolam is a safe and effective premedication option for pediatric patients.
- The efficacy of nasal midazolam is particularly pronounced in younger children (infants and pre-schoolers).
- This route offers a viable alternative for improving the pre-anesthetic experience in pediatric surgery.
Background And Aim:
To evaluate the efficacy of premedication with midazolam (mdz) administered using a nasal route compared to diazepam (dz) administered by mouth in children of different ages.
Experimental Design:
A comparative type study was performed in randomly selected pediatric patients undergoing surgery. The study lasted 3 months.
Setting:
Recovery room and operating theatre for Pediatric Surgery and ENT.
Patients:
A total of 248 patients were studied, divided into 3 age groups: group A were aged under 2 years; group B were pre-school age and group C were school-age.
Operations:
Two subgroups were formed based on the premedication used: group M = 0.2 mg/kg of mdz using a nasal route on arrival in the operating unit; group D = 0.2 mg/kg of dz per os 45' before induction. PARAMETERS STUDIED: In addition to acceptance of treatment, which was deemed to be good, poor or refused, the authors evaluated the level of sedation (score from 5 to 1: awake-asleep), anxiety on entering SO (score from 1 to 4: none-excessive) and the level of collaboration during the induction of general anesthesia (score 1-4: excellent-nil).
Results:
The nasal route was well accepted by 59% of patients in group A, 62% of group B and 97% of group C. Statistical analysis using Kruskall Wallis test showed significant differences in groups A and B between the two subgroups M and D for all the parameters studied, whereas there were no significant differences in group C.
Conclusions:
Premedication with mdz using a nasal route was safe and efficacious, above all in early and later infancy.