title: Midazolam premedication in children: a pilot study comparing intramuscular and intranasal administration.
abstract: The purpose of this study was to compare the effectiveness of intramuscular and intranasal midazolam used as a premedication before intravenous conscious sedation. Twenty-three children who were scheduled to receive dental treatment under intravenous sedation participated. The patients ranged in age from 2 to 9 years (mean age, 5.13 years) and were randomly assigned to receive a dose of 0.2 mg/kg of midazolam premedication via either intramuscular or intranasal administration. All patients received 50% nitrous oxide and 50% oxygen inhalation sedation and local anesthetic (0.2 mL of 4% prilocaine hydrochloride) before venipuncture. The sedation level, movement, and crying were evaluated at the following time points: 10 minutes after drug administration and at the times of parental separation, passive papoose board restraint, nitrous oxide nasal hood placement, local anesthetic administration, and initial venipuncture attempt. Mean ratings for the behavioral parameters of sedation level, degree of movement, and degree of crying were consistently higher but not significant in the intramuscular midazolam group at all 6 assessment points. Intramuscular midazolam was found to be statistically more effective in providing a better sedation level and less movement at the time of venipuncture than intranasal administration. Our findings indicate a tendency for intramuscular midazolam to be more effective as a premedication before intravenous sedation.
authors.affiliation: Advanced Pediatric Dentistry Program, University of Southern California School of Dentistry, 925 W 34th St, Los Angeles, CA 90089-0641, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Lam
authors.forename: Richard D
authors.initials: RD
authors.lastname: Udin
authors.forename: Stanley F
authors.initials: SF
authors.lastname: Malamed
authors.forename: David L
authors.initials: DL
authors.lastname: Good
authors.forename: Jane L
authors.initials: JL
authors.lastname: Forrest
mesh_terms: D000281:Administration, Intranasal; D000766:Anesthesia, Dental; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D016292:Procedural Sedation / Q000145:classification; D003448:Crying; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007273:Injections, Intramuscular; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D009068:Movement / Q000187:drug effects; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D018962:Phlebotomy; D010865:Pilot Projects; D011229:Preanesthetic Medication; D011318:Prilocaine / Q000008:administration & dosage; D012894:Sleep Stages / Q000187:drug effects
chemical_list: D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D011318:Prilocaine; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen