title: Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients.
abstract: The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventy-two adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The 36 patients of TG1 received 7.5 mg midazolam orally 15 min before MRI, whereas the 36 patients of TG2 received one (or, if necessary, two) pumps of a midazolam nasal spray into each nostril immediately prior to MRI (in total, 1 or 2 mg). Patients' tolerance, anxiety and sedation were assessed using a questionnaire and a visual analogue scale immediately before and after MRI. Image quality was evaluated using a five-point-scale. In TG1, 18/36 MRI examinations (50%) had to be cancelled, the reduction of anxiety was insufficient in 12/18 remaining patients (67%). In TG2, 35/36 MRI examinations (97%) were completed successfully, without relevant adverse effects. MRI image quality was rated higher among patients of TG2 compared to TG1 (p<0.001). Low-dose intranasal midazolam is an effective and patient-friendly solution to overcome anxiety in claustrophobic patients in a broad spectrum of body MRI. Its anxiolytic effect is superior to that of the orally administrated form.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland. Frank.Tschirch@usz.ch
authors.forename: Frank T C
authors.initials: FT
authors.lastname: Tschirch
authors.forename: Kerstin
authors.initials: K
authors.lastname: Göpfert
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Fröhlich
authors.forename: Genevieve
authors.initials: G
authors.lastname: Brunner
authors.forename: Dominik
authors.initials: D
authors.lastname: Weishaupt
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D001007:Anxiety / Q000517:prevention & control / Q000523:psychology; D001143:Arousal / Q000187:drug effects; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging / Q000523:psychology*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010698:Phobic Disorders / Q000517:prevention & control* / Q000523:psychology; D011187:Posture; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam