title: Sedation with intranasal midazolam of Angolan children undergoing invasive procedures.
abstract: OBJECTIVE
  Ambulatory surgery is a daily requirement in poor countries, and limited means and insufficient trained staff lead to the lack of attention to the patient's pain. Midazolam is a rapid-onset, short-acting benzodiazepine which is used safely to reduce pain in children. We evaluated the practicability of intranasal midazolam sedation in a suburban hospital in Luanda (Angola), during the surgical procedures.
  
  
  METHODS
  Intranasal midazolam solution was administered at a dose of 0.5 mg/kg. Using the Ramsay's reactivity score, we gave a score to four different types of children's behaviour: moaning, shouting, crying and struggling, and the surgeon evaluated the ease of completing the surgical procedure using scores from 0 (very easy) to 3 (managing with difficulty).
  
  
  RESULTS
  Eighty children (median age, 3 years) were recruited, and 140 surgical procedures were performed. Fifty-two children were treated with midazolam during 85 procedures, and 28 children were not treated during 55 procedures. We found a significant difference between the two groups on the shouting, crying and struggling parameters (p < 0.001). The mean score of the ease of completing the procedures was significantly different among the two groups (p < 0.0001).
  
  
  CONCLUSIONS
  These results provide a model of procedural sedation in ambulatory surgical procedures in poor countries, thus abolishing pain and making the surgeon's job easier.
authors.affiliation: Divina Providéncia Hospital, Luanda, Angola.
authors.forename: Lumana
authors.initials: L
authors.lastname: Kawanda
authors.forename: Ivan
authors.initials: I
authors.lastname: Capobianco
authors.forename: Meta
authors.initials: M
authors.lastname: Starc
authors.forename: Daniel
authors.initials: D
authors.lastname: Felipe
authors.forename: Davide
authors.initials: D
authors.lastname: Zanon
authors.forename: Egidio
authors.initials: E
authors.lastname: Barbi
authors.forename: Nadine
authors.initials: N
authors.lastname: Munkela
authors.forename: Verónica
authors.initials: V
authors.lastname: Rodrigues
authors.forename: Lúis
authors.initials: L
authors.lastname: Malundo
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Not
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000810:Angola; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D016292:Procedural Sedation; D003448:Crying; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam