Comparison of preanesthetic sedation in pediatric patients with oral and intranasal midazolam.
OBJECTIVE
Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children.


METHODS
With randomization, Group O (30 children): Received oral midazolam syrup 0.5 mg/kg and Group IN (30 children): Received intranasal midazolam spray 0.2 mg/kg. Every child was observed for acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug. Data were analyzed using Student's t-test, standard error of the difference between two means and Chi-square test.


RESULTS
In Group O and IN, 15/30 children (50%) and 7/30 children (23%) accepted drug easily (P < 0.05); 4/22 children (18%) in Group O and 11/20 children (55%) in Group IN cried after drug administration (P < 0.05). In both the groups, sedation at 20 min after premedication (Group O [80%] 24/30 vs. Group IN [77%] 23/30), parental separation and acceptance to mask were comparable (P > 0.05); 12/30 children (40%) in Group IN showed transient nasal irritation.


CONCLUSIONS
Oral midazolam and intranasal midazolam spray produce similar anxiolysis and sedation, but acceptance of drug and response to drug administration is better with oral route.
Department of Anaesthesiology, Government Medical College, Aurangabad, Maharashtra, India.
Purvashree Vijay
PV
Deshmukh
Department of Anaesthesiology, Government Medical College, Aurangabad, Maharashtra, India.
Sadhana Sudhir
SS
Kulkarni
Department of Anaesthesiology, Government Medical College, Aurangabad, Maharashtra, India.
Mukund Kachru
MK
Parchandekar
Department of Anaesthesiology, Government Medical College, Aurangabad, Maharashtra, India.
Sneha Purshottam
SP
Sikchi
Children; intranasal spray; midazolam; oral; preanesthetic sedation