Journal of Clinical and Diagnostic Research (Feb 2012)
Midazolam Pre-medication in Paediatrics: Comparison of the Intranasal and Sublingual Routes by Using an Atomizer Spray
Abstract
Introduction: Most of the children suffer from severe anxiety and apprehension when they are separated from their parents or family members for the induction of anaesthesia. Materials and Methods: In a prospective randomized double blind study, the intra-nasal and sub-lingual administration of midazolam in paediatric patients who were undergoing root canal procedures which required general anaesthesia was evaluated in 60 children who were aged between 2-6 years, with ASA physical status I and II by using a new midazolam atomiser spray. The patients were divided into two groups of 30 patients each and they received midazolam 0.3mgkg-1 either intranasally or sub-lingually in a randomized manner. The heart rate, oxygen saturation (spo2), respiratory rate and the degree of sedation before and at 5 min, 10 min and 15 min (separation score) after the drug administration, during the mask application (mask acceptance score), before induction (induction score) and during the recovery at 10 min, 20min and 30mins (recovery score) were recorded and compared. Results: In our study, 60% of the paediatric patients cried during the administration of midazolam by the intra-nasal route, while only 16% of the paediatric patients cried during its administration by the sub-lingual route. A bitter taste was observed in 45% (14/30) of the patients who received midazolam by the sublingual route. Although there was a slight increase in the heart rate in the intra-nasal group, no statistically significant variation in the heart rate, the respiratory rate and the oxygen saturation was found from the baseline in both the groups (P>0.05). A sedation score of >3(approx) was achieved in both the groups within 10 minutes of the drug administration. The response to the child parent separation, the mask application score , the induction score and the recovery score did not differ significantly between the two groups ( P >0.05). Conclusion: Both the intra-nasal and sub-lingual administration of midazolam as a Pre-medication is safe and equally effective in paediatric patients.
