A comparison of midazolam with trimeprazine as an oral premedicant for children

Abstract

SummaryThe effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg ¹1 given 30 min pre-operatively was compared with trimeprazine 2 mg.kg ¹1 given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p ¼ 0:0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.

Is midazolam superior to triclofos and hydroxyzine as premedicant in children?

“…Acceptance of the drug was assessed by this independent observer using the compliance score (1 = Good – readily takes medicine, 2 = Fair – accepts medicine with persuasion, 3 = Poor –unwilling to take medicine or spits it out, 4 = Refuses medicine). [8]…”

“…Quality of anesthetic induction in terms of acceptance of face mask was graded on four point score (1 = Poor – afraid, combative, crying, 2 = Fair – moderate fear of mask, not easily calmed, 3 = Good – slight fear of mask, easily calmed, 4 = Excellent – unafraid, cooperative, accepts mask easily). [8] An intravenous infusion line was set up after the child was asleep. Endotracheal intubation was done after giving injection vecuronium (0.1 mg/kg) and anesthesia was maintained with nitrous oxide in 33% oxygen and sevoflurane with supplemental doses of vecuronium (0.025 mg/kg) as and when required for controlled ventilation.…”

Paediatric sedation for imaging is safe and effective in a district general hospital

“…28 There are several articles covering the use of alimemazine as a sedative agent in paediatrics, but few in relation to imaging. [29][30][31] Two groups have reported a success rate of 85% for imaging acquisition when alimemazine was combined with either chloral hydrate or papaveretum (a mixture of opioids). 12,32 The pharmacokinetics of alimemazine are well studied, showing a maximal venous blood drug concentration 1-2 h after ingestion and with a half-life of 6.8 h. 33 A survey of parents showed a median time of "return to normality" of the child of 21.5 h when chloral hydrate and alimemazine were used together.…”

Are antihistamines effective in children? A review of the evidence

“…These trials found conflicting results with some reporting short-term improvement while on alimemazine 15–19. Alimemazine has been shown to have the sedative effect, necessary for the use as a premedicant in children 20 21. In addition, in a randomised placebo-controlled trial with 15 children, alimemazine caused relief of retching after Nissen fundoplication 22.…”