Comparison of rectal to intramuscular administration of midazolam and atropine for premedication of children

Abstract

The effectiveness of midazolam and atropine as anaesthetic premedication was investigated, comparing rectal to intramuscular administration. A total of 202 children varying in age from 10 months to 9 years, who had been admitted to the Day Surgery Department for short ENT procedures, were assigned to one of two groups on a random basis. The first group (n = 102) was given 0.5 mg/kg midazolam and 0.05 mg/kg atropine as a rectal solution 30 to 75 min prior to induction, while the second group (n = 100) was given 0.15 mg/kg midazolam and 0.02 mg/kg atropine as an intramuscular injection 20 to 60 min prior to induction. The levels of sedation and salivation were compared, as was the degree of tolerance to intravenous induction. The parents of children older than 3 years of age were given a questionnaire designed to determine the degree of amnesia. We found this combination of drugs to be effective in the relief of anxiety, the inhibition of salivary secretion and the promotion of memory loss, regardless of the route of administration. We feel that rectal administration is preferable because it is not associated with pain or anxiety.

What is the level of evidence for the amnestic effects of sedatives in pediatric patients? A systematic review and meta-analyses

“…Drugs currently used in clinical practice are reported in the following studies: midazolam was investigated in 33 trials [7, 14–16, 19, 27, 28, 31, 33, 35, 39–45, 47, 48, 50–54, 59, 61, 63, 66–71], nitrous oxide in seven [26, 30, 34, 42, 46, 50, 51], ketamine in eight [13–17, 26, 34, 37, 44, 49, 70], dexmedetomidine in one [49] and propofol in four [13, 14, 46, 47]. Besides, all drugs investigated in 23 studies were the ones currently used: 19 involved midazolam [7, 19, 27, 31, 33, 35, 40, 41, 50–52, 54, 61, 63, 66–70], three nitrous oxide [46, 50, 51], four ketamine [13, 17, 49, 70], one dexmedetomidine [49] and two propofol [13,46]. …”

“…Anterograde amnesia was evaluated in all studies, whereas retrograde amnesia was assessed in only 10 studies [7,33,35,37,39,40,52,54,60,66]. Amnesia was evaluated mainly by measuring patient recall of pictures/toys and events, except for the six trials [13,41,16,19,38,42].…”

Effects of benzodiazepines on explicit memory in a paediatric surgery setting

“…In addition, laboratory research has consistently shown that benzodiazepines produce anterograde amnesia-impaired memory for information learned after drug administration with no impairment for information learned pre-drug (Curran 1986). The present study was designed to extend prior lab-based findings to an applied setting where such amnestic effects might be beneficial (DeJong and Verburg 1988). In addition, it extended previous adult-focused research by examining the cognitive effects of benzodiazepines in children.…”

“…Many anaesthesiologists (e.g. DeJong and Verburg 1988) have noted that drug-induced amnesia could also be beneficial to children having surgery, as it might attenuate the psychological difficulties associated with separation from parents and/or problematic anaesthesia induction.…”

Effects of midazolam on explicit vs implicit memory in a pediatric surgery setting

“…surgery (e.g., DeJong and Verburg 1988;Kupietzky et al 1996;Playfor et al 2000). Midazolam is a benzodiazepine with a short half-life, making it a good candidate for use in the day surgery setting (Smith et al 1981).…”