Efficacy of Different Doses of Oral Midazolam for Pre Operation Sedation of Children

Beirami, Faranak; Khoshfetrat, Masoum; Babaiyan, Saeede; Ansari-Moghaddam, Alireza

doi:10.17795/zjrms-6671

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…Combining the documentation by Beirami et al with the report of Sheta et al 0.75 mg/kg oral midazolam empirically is associated with minimal or no causation of deep sedation. 4,13 In the two groups of this study, 0% deep sedation was observed supporting Beirami et al and of Sheta et al 4,13 Excellent sedation is critical to achieving zero agitation level and circumventing the attendant short term and long term sequelae of preoperative anxiety in children. The evidence that children aged 1 to 5 years exhibit the highest level of separation anxiety, and the efficacy of oral midazolam premedication in decreasing the incidence of preoperative and emergence agitation among children has been documented.…”

Section: Discussionsupporting

confidence: 78%

“…4 Similarly Beirami et al documented that undue sedation occurred in their group C subjects following the administration of 1 mg/kg oral midazolam. 13 Inferentially, a dose of 0.75 mg/kg or 0.8 mg/kg of injectable midazolam given orally as premedication, when compared to a 0.5 mg/kg dose, provided a rapid onset of a more desirable sedation, while a dose of 1.0 mg/kg produced an undue over sedation, thereby, posing threat of more harm than benefit in a proportion of children. Combining the documentation by Beirami et al with the report of Sheta et al 0.75 mg/kg oral midazolam empirically is associated with minimal or no causation of deep sedation.…”

Section: Discussionmentioning

confidence: 99%

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Effect of two different doses of oral midazolam premedication on separation anxiety in children scheduled for herniotomy

2023

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Background: Peri-operative separation anxiety in children adversely impacts on their cognitive function and behavioural outcome. The aim of the study was to assess the effect of two different doses of oral midazolam premedication on separation anxiety in paediatric patients scheduled for herniotomy. Methods: Eighty-four eligible children aged 1-6 years, of American Society of Anesthesiologists (ASA) class I or II, scheduled for herniotomy, were randomized into two groups, A and B, of 42 each after ethical clearance and written parental consent. Children in group A and group B received 0.5 mg/kg and 0.75 mg/kg respectively of oral midazolam flavoured with paracetamol syrup, were observed, and later separated from parents at 30 min post-premedication. Premedicant acceptability was noted, and separation anxiety was assessed using the Richmond agitation sedation scale (RASS). Statistical significance was set at p<0.05. Results: All 84 children completed the study. At 30 min post-premedication, 47.6% in group A and 19.1% in group B had light sedation, while 52.4% in group A and 80.9% in group B were moderately sedated, p=0.0001. Premedicant acceptability and agitation scores between the groups were comparable, p>0.05. Conclusions: Oral 0.5 mg/kg and 0.75 mg/kg midazolam induced desirable sedation in children at the 30th min with comparable lower agitation scores; however, the 0.75 mg/kg dose achieved significantly faster onset and higher level of sedation in a greater proportion of the subjects.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Effect of two different doses of oral midazolam premedication on separation anxiety in children scheduled for herniotomy

2023

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“…According to previous relevant literature and our preliminary trials 23 , we choose 0.5 mg·kg −1 as constant dose of midazolam oral solution (10 ml: 20 mg, Yichang Humanwell, Inc., YiChang, HuBei; SFDA No. H20213321), the initial dose of intranasal esketamine is 1 mg·kg −1 as followed (2 ml: 50 mg, Jiangsu Hengrui Medicine; SFDA No.…”

Section: Methodsmentioning

confidence: 99%

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures：a prospective cohort study

Wang¹,

Zeng²,

Zhao³

et al. 2023

International Journal of Surgery

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Background: Severe dental phobia or failure to cooperate with treatment are very common in outpatient pediatric dentistry. Personalized and appropriate noninvasive anesthesia methods can save medical expenses, improve treatment efficiency, reduce the anxiety of children, and improve the satisfaction of nursing staff. Currently, there is little conclusive evidence for noninvasive moderate sedation strategies in pediatric dental surgery. Materials and methods: The trial was conducted from May 2022 to September 2022. Each child was first given midazolam oral solution 0.5 mg·kg −1 , and when the Modified Observer’s Assessment of Alertness and Sedation score reached 4, a biased coin design up-down method was used to adjust the dose of esketamine. The primary outcome was the ED 95 and 95% CI of intranasal esketamine hydrochloride with midazolam 0.5 mg·kg −1 . Secondary outcomes included the onset time of sedation, treatment and awakening times, and the incidence of adverse events. Results: A total of 60 children were enrolled; 53 children were successfully sedated but 7 were not. The ED 95 of intranasal esketamine with 0.5 mg·kg −1 midazolam oral liquid for the treatment of dental caries was 1.99 mg·kg −1 (95% CI 1.95–2.01 mg·kg −1 ). The mean onset time of sedation for all patients was 43.7±6.9 min. 15.0 (10–24.0) min for examination and 89.4±19.5 min for awakening. The incidence of intraoperative nausea and vomiting was 8.3%. Adverse reactions such as transient hypertension and tachycardia occurred during the operations. Conclusion: The ED 95 of intranasal esketamine with 0.5 mg·kg −1 midazolam oral liquid for the outpatient pediatric dentistry procedure under moderate sedation was 1.99 mg·kg −1 . For children aged 2–6 years with dental anxiety who require dental surgery, anesthesiologists may consider using midazolam oral solution combined with esketamine nasal drops for noninvasive sedation after a preoperative anxiety scale evaluation.

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Efficacy of Different Doses of Oral Midazolam for Pre Operation Sedation of Children

Cited by 2 publications

References 17 publications

Effect of two different doses of oral midazolam premedication on separation anxiety in children scheduled for herniotomy

Effect of two different doses of oral midazolam premedication on separation anxiety in children scheduled for herniotomy

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures：a prospective cohort study

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