Intravenous midazolam in small bowel biopsy.

Abstract

Intravenous midazolam in small bowel biopsy EDITOR,-Small bowel biopsy has an important role in paediatric gastroenterology. The diagnosis of coeliac disease, the second most common chronic disease in Swedish children, is fully based for instance on the findings of serial small bowel biopsies. In Sweden most paediatric centres perform biopsies using peroral capsule instruments and without general anaesthesia. This biopsy procedure is uncomfortable to children. Optimal sedation is thus essential. Moreover, in a well sedated child the radiation dose can be minimised.' We have previously found intravenous midazolam to be effective and superior to other sedatives given orally.2

Small bowel capsule biopsy in children: parents’ opinions on children’s discomfort

“…All children were given the prokinetic drug metoclopramide intravenously immediately before the midazolam was administered. Details of the doses administered are given elsewhere (2). The biopsy was performed with a paediatric Storz capsule (Karl Storz AG, Germany) under intermittent uoroscopy by one of the authors.…”

“…Most paediatric clinics in Sweden perform the biopsies using peroral capsule instruments (1) under conscious sedation, e.g. intravenous midazolam, which is an effective and safe means of sedation for paediatric patients (2). This study was designed to nd out how parents react to the discomfort of their children undergoing small bowel biopsy.…”

Technique of Small‐Bowel Biopsy

“…), which has a rigid tubing that permits manipulation and can be made even more maneuverable by the use of an inner metal guide wire. Immediately prior to the biopsy procedure, the children are given intravenous metoclopramide 0.30 mg/kg body weight (maximum dose, 10 mg) followed by intravenous midazolam in an age‐adjusted dose (3). Using this technique in 403 children (median age, 2.5 years; range, 0.7‐17), we have reduced the median biopsy procedure time, as measured from the moment the child has swallowed the capsule and the fluoroscopy is started to the moment the capsule is fired, to 5 min (range, 1‐45 min) and the median fluoroscopy time to 5 s (range, 1‐48 s).…”