Oral Midazolam Premedication for Children Undergoing General Anaesthesia for Dental Care

Abstract

Objectives. To assess the efficacy and safety of injectable midazolam administered orally in 3 different doses in children undergoing complete dental rehabilitation under GA. Subjects and Methods. 60 children aged 2–6 years were enrolled in the study. The children were randomly assigned to one of 3 groups and received orally 0.5, 0.75, or 1.0 mg/kg of injectable midazolam mixed with apple juice 30 minutes before separation from parents. The following measurements were assessed: patient's acceptance of the medication, reaction to separation from parents, sedation scores, and recovery conditions. Results. More children were comfortable with parent separation in the group that received the 1.0 mg/kg dose (90%) compared to the group that received the 0.75 mg/kg dose (75%) and the group that received the 0.5 mg/kg dose (55%). The number of children who had desirable sedation was similar in the 0.75 mg/kg and 1.0 mg/kg dose groups. Twenty five percent of the children in the group that received the 0.5 mg/kg dose did not allow venepuncture before induction of GA, and induction of GA was poor for 20% of the children in this group. An increasing number of children scored excellent in terms of ease of venepuncture in 0.75 mg/kg dose group (10%) and in the 1.0 mg/kg dose group (20%) and in terms of induction of GA, 25% and 35%, respectively. Recovery of spontaneous ventilation and extubation was delayed by over 15 minutes in 2 children in the 1.0 mg/kg dose group. Conclusion. The dose of 0.75 mg/kg of injectable midazolam given orally as premedication is acceptable, effective, and safe.

Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

“…and the patients discharged earlier from the hospital [at 15 min 77.8% of the patients in group o were discharged vs. 46.7% in group N]. This does not meet the results in the study done by Verma et al [16] On comparing the effect of oral and nasal midazolam, they stated that the recovery times [11.63 ± 4.19 minutes in nasal group vs. 25.20 ± 9.36 minutes in the oral group], and post-anesthesia recovery scores were better in the nasal spray group and this was same in the clinical study done by Sheta and AlSarheed [14] where they used oral midazolam as a premedication for dental care, The delay in the nasal route in our study could be attributed to the addition of ketamine in the nasal group…”

“…In a study bySheta and Al Sarheed [14] apple syrup was used as a carrier. Mishra et al [17] mixed IV midazolam with honey [5 times the drug volume], which was well accepted by most of their subjects, in our study we have mixed midazolam with either flavoured paracetamol for oral preparation or with ketamine for nasal preparation.…”

“…Among the variables, pain poses a diagnostic dilemma [13]. Behavioral signs of emergence agitation often mimic those of postoperative pain [14].…”

Oral premedication in children: A randomized study of a combination of oral midazolam, ketamine with atropine vs midazolam and atropine vs ketamine and atropine

“…Midazolam and ketamine has been used extensively for pharmacological premedication, with adequate results. [2][3][4][5] Combination of oral midazolam with ketamine was used to get better results with lesser side effects. 6 Oral preparation has its own disadvantages like variable absorption, bioavailability, and being unpalatable, it is still better than needle pricks in children.…”

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“…Drugs of different classes like sedativeantianxiety drugs, opioids, anticholinergics, neuroleptics, H 2 blocker and antiemetics have been used for premedication. 3,4 Preoperative treatments also aims at reducing the emergence agitation occurring during recovery. 5 The comparison between the use of midazolam and diazepam as preoperative medication has been studied over different countries: USA, India, Iran and many other countries, midazolam found to provide pre operative sedative effect superior to that of diazepam.…”