Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens

Abstract

Our aim was to characterize effectiveness and complications in children receiving oral midazolam alone, nasal midazolam alone, or oral midazolam with other sedatives. Children received oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative medications. All subjects received a presedation history and physical examination and were sedated per protocol by any of 28 resident providers under attending supervision. Sedations were rated for success and complications by clinicians. Postoperative complications were assessed by trained staff up to 48 hours postoperatively. Seven hundred and one encounters, completed over 24 months, yielded 650 usable sedations. The majority of children were healthy (469; 68.2%) and 86% (532) weighed between 10 and 25 kg. Sedations were deemed successful in about 80% of cases. Planned treatment was completed in over 85% of encounters. Oral midazolam alone yielded the best behavior. Physical assessment factors of behavior and age were correlated (P ¼ .035) with effectiveness. Hiccups and a positive medical history were significantly related (P ¼ .049). Side effects of either nausea/vomiting, dysphoria, or hiccups occurred in less than 10% of cases. All 3 regimens were effective with minimal postoperative complications.

Comparing sedative effect of dexmedetomidine versus midazolam for sedation of children while undergoing computerized tomography imaging

“…MID is the most common drug which is used for pediatric anesthesia due to some beneficial effects in children including good sedation, fast onset, and limited duration of action and some side effects such as restlessness, decrease in respiratory function, paradoxical reaction, and cognitive impairment. [ 2 ] Side effects and complications of three different regimes of MID medication, including oral alone, nasal, and combination of both together, were compared in 650 cases by Gentz et al [ 13 ] study. Its results showed that successful rate of sedations was 80% and the planned treatment was completed in over 85% of cases.…”

“…[ 8 9 10 ] Therefore, numerous studies compared different agents such as dexmedetomidine (DEX), propofol, pentobarbital, midazolam (MID), chloral hydrate, ketamine, and nitrous oxide alone or in combination with one another. [ 8 11 12 13 14 15 ]…”

“…[ 16 17 ] On the contrary, MID is a potent anticonvulsant, which usually is administered intravenously as well as intramuscularly. [ 13 ] Other forms of administration, such as intranasally, rectally, or buccal injection, may be a substitute method for this matter.…”

Uso del midazolam en el control y manejo de la ansiedad en niños durante la atención odontológica: una revisión bibliográfica

“…El efecto que tengan dependerá de la dosis y de la respuesta del paciente, logrando así sedación o un efecto tranquilizante en cantidades bajas, y en dosis altas, hipnosis, que corresponde a un estado similar al que se presenta con el sueño 11,[26][27][28] .…”

“…El paciente se puede recuperar rápidamente, ya que cuenta con una vida media corta (de 1 a 4 horas). Usualmente se utiliza en dosis de 0,5mg/kg y no requiere uso de soporte ventilatorio ni de oxígeno [22][23][24][25][26][27][28][29][30][31][32] .…”