Serum concentration of oral midazolam as pediatric preanesthetic medication and factors related to the sedation level

Matsuda, Hiromi; Takenaka, Jungo; Kawabata, Mariko; Komatsu, Toshiaki; Sakanoue, Kazumi; Atsuda, Koichiro; Okamoto, Hirotsugu

doi:10.1111/aas.14077

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Matsuda et al . [11 ▪ ] recently showed that uncooperative behaviour at induction is not caused by low midazolam serum concentrations but is related to a young age of the child.…”

Section: Premedicationmentioning

confidence: 99%

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Jöhr¹

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review is to discuss recent developments in paediatric anaesthesia, which have evolved in an undulating fashion.Recent findingsThe role and efficacy of pharmacological premedication is reevaluated. The anxiolytic and sedative properties of midazolam and α2-agonists have now been defined more precisely. Both classes of drugs have their unique profile, and there is no reason to condemn one or the other. Midazolam is an excellent anxiolytic, whereas dexmedetomidine is superior in the postoperative period and for sedation during diagnostic imaging.A total intravenous technique with propofol is often considered to be the standard for the prevention of emergence agitation; but alternatives do exist, such as a co-medication with dexmedetomidine or opioids. In clinical reality, a multimodal approach may often be advisable.The theoretical basis for propofol dosing has recently been adapted. In contrast to previous beliefs, the context-sensitive half-life of propofol seems to be quite short beyond the first year of life.SummaryMidazolam and dexmedetomidine are not interchangeable; each compound has its pros and cons. As an anxiolytic drug, midazolam indisputably deserves its place, whereas dexmedetomidine is a better sedative and particularly beneficial in the postoperative period. New data will allow more precise age-adapted dosing of propofol.

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“…Matsuda et al . [11 ▪ ] recently showed that uncooperative behaviour at induction is not caused by low midazolam serum concentrations but is related to a young age of the child.…”

Section: Premedicationmentioning

confidence: 99%

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Jöhr¹

2023

Current Opinion in Anaesthesiology

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“…Various drugs and dosage forms may be used as premedication, including oral midazolam and ketamine. 7 Midazolam is currently one the most used premedication drugs in pediatric practice. 8 …”

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confidence: 99%

Is the combination of oral midazolam and ketamine as preanesthetic medication a safe and effective practice?

Módolo

Lima

Cumino

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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Median effective dosage of midazolam oral solution for preschool children in preoperative sedation

Jiang,

Wang,

Zhao

et al. 2024

Ibrain

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This study aimed to detect median effective dosage (ED50) of midazolam oral solution (MOS) for preschool children in preoperative sedation. Thirty children (3–6 years old, with a body mass index (BMI) of 18–28 kg/m2, American Society of Anesthesiologists status (ASA) I‐II) scheduled for the hidden penis correction surgery under general anesthesia were selected. The effective dosage of MOS for preschool children in preoperative sedation was measured by sequential method. The initial dose was set at 0.5 mg/kg, with a concentration gradient of 0.1 mg/kg. Sedation was deemed successful if the patients’ Ramsay sedation scores were ≥4 and Frankl treatment compliance rating scale was ≥3, without any grade III or higher adverse events during anesthesia. If these criteria were met, the dosage for the next patient was reduced by one gradient based on the last patient's dosage, otherwise, the dosage for the next patient was increased by one gradient. This process was repeated until the 7th inflection point from unsuccessful to successful sedation was reached, at which point the trial was terminated. Probit regression analysis was used to calculate the ED50, 95% effective doses (ED95) and 95% confidence interval (CI) of MOS. Adverse reactions such as bradycardia, nausea, vomiting, and blurred vision were recorded during sedation. This study revealed that the ED50 and ED95 of MOS for preschool children preoperative sedation are 0.627 mg/kg (95% CI 0.582–0.669 mg/kg) and 0.795 mg/kg (95% CI 0.712–1.211 mg/kg), respectively, providing a reference for the administration of MOS in this population.

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Serum concentration of oral midazolam as pediatric preanesthetic medication and factors related to the sedation level

Cited by 4 publications

References 18 publications

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Is the combination of oral midazolam and ketamine as preanesthetic medication a safe and effective practice?

Median effective dosage of midazolam oral solution for preschool children in preoperative sedation

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