January-March 2018

Comparison of Intranasal Midazolam and Oral Midazolam as Premedication for Pediatrics patients

Mamta G Patel1, Raksha R Patel2, Sandeep Anehosur3, V N Swadia4

1,3Associate Professor,2Tutor, 4Ex. Professor and Head, Department of Anaesthesia, Medical College Baroda.


BACKGROUND AND OBJECTIVES: Preoperative anxiety in children causes difficulty in separating the child from parents, can affects the smoothness of induction. It can also cause postoperative negative behavioural responses needs better pre anaesthetic sedation. Midazolam hydrochloride is world widely accepted benzodiazepine for premedication in paediatric patients. It has been proved to be an excellent premedication in children for various routes like oral, rectal, intravenous, intramuscular, sublingual and now nasal with its own merits and demerits. This present study compares oral Midazolam syrup (0.5mg/Kg) and intranasal Midazolam spray(0.2mg/Kg) as painless and needleless system of drug administration as premedication in paediatric patients posted for general surgeries. METHODS: A prospective, randomized, single bind clinical study was conducted on 60 paediatric patients posted for elective surgery during November 2011to November 2012. Patients were randomly assigned into two groups, Group-N: received intranasal Midazolam spray 0.2mg/Kg and Group-O: received oral Midazolam syrup 0.5mg/Kg. Every child was observed for sedation score, parental separation, acceptance to mask, recovery and side effects of drug. Data were analysed using Student‟s t-test for quantitative data and Chi-square test for qualitative data. RESULTS: At 5minutes after premedication mean sedation score in Group-N and Group-O were 2.83 ± 0.64 and 2.26 ± 0.52 respectively, which was highly significant (P<0.001). In both the groups, sedation score at 20 minutes after pre medication (Group-N: 3.96±0.55 and Group-O: 3.86±0.64), parental separation and acceptance to mask were comparable (p>0.05). CONCLUSION: Separation from parents and mask acceptance were satisfactory in both groups. Achievement of sedation was earlier in intranasal group than oral midazolam group. So, we concluded that, Intranasal Midazolam is a safe and effective alternative as a sedative premedication in paediatric patients.

Keywords: children, intranasal midazolam atomized spray, oral midazolam syrup, sedative pre medication

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