Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment: a double-blinded randomized placebo-controlled trial

Abstract

Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment. A double-blinded randomized placebo-controlled trial 1Efeitos peroperatórios da premedicação oral de midazolam em crianças submetidas a tratamento de pele por laser. Estudo duplo-cego randomizado e controlado. Mehrdad Shoroghi ABSTRACT Purpose:To investigate and compare the efficacy of oral midazolam with two different dosages in orange juice on perioperative hemodynamics and behavioral changes in children who underwent skin laser treatment in an academic educational Hospital. Methods: Ninety children, candidates for skin laser treatment were randomly assigned to 1 of 3 groups of 30 each: the placebo group received 0.1 ml/kg orange flavored juice, group 2 and 3 receiving 0.5 and 1 mg/kg of injectable midazolam mixed with an equal volume of orange juice, respectively. The main outcome measures included the mask acceptance, patients' behavioral scales and postoperative events. Results: There were no significant differences in heart rate, respiratory rate, and systolic blood pressure among the three groups. However, arterial oxygen saturation was significantly reduced in those given 1 mg.kg -1 midazolam. The median scores of anxiety, separation from parent, preparing an intravenous line, acceptance of the oxygen mask, good sedation, crying reduction and consciousness level were better in midazolam group. Postoperative agitation and re-crying were also more frequent in placebo receivers. Those given 1 mg.kg -1 midazolam were significantly more optimal for sedation, crying, consciousness, preparing an intravenous line, and postoperative re-crying compared with 0.5 mg.kg -1 midazolam receivers. Conclusion: As a preanaesthetic medication, the 1 mg.kg -1 dose of orally given midazolam especially in a volume of orange juice and can optimize the children's behavior during skin laser treatment with no serious adverse effects, enhancing their parents' satisfactions about the sedative protocol. Key words: Midazolam. Premedication. Anesthesia. Laser Therapy. Skin. RESUMO Objetivo:Investigar e comparar a eficácia do uso oral de midazolam com duas diferentes doses de suco de laranja na hemodinâmica peropeatória e mudanças de desempenho em crianças submetidas tratamento de pele por laser em Hospital educacional e acadêmico. Métodos: Noventa crianças candidatas a tratamento de pele por laser foram distribuídas aleatóriamente em três grupos de 30 cada: o grupo placebo recebeu 0.1mg/kg de suco de laranja, grupos dois e três receberam 0.5 e 1mg/kg de midazolam injetável misturado em igual volume de suco de laranja respectivamente. Os principais registros incluíam a aceitação da máscara, escalas de comportamento e eventos pós-operatórios. Resultados: Não houve diferenças significantes cardíacas, respiratórias e pressão sanguinea sistólica nos três grupos. Contudo, o nível de saturação de oxigênio foi reduzido significantemente nos que receberam 1mg.kg -1 de midazolam. Os níveis médios de ansiedade, separação dos pais, preparo intraveno...

Midazolam oral solution (Ozalin®): a profile of its use for procedural sedation or premedication before anaesthesia in children

“…Midazolam is very commonly used to provide procedural sedation or premedication before anaesthesia in infants, children and adolescents, due to its sedative properties and its rapid onset and short duration of action [1][2][3][4]. Oral formulations of midazolam are easy to administer, are effective in providing sedation, have minimal effects on recovery times and time to discharge, and are well tolerated, as shown in numerous studies of extemporaneous and marketed oral midazolam solutions/syrups in paediatric patients requiring procedural sedation or premedication before anaesthesia [5][6][7][8][9][10][11][12][13][14]. The use of oral midazolam as a premedication may be preferred over the use of midazolam administered by intravenous (IV) injection [10,11], rectal suppository [12] or intranasal spray [13,14].…”

Effect of two different doses of oral midazolam premedication on separation anxiety in children scheduled for herniotomy

“…The evidence that children aged 1 to 5 years exhibit the highest level of separation anxiety, and the efficacy of oral midazolam premedication in decreasing the incidence of preoperative and emergence agitation among children has been documented. 14,15 Thus, pre-operatively, anxiolytic premedication for susceptible paediatric patients is warranted on ground of ethical imperativeness.…”

Pediatrics in Clinics: Highlights

“…Shoroghi et al . (30) investigated and compared the efficacy of oral midazolam with two different dosages in orange juice on perioperative hemodynamics and behavioral changes in 90 children who underwent skin laser treatment in an academic educational Hospital. They were randomly assigned to 1 of 3 groups of 30 each: the placebo group received 0.1 ml/kg orange flavored juice, group 2 and 3 receiving 0.5 and 1 mg/kg of midazolam mixed in an equal volume of orange juice, respectively.…”