Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients

Sinha, Chandni; Kaur, Manpreet; Kumar, Ajeet; Kulkarni, Anand H; Ambareesha, M; Upadya, Madhusudan

doi:10.4103/0970-9185.92431

Cited by 18 publications

(20 citation statements)

References 25 publications

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“…In veterinary clinics, the combination of midazolam and butorphanol provides light to moderate sedation with minimal cardiovascular changes, and is often used clinically as a pre-anesthetic to isoflurane [ 14 , 23 , 27 ]. The combination of midazolam and butorphanol has also been used as a pre-anesthetic in human medicine during inhalant anesthesia [ 28 ]. In mice, combination of midazolam and butorphanol, along with medetomidine was used as injectable anesthesia in mice [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…In human and veterinary medicine, combinations of sedatives and analgesics are used as pre-anesthetics, which contribute to the stabilization of inhalant anesthesia, and conserve the use of gas during surgery. The drugs which used as pre-anesthetics include sedatives such as benzodiazepines and analgesics like opioid agents [ 14 , 28 ]. Several combinations of pre-anesthetics for inhalant anesthesia have been reported in both human and veterinary medicine [ 20 , 23 , 24 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of midazolam and butorphanol premedication on inhalant isoflurane anesthesia in mice

et al. 2015

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Isoflurane is a representative inhalant anesthesia used in laboratory animals. However, isoflurane mediates respiratory depression and adverse clinical reactions during induction. In the present study, we established a novel balanced anesthesia method in mice that combined isoflurane anesthesia with midazolam and butorphanol (MB). Thirty-four male C57BL/6J mice received either isoflurane alone or isoflurane with an intra-peritoneal MB premedication (3 mg/kg midazolam and 4 mg/kg butorphanol). The minimum alveolar concentration (MAC) in each group was evaluated. Induction time and adverse clinical reactions were recorded in each group. Core body temperature, heart rate, respiratory rate, and oxygen saturation (SPO2) were assessed before and for 1 h after induction. Premedication with MB achieved a significant reduction in MAC compared with isoflurane monoanesthesia (isoflurane, 1.38 ± 0.15%; isoflurane with MB, 0.78 ± 0.10%; P<0.05). Induction time was significantly shortened with MB premedication, and adverse reactions such as excitement or incontinence were observed less frequently. Furthermore, isoflurane anesthesia with MB premedication caused increase of respiratory rates compared to isoflurane monoanesthesia. No significant decrease of SPO2 was observed in MBI anesthesia, while a decrease in SPO2 was apparent with isoflurane monoanesthesia (baseline, 98.3% ± 1.1; 10 min after induction, 91.8 ± 6.4%; P<0.05). In conclusion, premedication with MB was effective for the mitigation of respiratory depression induced by isoflurane in mice, with rapid induction and fewer adverse clinical reactions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of midazolam and butorphanol premedication on inhalant isoflurane anesthesia in mice

et al. 2015

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“…Two RCTs (Singh et al, 2005;Sinha et al, 2012) compared midazolam oral solution with butorphanol, including 120 children. RCTs manifested that the depth of sedation of butorphanol was deeper [MD = −0.84 to 0.43, P < 0.05].…”

Section: Depth Of Sedationmentioning

confidence: 99%

Efficacy and Safety of Midazolam Oral Solution for Sedative Hypnosis and Anti-anxiety in Children: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Midazolam is recommended by health guidelines for sedation and hypnosis in children. Oral solution is a suitable dosage form for children. But there is no conclusive evidence for sedative-hypnosis and antianxiety effects by midazolam oral solution in children.Methods: Relevant studies were identified through searching PubMed, Embase, Cochrane Library, CINAHL, International Pharmaceuticals, four Chinese electronic databases, and relevant lists. Two reviewers independently selected trials, assessed trial quality, and extracted the data.Results: Eighty-nine randomized controlled trials (RCTs) comparing midazolam oral solution with placebo or blank (n = 33), dexmedetomidine (n = 15), ketamine (n = 11), different midazolam doses (n = 10), midazolam injection (n = 8), chloral hydrate (n = 7), diazepam (n = 5), N 2 O (n = 5), triclofos (n = 4), butorphanol (n = 2), fentanyl (n = 2), hydroxyzine (n = 1), and thiopental (n = 1) were identified. Meta-analysis showed no significant difference in the success rate and duration of sedation and hypnosis between midazolam oral and injectable solution (P > 0.05). The success rate of sedation and hypnosis of midazolam was higher than that of ketamine [risk ratio (RR) = 1.32, 95% CI (1.07, 1.62), I 2 = 0%, P < 0.01]. No significant difference was found in the success rate of sedation and hypnosis, mask acceptance, and parental separation between midazolam oral solution and dexmedetomidine (P > 0.05), and the result of one cohort study was consistent. The results of RCTs and a prospective cohort study showed that the incidence of adverse drug reactions (ADR) was 19.57% (189/966). Incidence of adverse reactions between dose groups of (0.25, 0.5] and (0.5, 1.0] mg/kg was similar [Pf (95% CI) = 0.10 (0.04, 0.24) and Pf (95% CI) = 0.09 (0.02, 0.39), respectively], higher than that of the dose group of (0, 0.25] mg/kg [Pf (95% CI) = 0.01 (0.00, 0.19)].Cheng et al. Efficacy and Safety of Midazolam Oral SolutionConclusions: Available evidence suggests that midazolam oral solution is as good as midazolam injection and dexmedetomidine and is better than ketamine. Based on efficacy and safety results, an oral midazolam solution dose of 0.5-1 mg/kg is recommended for children.

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“…A preanesthetic agent is usually administered in combination with sedatives and analgesic agents [ 6 , 20 ]. Among the combination of preanesthetics, midazolam and butorphanol (MB) are preferred in medicine since this combination has moderate sedative and analgesic actions and results in lesser cardiorespiratory influence [ 21 ]. This combination is also clinically used as a preanesthetic to complement of isoflurane’s anesthetic action in dogs and cats [ 14 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Combining isoflurane anesthesia with midazolam and butorphanol in rats

et al. 2016

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Representative inhalant anesthetic agent, isoflurane is commonly used during surgery in rats. However, isoflurane mediates relatively strong respiratory depression. In human and veterinary medicine, sedatives and analgesics are co-administered to complement the anesthetic action of inhalant anesthesia. The present study aimed to establish the novel balanced anesthesia that combines midazolam and butorphanol with isoflurane (MBI) in rats. Male Sprague Dawley rats were divided into 2 groups, and administered either isoflurane monoanesthesia or isoflurane with midazolam (2.5 mg/kg, ip) and butorphanol (2.0 mg/kg, ip). The minimum alveolar concentration (MAC) in each group was evaluated. Induction and recovery times were measured in each group. Adverse reactions during induction were also recorded. In each group, vital signs were assessed for 1 h under 1.5×MAC of isoflurane. Instability of vital signs was assessed under each anesthesia by calculating coefficient of variance. Compared with isoflurane monoanesthesia, MBI anesthesia caused 32% MAC reduction (isoflurane monoanesthesia: 1.30 ± 0.09%, MBI 0.87 ± 0.08%, P<0.05). MB premedication mediated smooth sedating action with low incidence of adverse reactions such as urination and defecation. Isoflurane monoanesthsesia remarkably decreased respiratory rate and saturation O2 (SPO2). In contrast, MBI anesthesia resulted in a relatively stable respiratory rate without decreases in SPO2 during the anesthetic period. In summary, MB premedication is effective for attenuating respiratory depression induced by isoflurane, and achieving smooth induction. This anesthetic protocol serves as a novel option for appropriate anesthesia in rats.

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Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients

Cited by 18 publications

References 25 publications

Effect of midazolam and butorphanol premedication on inhalant isoflurane anesthesia in mice

Effect of midazolam and butorphanol premedication on inhalant isoflurane anesthesia in mice

Efficacy and Safety of Midazolam Oral Solution for Sedative Hypnosis and Anti-anxiety in Children: A Systematic Review and Meta-Analysis

Combining isoflurane anesthesia with midazolam and butorphanol in rats

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