Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial

Abstract

OBJECTIVES: Prevention and reduction of pain, anxiety, and fear during medical procedures is one of the most important factors that should be considered in pediatric emergencies. The aim of this study was to compare the efficacy of oral versus intranasal midazolam in sedation during radiologic imaging in the largest province of Iran, Kerman. MATERIALS AND METHODS: Eighty children were enrolled in this single-blind clinical trial based on convenience sampling and were divided into two groups receiving 0.5 mg/kg midazolam in oral route administration and 0.2 mg/kg midazolam in intranasal route administration. Finally, 75 patients remained for evaluating medication acceptability, sedation level, onset time of sedation, additional sedative dose, adverse effects of sedation, and provider satisfaction. RESULTS: Children in the intranasal group accepted medication more easily (89.8% vs. 36.9%; P ≤ 0.001), while these children received a lower sedation dose, but the sedation level in both methods was similar ( P = 0.72). Our findings showed that children in the intranasal sedation group had a faster onset of sedation compared to the oral group (17.94 ± 8.99 vs. 34.50 ± 11.45; P ≤ 0.001). The frequency of midazolam side effects had no difference between the groups (29.7% vs. 15.8%; P = 0.15). CONCLUSION: Intranasal midazolam with a lower sedation dose induces a faster onset and better acceptance. Intranasal midazolam can be used as an effective sedative method for pediatric patients, especially in emergency wards.

Pediatric sedation for emergency, imaging and endoscopic procedures: a worldwide review from the last five years

“…From the analysis of 10 studies, 2,[19][20][21][22][23][24][25][26][27] we observed that Propofol, in monotherapy, has been effective for this purpose with bolus from 1 to 2 mg/kg, with an average maintenance of 100 mcg/kg/min. 19,20 Most commonly described adverse effects were desaturation, laryngospasm and hypotension.…”

“…Lam, 2018 2 Malia, 2018 24 Cossovel, 2022 26 Mayel, 2020 25 Sayed,2022 20 Midazolam IN ou VO: 0,2 -1 mg/kg Consider for premedication. When in association, it was related to higher latency and longer time until awakening.…”

“…Intranasal Midazolam has gained more adherence, due to better acceptance by the patient, need for lower doses and faster sedation onset, compared to oral route, despite sedation effectiveness and side effects incidence being similar between the two routes. 24,25,26 Doses from 0.2 to 1 mg/kg showed good results in sedation for quick exams -such as computed tomography -or as pre-medication to facilitate cooperation and separation from parents. 2,20,25,26 Most reported side effects were: agitation on awakening, diplopia, dizziness and hiccups.…”

“…24,25,26 Doses from 0.2 to 1 mg/kg showed good results in sedation for quick exams -such as computed tomography -or as pre-medication to facilitate cooperation and separation from parents. 2,20,25,26 Most reported side effects were: agitation on awakening, diplopia, dizziness and hiccups. 2 For imaging exams, only one study 26 discussed Dexmedetomidine intranasal sedation, while others reported the traditional intravenous use.…”

A comparative evaluation of nebulized dexmedetomidine and nebulized ketamine as a premedication in pediatric surgeries: A randomized controlled trial

“…Diverse medications have been proposed as a premedication to alleviate children's anxiety and facilitate their separation from their parents [2] . The optimal premedication for children must be readily acceptable, have a rapid and dependable onset, and have minimal adverse effects [3] . Aerosolized medications may facilitate enhanced absorption via the nasal, oral, and respiratory mucous membranes, with advantage of better acceptability by the patient [4] .…”