Oral midazolam premedication in children: the minimum time interval for separation from parents

Abstract

To determine the minimum time interval between oral midazolam (0.5 mg" kg -~) Accepted for publication 16th April, 1993. prdmddication (valeur de base), au moment de la sdparation et pendant I'application du masque facial h l~nduction de I'anesthisie. Nous avons trouv~ que les changements de friquence cardiaque et de pression artdrielle systolique ont dtd semblables clans les trois groupes au cours de notre dtude. Le niveau de sddation d la sdparation et l'application du masque a dtd plus dlev~ que la valeur de base et n'est pas diffdrent entre les trois groupes. Le niveau d'anxiolyse n'a pas vari~ de la valeur de base d aucun moment dans les trois groupes. Nous concluons que les enfants peuvent ~tre sdpard de leurs parents aussi prdcocdment que 10 minutes aprds avoir re~u 0,5 mg" kg -1 de midazolam par voie oral.Oral midazolam is safe and effective for premedication of children scheduled for ambulatory surgery. 1.2 It has a rapid and reliable onset of action, few side effects and does not delay recovery. McMillan et al. demonstrated that oral midazolam in doses of 0.5, 0.75 and 1.0 mg-kg -1 produced excellent sedation and anxiolysis scores 15 min after administration to children 1-6 yr and at the time of separation from parents at 30 min. I However, the ease of separation from parents was assessed at only one time, 30 min after oral midazolam premedication. Similarly, Weldon et al. recommended that oral midazolam be given 30-45 min preoperatively) It has been our experience, however, that children could be separated from their parents less than 30 rain after receiving oral midazolam without compromising the degree of sedation and anxiolysis. We therefore sought to determine the minimum time interval between administration of oral midazolam (0.5 mg. kg -l) and separation of the children from their parents that would ensure a smooth and calm separation. MethodsThis randomized study was approved by the Human Subjects Review Committee and written parental consent was obtained. Midazolam (0.5 mg-kg -I) was administered to 30 children, ASA I or II and aged 1-6 years, who CAN J ANAESTH 1993 / 40:8 / pp 726-9

Oral midazolam premedication for paediatric day case patients

“…Recent reports have suggested that oral midazolam is an effective premedication in children (4,5). The use of sedative premedication for children having day stay surgery remains an area of controversy, however, and there is only one published report of S.H.…”

Premedication of the pediatric patient – anesthesia for the uncooperative child

“…Midazolam doses for premedication via different routes are presented in Table 1. Clinical sedative effects are seen within 5-10 min of oral midazolam administration; the minimum time interval for successfully separating premedicated children from their parents is 10 min and the peak effect is achieved in 20-30 min [13]. The sedative effect is seen as happiness and loss of balance.…”

Prämedikationsregime im Vergleich

“…Am häufigsten werden dabei Benzodiazepine, insbesondere Midazolam, verwendet, da so eine Reduktion des Angstniveaus der Patienten, eine teilweise antegrade Amnesie, eine bessere Narkoseinduktion sowie eine Reduktion pathologischer, postoperativer Verhaltensmuster am effektivsten erreicht werden können [5]. Hinsichtlich des idealen Zeitpunkts der Prämedikation nach oraler Applikation liegen bisher nur wenige Daten vor, doch wird für die p.o.-Gabe von Midazolam ein mindestens 20-minütiger Abstand bis zur Narkoseinduktion empfohlen [6,7]. In der klinischen Praxis kommt es jedoch nicht selten aufgrund von Organisationsproblemen im OP-Bereich oder auf der peripheren Station, einer Änderung chirurgischer Maßnah-men sowie der variablen Ankunft des Patienten und der behandelnden Ärzte im OP-Saal zu unregelmäßigen Zeitabstän-den zwischen der oralen Applikation von Midazolam und der Narkoseeinleitung.…”