Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging

Abstract

Our study indicates that the combination of oral diphenhydramine with oral midazolam resulted in safe and effective sedation for children undergoing MRI. The use of this combination might be more advantageous compared with midazolam alone, resulting in less sedation failure during MRI.

Non-Intravenous Sedatives and Analgesics for Procedural Sedation for Imaging Procedures in Pediatric Patients

“…The most common agent evaluated was PO midazolam. [7][8][9][10][11][12][13][14][19][20]22 Table 4 provides a summary of dosing information and adverse events reported in the included studies.…”

“…The addition of diphenhydramine was found to increase the rate of MRI completion, although sedation was more likely to fail in children ≥5 years of age. 7 It is not clear why older children had less response. The study evaluated only children 1 to 7 years old, so this finding could be a result of a small sample size.…”

“…Only 1 study was identified that used a sedative through an extravascular route for MRI. Cengiz and colleagues 7 compared PO midazolam, 0.5 mg/kg, to a combination of PO midazolam, 0.5 mg/kg, and diphenhydramine, 1.25 mg/kg. Midazolam monotherapy failed to achieve adequate sedation in significantly more patients than in the group receiving combination therapy (41% vs. 18%, respectively, p=0.01).…”

“…Seven studies included a comparator group; all with a relatively small sample size, making it difficult to draw conclusions. 4,7,[13][14][19][20]22 Three studies compared PO or IN midazolam to PO chloral hydrate. 4,13,19 It should be noted that chloral hydrate is no longer commercially available, although some institutions may compound a solution.…”

Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies

“…Doses are typically given at night because a significant effect of the medication is somnolence. Although there have been some controlled trials of diphenhydramine as a sedative, 138,139 clonidine has been less well studied. 140 …”