Pharmacokinetic and pharmacodynamic study of midazolam in children during esophagogastroduodenoscopy

Tolia, Vasundhara; Brennan, Sandra; Aravind, M.K.; Kauffman, Ralph E.

doi:10.1016/s0022-3476(05)82066-9

Cited by 72 publications

(37 citation statements)

References 13 publications

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“…Midazolam was by far the most frequently used sedative [10,11], either alone or in association. It was used at 23 centres, followed by meperidine [12,13], which was used at seven centres.…”

Section: Discussionmentioning

confidence: 99%

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres

Barbato¹,

Magarotto²,

Crivellaro³

et al. 1997

Eur Respir J

110

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We have undertaken a survey to establish current practices and differences in the use of bronchoscopes in children in European centres.A questionnaire was sent to all 220 members of the Paediatric Assembly of the European Respiratory Society (ERS). The questions concerned the following points: indications for bronchoscopy; site of bronchoscopy; type of sedation; any oxygen supplementation during the procedure; number of procedures performed in the previous 12 months; number of procedures performed in the neonatal intensive care unit; number of bronchoalveolar lavages (BALs); side-effects during and after the procedures; and diagnostic yield.Fifty one European centres (40.8% of the European centres contacted) took part in the study. A total of 7,446 bronchoscopies had been performed in the last 12 months: 4,587 using the flexible bronchoscope and 2,859 using the rigid bronchoscope. At centres using only the fibreoptic bronchoscope, the most frequent indication was "recurrent/persistent pneumonia" (17%); at centres using only the rigid bronchoscope, it was "foreign body inhalation" (36.7%); at centres using both methods, the most frequent indication was "other indications" (23.9%).In 12 months, 2,231 BALs were performed: 1,419 in immunocompetent children and 812 in immunocompromised patients. In centres using only the fibreoptic bronchoscope, the highest yield was for "stridor" (81%); in centres using only the rigid bronchoscope, the highest yield was for "persistent atelectasis" (68%); and in centres using both instruments, it was for "foreign body inhalation" (93%).The results of the study suggest that bronchoscopy in children is now a wellestablished procedure at several European centres, while others are just beginning to use this technique. Eur Respir J 1997; 10: 1761-1766 In the past, bronchial endoscopy called for the use of the rigid bronchoscope and was consequently used very infrequently in children [1]. The advent of thin and ultrathin fibreoptic bronchoscopes has considerably extended the use of this procedure [2], even in the neonatal field [3].Since there is no European survey of the highly specialized paediatric pneumology centres where rigid and flexible bronchoscopes are routinely used in children, the Paediatric Bronchology Group of the European Respiratory Society (ERS) prepared a questionnaire and sent it to all member paediatricians with a view to gaining a picture of the situation in Europe and obtaining information on the most common indications for paediatric bronchoscopy, the number of procedures performed each year, where such procedures are carried out, what type of sedation is used and what results are obtained. Materials and methodsThe questionnaire was sent in March 1995 to all 220 members of the Paediatric Assembly listed on the ERS Roster of July 1993, using the Scientific Group Code 07.01, .02, .03, .04, .05, .06 and .07. There were 172 paediatricians from 125 European centres, and 48 from 43 centres outside Europe. The questions concerned the following points: the most c...

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“…Midazolam was by far the most frequently used sedative [10,11], either alone or in association. It was used at 23 centres, followed by meperidine [12,13], which was used at seven centres.…”

Section: Discussionmentioning

confidence: 99%

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres

Barbato¹,

Magarotto²,

Crivellaro³

et al. 1997

Eur Respir J

110

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“…In our study, children _> 11 years of age had a higher rate of amnesia following midazolam administration compared with children 11 years. Although the mechanism of this differences is unknown, one possible explanation is that children metabolize midazolam more rapidly than adults resulting in lower plasma concentration [21]. It may be possible that the younger children had lower plasma concentration resulting in less amnesia compared to the older children.…”

Section: Discussionmentioning

confidence: 99%

Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy

Bahal-O'Mara

Nahata

Murray

et al. 1994

Eur J Clin Pharmacol

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We conducted a randomized, double-blind trial evaluating the efficacy and safety of meperidine 2 mg.kg-1 (M) and meperidine 2 mg.kg-1 plus midazolam 0.05 mg.kg-1 (M + M) in 40 pediatric outpatients (age 1 to 17 years) undergoing upper endoscopy procedures. The physician and nurse performing the procedure were asked to rate cooperation, emotional status, drowsiness, and overall efficacy. A blinded observer recorded the frequency of negative behaviors indicating distress, vital signs, and oxygen saturation before, during, and after the procedure. No significant differences were noted in the overall efficacy of the regimens. Good or excellent efficacy was noted in 15 of 21 children (71%) in the M group and 15 of 19 children (79%) in the M + M group by physicians; nurses assigned a good or excellent rating for 14 of 21 (67%) and 13 of 19 (68%) in the M and M + M groups, respectively. Immediately following the procedure, amnesia was noted in 4 of 17 (23%) patients who received M versus 14 of 18 (78%) patients who received M + M (P = 0.002). Of the children who received M + M, the amnesia tended to occur more frequently in older children (> 11 years, 8 children, rate of amnesia 100%) than in younger children (< or = 11 years, 6 of 10 evaluable children, rate of amnesia 60%). There was no significant difference between the frequency of negative behaviors, rate of adverse effects, or changes in vital signs or oxygen saturation noted with the two drug regimens.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Its major metabolite, /-hydroxymidazolam, is less active than for instance the major metab olite of diazepam, thus reducing the risk of accumulation. The side-effects of midazolam, mostly used as an induction or premedication agent for general anaesthesia, have not been assessed widely in children [12,13], Sievers et al [12] noted a significant decrease in systolic blood pressure following midazolam adminis tration in children, although no marked hypo tension occurred. In the pharmacolocigal study of Jacqz-Aigran et al [14], no adverse effects were noted in children.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Midazolam or Vecuronium on Blood Pressure and Cerebral Blood Flow Velocity in the Premature Newborn

Straaten¹,

Rademaker²,

Vries³

1992

Dev Pharmacol Ther

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The effect of midazolam and vecuronium on mean arterial pressure (MAP) and mean cerebral blood flow velocity (MCBFV) was evaluated in premature infants (birthweight 550-2,560 g; gestational age 26-36 weeks) randomised to receive either 0.1 mg/kg midazolam (n = 7) or 0.05 mg/kg vecuronium (n = 8) intravenously. MAP, by means of an indwelling arterial cathether, and MCBFV, by means of noninvasive pulsed-Doppler of the middle cerebral artery, were measured every 5 min, starting at 10 min prior to until 1 h after drug administration. A transient 25-43% decrease in MCBFV (mean 0.06 m/s) dependent on a 8-23% decrease in blood pressure (mean 9 mm Fig) was noted in all patients within 15 min following administration of midazolam, which returned to baseline values within 1 h. In 2 out of 7 infants, a plasma expander was required. In contrast, vecuronium only decreased the MCBFV in 3 of 8 infants. Thus, a bolus of midazolam transiently decreased blood pressure and MCBFV, and should be used cautiously in sick preterm infants.

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Pharmacokinetic and pharmacodynamic study of midazolam in children during esophagogastroduodenoscopy

Cited by 72 publications

References 13 publications

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres

Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy

Comparison of the Effect of Midazolam or Vecuronium on Blood Pressure and Cerebral Blood Flow Velocity in the Premature Newborn

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