Rectal midazolam as premedicant in children: a dose response study

Abstract

Summa yRectally administered midazolam has proved to be a reliable and acceptable way of premedicating children. In order to determine the optimal dose 80 children were randomized in a double-blind manner to receive one of four different dosages of midazolam (0.2-0.3-0.4-0.5 mg-kg-') in combination with atropine 0.02 mg-kg-' rectally. Observations before and after premedication showed no clinically relevant differences in ventilatory and cardiovascular parameters. Neither did the groups differ as regards acceptance of the mask or awakening from anaesthesia. Regardless of group the level of sedation was increased, but only children receiving 0.4 or 0.5 mg-kg-' of midazolam showed an increase in the level of anxiolysis. For this reason a low dose of midazolam (0.2 mgekg-') can be used, except in cases where pronounced anxiolysis is required.

Premedication with midazolam in young children: a comparison of four routes of administration

“…In the study by Andersen et al . (12), a satisfactory sedation level was achieved at 10–25 min after rectal midazolam administration. Oral and rectal midazolam provided maximal sedation and anxiolysis at 30 min.…”

“…Despite its common usage, the preferred route of administration remains in dispute. Many body orifices and other ways serve as tentative routes for administration: the most popular routes in descending order being oral (2,10,11,13,14) followed by rectal (3,4,6,12,15). Other possibilities include intranasal administration (16,17), sublingual (5,6), intramuscular (18) and jet injection (19).…”

“…These doses were based on published data from dose‐ranging studies (3–5,10–12). The preanaesthetic medication was given by the nurse in the admission unit and the response to drug administration was recorded on a two‐point scale: 1=crying, 2=not crying.…”

Midazolam Syrup as a Premedication in Paediatric Patients- A Randomised, Doubleblind, Parallel Group, Placebo-Controlled Study

“…Midazolam is found to be an effective pre-anaesthetic medication for children, administered either orally, [21] rectally, [17,22] intramuscularly, [23] intranasally, [24] sublingually [25] and by jet injection. [26] Of all the routes, oral is the most acceptable route in children because of its unique advantages.…”