Respiratory depression in children receiving diazepam for acute seizures: a prospective study

Norris, Elizabeth; Marzouk, O.; Nunn, Anthony J; McIntyre, John S.; Choonara, Imti

doi:10.1111/j.1469-8749.1999.tb00613.x

Cited by 20 publications

(18 citation statements)

References 17 publications

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“…It can be socially awkward for some patients and caretakers, is expensive, and may cause respiratory adverse effects (especially if given in multiple doses or with other medications). 9,10 Of particular note, adolescents and their parents or caretakers may prefer IN-MMAD because of the social awkwardness associated with RD administration.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric Patients With Epilepsy

Holsti¹,

Dudley²,

Schunk³

et al. 2010

Arch Pediatr Adolesc Med

129

127

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Objective: To compare intranasal midazolam, using a Mucosal Atomization Device (IN-MMAD), with rectal diazepam (RD) for the home treatment of seizures in children with epilepsy.Design: Prospective randomized study.Setting: Patients' homes and a freestanding children's hospital that serves as a referral center for 5 states.Patients: A total of 358 pediatric patients who visited a pediatric neurology clinic from July 2006 through September 2008 and were prescribed a home rescue medication for their next seizure.Intervention: Caretakers were randomized to use either 0.2 mg/kg of IN-MMAD (maximum, 10 mg) or 0.3 to 0.5 mg/kg of RD (maximum, 20 mg) at home for their child's next seizure if it lasted more than 5 minutes.Outcome Measures: The primary outcome measure was total seizure time after medication administration. Our secondary outcome measures were total seizure time, time to medication administration, respiratory complications, emergency medical service support, emergency department visits, hospitalizations, and caretakers' ease of administration and satisfaction with the medication.Results: A total of 92 caretakers gave the study medication during a child's seizure (50 IN-MMAD, 42 RD). The median time from medication administration to seizure cessation for IN-MMAD was 1.3 minutes less than for RD (95% confidence interval, 0.0-3.5 minutes; P=.09). The median time to medication administration was 5.0 minutes for each group. No differences in complications were found between treatment groups. Caretakers were more satisfied with IN-MMAD and report that it was easier to give than RD. Conclusions:There was no detectable difference in efficacy between IN-MMAD and RD as a rescue medication for terminating seizures at home in pediatric patients with epilepsy. Ease of administration and overall satisfaction was higher with IN-MMAD compared with RD.

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Section: Resultsmentioning

confidence: 99%

“…Respiratory depression and need for ventilatory support has been reported in some patients who receive diazepam. 9,10 In the United States, the cost of RD (Diastat) is roughly $212 per dose. 11 Midazolam is available for intranasal (IN) and buccal administration but has not been developed for rectal administration.…”

mentioning

confidence: 99%

Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric Patients With Epilepsy

Holsti¹,

Dudley²,

Schunk³

et al. 2010

Arch Pediatr Adolesc Med

129

127

View full text Add to dashboard Cite

show abstract

“…Respiratory depression has been reported in humans following diazepam administration (21)(22)(23)(24). In children with seizures, the overall incidence of respiratory depression following diazepam administration intravenously, rectally, or both was 20%, 5%, and 9%, respectively (25,26). Respiratory depression has also been reported in adult humans following the use of diazepam (27).…”

Section: Discussionmentioning

confidence: 99%

Comparison between the anaesthetic effects of xylazine–ketamine and diazepam–ketamine: physiological and blood parameters in young hamadryas baboons (Papio hamadryas)

Al-Sobayil¹,

Sadan²,

Al-Shoshan³

2018

Turk J Vet Anim Sci

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The objective of this study was to evaluate the anaesthetic effects on young hamadryas baboons (Papio hamadryas) of xylazine-ketamine (XK) compared to diazepam-ketamine (DK). Six healthy young male hamadryas baboons were first premedicated with xylazine HCl (0.5 mg/kg, IM) and anaesthetised 20 min later with ketamine (10 mg/kg, IM). After a 10-day washout period, the hamadryas baboons were premedicated with diazepam (1 mg/kg, IM) and anaesthetised 20 min later with ketamine (10 mg/kg, IM). The onset, duration, and the depth of anaesthesia were determined by recording palpebral, corneal, and jaw reflexes. The results showed a significant decrease in heart rate and rectal temperature after XK injection, while a significant reduction in respiratory rate was seen when using the DK protocol. A highly significant increase in the levels of glucose was observed with the XK regimen. Blood pressure decreased when using both anaesthetic regimens, but this reduction did not reach significant levels. The quality of recovery was better when using XK compared to DK. In conclusion, major complications including bradycardia, hypothermia, and hyperglycaemia should be considered with a combination of XK. However, no complications other than bradypnea and hypercapnia should be expected when immobilising young hamadryas baboons with DK. No significant difference was observed in CBC, electrolytes, or lactate level between the anaesthesia protocols.

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“…This limitation leads to repeated administration of diazepam, largely in settings where alternative safe and effective anti-convulsants are not available [ 14 ]. The key danger with repeated dosing of diazepam is respiratory depression [ 13 , 15 ], an uncommon occurrence with appropriate dosing of the drug [ 16 ]. Furthermore, the use of phenobarbital, a readily available second-line agent, in addition to diazepam may increase the risk of respiratory depression [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of anti-convulsant treatment failure in children presenting with malaria and prolonged seizures in Kampala, Uganda

Mpimbaza

Staedke

Ndeezi

et al. 2009

Malar J

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Background: In endemic areas, falciparum malaria remains the leading cause of seizures in children presenting to emergency departments. In addition, seizures in malaria have been shown to increase morbidity and mortality in these patients. The management of seizures in malaria is sometimes complicated by the refractory nature of these seizures to readily available anticonvulsants. The objective of this study was to determine predictors of anti-convulsant treatment failure and seizure recurrence after initial control among children with malaria.

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Respiratory depression in children receiving diazepam for acute seizures: a prospective study

Cited by 20 publications

References 17 publications

Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric Patients With Epilepsy

Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric Patients With Epilepsy

Comparison between the anaesthetic effects of xylazine–ketamine and diazepam–ketamine: physiological and blood parameters in young hamadryas baboons (Papio hamadryas)

Predictors of anti-convulsant treatment failure in children presenting with malaria and prolonged seizures in Kampala, Uganda

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