Document Type : Original Article

Authors

1 Associate Professor, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Preservation of sedation is vital and of great significance to successfully carry out diagnostic-therapeutic procedures in children and researchers believe that it is indispensable to offer a safe medication with appropriate administration in this regard. Hence, the present study aimed at evaluating the efficacy of different doses of submucosal Midazolam to induce sedation in children undergoing diagnostic procedures.
Methods: The present study was a clinical trial, in which 99 patients undergoing diagnostic procedures within the age range of 3 months to 5 years were selected and divided into three groups (n=33) of receiving submucosal Midazolam administration with doses of 0.3, 0.4, and 0.5 mg/kg. Then, the onset time of sedation, level of sedation, and duration of drug action were recorded and compared among the three groups.
Results: In the present study, the level of sedation 30 min after the administration of Midazolam 0.3 mg/kg with the mean value of 2.42±0.83 was significantly lower than that of Midazolam 0.4 and 0.5 mg/kg with the mean values of 3.51±0.62 and 3.36±0.60, respectively (p -value <0.001). However, two doses of 0.4 and 0.5 mg/kg did not differ significantly.
Conclusion: The best sub-mucosal dosage of midazolam for sedation with the least complications for pediatric diagnostic procedures is 0.4mg/kg.

Keywords

  1. Rothman DL. Sedation of the pediatric patient. J Calif Dent Assoc 2013; 41(8):603-11.
  2. Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr 2017; 29(3):340-6.
  3. Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med 1998; 31(6):688-97.
  4. Cahoon GD, Davison TE. Prediction of compliance with MRI procedures among children of ages 3 years to 12 years. Pediatr Radiol 2014; 44(10):1302-9.
  5. Martin ML, Lennox PH. Sedation and analgesia in the interventional radiology department. Journal of Vascular and Interventional Radiology. 2003; 14(9):1119-28..
  6. Yaster M. Multimodal analgesia in children. Eur J Anaesthesiol 2010; 27(10):851-7.
  7. Griffin CE 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system–mediated effects. Ochsner J 2013; 13(2):214-23.
  8. Rabach I, Peri F, Minute M, Aru E, Lucafò M, Di Mascio A, et al. Sedation and analgesia in children with cerebral palsy: a narrative review. World J Pediatr 2019; 15(5):432-40.
  9. Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. The Lancet. 1999; 353(9153):623-6.
  10. Lam JK, Xu Y, Worsley A, Wong IC. Oral transmucosal drug delivery for pediatric use. Adv Drug Deliv Rev 2014; 73:50-62.
  11. Southerland JH, Brown LR. Conscious intravenous sedation in dentistry: a review of current therapy. Dent Clin North Am 2016; 60(2):309-46.
  12. Mula M. The safety and tolerability of intranasal midazolam in epilepsy. Expert Rev Neurother 2014; 14(7):735-40.
  13. Milnes AR, Wilson S. Alternatives to Oral Sedation. InOral Sedation for Dental Procedures in Children 2015 (pp. 141-155). Springer, Berlin, Heidelberg.
  14. Coulthard P, Craig D, Holden C, Robb ND, Sury M, Chopra S, et al. Current UK dental sedation practice and the'National Institute for Health and Care Excellence'(NICE) guideline 112: sedation in children and young people. Br Dent J 2015; 218(8):E14.
  15. Ghai B, Jain K, Saxena AK, Bhatia N, Sodhi KS. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double‐blind, and controlled study. Paediatr Anaesth 2017; 27(1):37-44.
  16. Jo CW, Park CH, Lee JH, Kim JH. Managing the behavior of a patient with autism by sedation via submucosal route during dental treatment. J Dent Anesth Pain Med 2017; 17(2):157-61.
  17. McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005; 366(9481):205-10.
  18. Momen AA, Azizi Malamiri R, Nikkhah A, Jafari M, Fayezi A, Riahi K, et al. Efficacy and safety of intramuscular midazolam versus rectal diazepam in controlling status epilepticus in children. Eur J Paediatr Neurol 2015; 19(2):149-54.
  19. Mpimbaza A, Ndeezi G, Staedke S, Rosenthal PJ, Byarugaba J. Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pediatrics 2008; 121(1):e58-64.
  20. Majidinejad S, Taherian K, Esmailian M, Khazaei M, Samaie V. Oral midazolam-ketamine versus midazolam alone for procedural sedation of children undergoing computed tomography; a randomized clinical trial. Emerg (Tehran) 2015; 3(2):64-9.
  21. Smith R, Brown J. Midazolam for status epilepticus. Aust Prescr 2017; 40(1):23-5.
  22. Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong J, Tait A. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 2000; 84(6):743-8.
  23. Coté CJ, Wilson S, American Academy Of Pediatrics, American Academy Of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics 2016; 138(1):e20161212.
  24. Sury M, Bullock I, Rabar S, Demott K, Guideline Development Group. Sedation for diagnostic and therapeutic procedures in children and young people: summary of NICE guidance. Bmj 2010; 341:c6819.
  25. Ahmed SS, Unland T, Slaven JE, Nitu ME. High dose dexmedetomidine: effective as a sole agent sedation for children undergoing MRI. Int J Pediatr 2015; 2015:397372.
  26. Sunbul N, Delvi MB, Zahrani TA, Salama F. Buccal versus intranasal midazolam sedation for pediatric dental patients. Pediatr Dent 2014; 36(7):483-8.
  27. Manoj M, Satya Prakash MV, Swaminathan S, Kamaladevi RK. Comparison of ease of administration of intranasal midazolam spray and oral midazolam syrup by parents as premedication to children undergoing elective surgery. J Anesth 2017; 31(3):351-7.
  28. Musani IE, Chandan NV. A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children. Eur Arch Paediatr Dent 2015; 16(5):417-24.