EVIDENCE LIBRARY
Preschool Premedication Trial Found Similar Sedation but Different Acceptance by Midazolam Route
A randomized study comparing oral syrup with intranasal spray found similar sedation at 20 minutes, while administration was better accepted orally. Route affected experience as well as dosing.
A randomized study comparing oral syrup with intranasal spray found similar sedation at 20 minutes, while administration was better accepted orally. Route affected experience as well as dosing.
The comparison
Deshmukh and colleagues randomized 60 children aged one to five years undergoing short routine operations. The study compared a selected oral-syrup regimen with a selected intranasal-spray regimen, rather than equal numerical doses by interchangeable routes.
Satisfactory sedation at 20 minutes occurred in 24 of 30 oral-group children and 23 of 30 intranasal-group children. Parental separation and mask acceptance were comparable. Oral administration was more readily accepted, while transient nasal irritation occurred in 12 of 30 intranasal recipients.
What similar scores leave unresolved
A nonsignificant difference in sedation scores does not demonstrate that the products have identical absorption or are equivalent for every use. The trial involved generally healthy preschool children and a particular preoperative setting.
The sample was too small to establish the frequency of uncommon complications. Its short observation and recovery assessments did not establish long-term behavioral effects or define safety in children with substantial comorbidities.
Forensic application
When reconstructing a sedation event, retain route, formulation, administration difficulty, and elapsed time. A child’s resistance during nasal administration is not the same outcome as failure to achieve sedation twenty minutes later. The study illustrates why those observations should be recorded separately.
Source
Original analysis of the supplied paper: Comparison of preanesthetic sedation in pediatric patients with oral and intranasal midazolam. Paper identifier: PMC5009843.