Oral Midazolam in Children: Effect of Time and Adjunctive Therapy 8. Craig Weldon, MD, Mehernoor F. Watcha, MD, and Pad F. White, PhD, MD, FFARACS Department of Anesthesiology, Division of Clinical Research, Washington University School of Medicine, St. Louis, Missouri, and the Department of Anesthesiology and Pain Management, University of Texas Southwestern
Medical Center, Dallas, Texas
The purpose of this study was to determine the influence of timing and concomitant administration of atropine and/or meperidine on the perioperative effects of oral midazolam in children. In 154 healthy children, 1-8 yr old, we studied six oral preanesthetic medication regimens according to a randomized, double-blind protocol. Group A (placebo) received 5 mL of apple juice. The other five groups received medication with apple juice to a totalvolume of 5 mL, 20-60 min before induction of anesthesia. Group B received atropine (0.02 mgkg); group C received midazolam (0.5mgkg); group D received midazolam (0.5 mgkg) and atropine (0.02 mgkg); group E received meperidine (1.5 mg/kg) and atropine (0.02 mgkg); and group F received meperidine (1.5 mgkg), atropine (0.02 m&), and midazolam (0.5 mgkg). The sedative effect of midazolam was maximal 30 min after oral administration. Ninety-five percent of the children who were separated from
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reanesthetic medication in children should relieve anxiety, reduce the trauma associated with separation from their parents, and facilitate induction of anesthesia without prolonging the recovery period (1-12). Although various combinations of drugs and routes of administration have been used in children for preanesthetic sedation, the oral route remains the least threatening method of drug administration (4-11). A combination of oral meperidine, diazepam, and atropine has been reported to decrease anxiety and to facilitate induction of anesthesia (7).More recently, oral midazolam, 0.5-0.75 mg/kg, was shown to be an effective preanesthetic medication technique that did not prolong This material was presented in part at the American Sodety of Anesthesiologistsmeeting in Las Vegas, Nevada, October 19-23, 1990, and at the International Anesthesia Research Society meeting in San AntoNo, Texas, March 9-12,1991. Accepkd for publicationFebruary 20,1992. Address mrrespondence to Dr. White, Department of Anesthesiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 752359068. 01992 by the International Anesthesia Research Society ooo3-2999/92/s5.00
their parents within 45 min after oral midazolam administration (with or without atropine) had satisfactory separation scores (vs 66% of those separated after 45 min; P < 0.02). Midazolam-treated patients were more cooperative with a mask induction of anesthesia compared with non-midazolam-treated children (83% vs 56%). Neither atropine nor meperidine appeared to significantly improve the effectiveness of oral midazolam. No preoperative changes in heart rate, respiratory rate, or hemoglobin oxygen saturationwere noted in any of the treatment groups. Finally, oral midazolam did not prolong recovery even after outpatient procedures lasting
Medical Center, Dallas, Texas
The purpose of this study was to determine the influence of timing and concomitant administration of atropine and/or meperidine on the perioperative effects of oral midazolam in children. In 154 healthy children, 1-8 yr old, we studied six oral preanesthetic medication regimens according to a randomized, double-blind protocol. Group A (placebo) received 5 mL of apple juice. The other five groups received medication with apple juice to a totalvolume of 5 mL, 20-60 min before induction of anesthesia. Group B received atropine (0.02 mgkg); group C received midazolam (0.5mgkg); group D received midazolam (0.5 mgkg) and atropine (0.02 mgkg); group E received meperidine (1.5 mg/kg) and atropine (0.02 mgkg); and group F received meperidine (1.5 mgkg), atropine (0.02 m&), and midazolam (0.5 mgkg). The sedative effect of midazolam was maximal 30 min after oral administration. Ninety-five percent of the children who were separated from
P
reanesthetic medication in children should relieve anxiety, reduce the trauma associated with separation from their parents, and facilitate induction of anesthesia without prolonging the recovery period (1-12). Although various combinations of drugs and routes of administration have been used in children for preanesthetic sedation, the oral route remains the least threatening method of drug administration (4-11). A combination of oral meperidine, diazepam, and atropine has been reported to decrease anxiety and to facilitate induction of anesthesia (7).More recently, oral midazolam, 0.5-0.75 mg/kg, was shown to be an effective preanesthetic medication technique that did not prolong This material was presented in part at the American Sodety of Anesthesiologistsmeeting in Las Vegas, Nevada, October 19-23, 1990, and at the International Anesthesia Research Society meeting in San AntoNo, Texas, March 9-12,1991. Accepkd for publicationFebruary 20,1992. Address mrrespondence to Dr. White, Department of Anesthesiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 752359068. 01992 by the International Anesthesia Research Society ooo3-2999/92/s5.00
their parents within 45 min after oral midazolam administration (with or without atropine) had satisfactory separation scores (vs 66% of those separated after 45 min; P < 0.02). Midazolam-treated patients were more cooperative with a mask induction of anesthesia compared with non-midazolam-treated children (83% vs 56%). Neither atropine nor meperidine appeared to significantly improve the effectiveness of oral midazolam. No preoperative changes in heart rate, respiratory rate, or hemoglobin oxygen saturationwere noted in any of the treatment groups. Finally, oral midazolam did not prolong recovery even after outpatient procedures lasting
