Effects of intranasal midazolam as premedication in paediatric anaesthesia. A clinical study

Introduction Operation theatre environment, surgery and anaesthesia cause stress and anxiety. This can cause psychological disturbances, especially in children. Sedative and anxiolytic premedication have been used to prevent such outcomes. Intranasal route is least traumatic and easily accepted. Intranasal midazolam has been used for premedication in children. Objectives This study was undertaken to evaluate the efficacy of intranasal midazolam as premedication with regard to degree of sedation, ease of parental separation, response to venepuncture, response to induction, post anaesthesia recovery characteristics and side effects if any. Materials and Methods Sixty patients, ASA grade I and II, between 3-6 years of age group of either sex posted for elective surgery under general anaesthesia, randomly divided into 2 groups of 30 patients each were studied. The response to parental separation, venepuncture and mask placement, post anaesthesia recovery characteristics and side effects were recorded. ECG, NIBP, HR, SpO2 were monitored. Results In midazolam group, 80% of the children were satisfactorily sedated at 5 min after administration of the drug whereas in normal saline group only 50% were satisfactorily sedated. In midazolam group, at 10 mins, parental separation in 90% children was much easier compared to 13.3% in NS group. Response to venepuncture was more satisfactory in midazolam group than normal saline. Response to mask placement was also good in midazolam group. There was no undue prolongation of recovery time in both the groups. Conclusions The study shows that intranasal midazolam 0.2 mg/kg administered 15 min prior to induction in children of 3-6 years of age produces satisfactory level of sedation, ease of separation from parents, decreased discomfort associated with venepuncture with better mask acceptance. No significant hemodynamic changes occurred throughout the procedure.