Anesthesia & Clinical Research
Open Access

Abstract

Pre-Anesthetic Midazolam: A Randomized Trial with Three Different Routes of Administration

Ashwani K. Chhibber, Kenneth Fickling and Stewart J. Lustik

Aim: We aimed to determine the most effective route of midazolam administration in children prior to surgery to produce a cooperative patient.

Background: Pediatric patients often experience preoperative anxiety and uncooperativeness which has been associated with postoperative behavioral problems.

Methods/Materials: Ninety-nine children one to six years old with ASA status 1 or 2 requiring minor outpatient surgical procedures were enrolled in the study. Patients were randomized to receive preoperative midazolam rectally, nasally, or orally. Patients were graded on a three point cooperativeness scale at baseline, during midazolam administration, 20 minutes after administration, at parent separation, and at induction.

Results: Children receiving midazolam by the rectal route were more cooperative than the nasal or oral groups during administration of midazolam, at separation and at induction. The rectal group had similar cooperativeness to baseline at administration, while the nasal and oral groups were less cooperative at administration than at baseline.

Conclusions: In children undergoing surgical procedures under general anesthesia, rectal administration of midazolam, compared to oral or nasal routes, is better tolerated and more effective at alleviating perioperative uncooperativeness.