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Q: anesthesia ( Answered,   2 Comments )
Subject: anesthesia
Category: Health > Children
Asked by: cvsprasad1234-ga
List Price: $2.00
Posted: 06 Dec 2002 10:27 PST
Expires: 05 Jan 2003 10:27 PST
Question ID: 120410
before administering anesthesia to infants and children under
five,intra nasal midazolam is followed  ,please suggest some articles
and journals containing the relevant articles
Subject: Re: anesthesia
Answered By: kutsavi-ga on 21 Dec 2002 08:01 PST
Hey there cvsprasad1234,

Here are references to 19 articles on the pediatric use of Midazolam:

An article in Italian titled:  Sedation in pediatric dental patients.
A comparison of intranasal midazolam and oral diazepam
Original Title:Sedación en odontopediatría.  Comparación del midazolam
vía intranasal, con el diazepam vía oral
By:  Martínez SMI, Martínez RJI
Rev ADM 1995; 52(5): 261-265.

A comparison of intranasal midazolam and oral diazepam in pediatric
sedation for dental patients was done. Forty highly anxious children
age 3 to 5 years, were studied. Two study groups were formed with 20
patients in each group. The first group received intransal midazolam
0.3 mg/kg. The second group received oral diazepam 0.3 mg/kg.

Results indicate that the onset of sedation is faster with midazolam
than diazepam, with superior performance in the parameters of sedation
and better reponse during dental treatment. Recovery was faster in the
midazolam grouip. Intranasal route of administration was effective and
efficient for preescolar children. Both drugs were safe.

Abstracts to 9 articles:  Intranasal Midazolam for Pediatric sedation
[Abstracts are contained on this page]

3     al-Rakaf, H., L. L. Bello, et al. (2001). “Intra-nasal midazolam
in conscious sedation of young paediatric dental patients.” Int J
Paediatr Dent 11(1): 33-40.

4     Bates, B. A., S. A. Schutzman, et al. (1994). “A comparison of
intranasal sufentanil and midazolam to intramuscular meperidine,
promethazine, and chlorpromazine for conscious sedation in children.”
Ann Emerg Med 24(4): 646-51.

 5     Davis, P. J., J. A. Tome, et al. (1995). “Preanesthetic
medication with intranasal midazolam for brief pediatric surgical
procedures. Effect on recovery and hospital discharge times.”
Anesthesiology 82(1): 2-5.

6     Henry, R. J., N. Ruano, et al. (1998). “A pharmacokinetic study
of midazolam in dogs: nasal drop vs. atomizer administration.” Pediatr
Dent 20(5): 321-6.

 7     Louon, A. and V. G. Reddy (1994). “Nasal midazolam and ketamine
for paediatric sedation during computerised tomography.” Acta
Anaesthesiol Scand 38(3): 259-61.
8     Malinovsky, J. M., C. Populaire, et al. (1995). “Premedication
with midazolam in children. Effect of intranasal, rectal and oral
routes on plasma midazolam concentrations.” Anaesthesia 50(4): 351-4.

 9     Theroux, M. C., D. W. West, et al. (1993). “Efficacy of
intranasal midazolam in facilitating suturing of lacerations in
preschool children in the emergency department.” Pediatrics 91(3):

 10     Yealy, D. M., J. H. Ellis, et al. (1992). “Intranasal
midazolam as a sedative for children during laceration repair.” Am J
Emerg Med 10(6): 584-7.

11     Zedie, N., D. W. Amory, et al. (1996). “Comparison of
intranasal midazolam and sufentanil premedication in pediatric
outpatients.” Clin Pharmacol Ther 59(3): 341-8.

References to articles from 
"Site of Dependence; A site on benzodiazepine dependence, withdrawal
and other side effects"
( )

McCormick AS et al.
Bronchospasm During Inhalation of Nebulized Midazolam.
Br J Anaesth 1998; 80: 564-565

Mets B, Horsell A, Linton DM.
Midazolam-Induced Benzodiazepine Withdrawal Syndrome.
Anaesthesia 1991; 46: 28-29.

Martinez-Tilleria A, Cano NE et al.
Paradoxical Reaction to Midazolam after Its Use as a Sedative in
Regional Anesthesia.
Rev Esp Anestesiol Reanim 1992; 39: 379-380.

Massanari M et al.
Paradoxical Reactions in Children Associated with Midazolam Use
During Endoscopy.
Clin Pediatr (Phila) 1997; 36: 681-684.

From "Comment" area below by "surgeon-ga":
Yale-New Haven Hospital news release:  Study Shows Its Takes More Than
Hugs To Calm Kids Before Surgery
Premedication Reduces Child's Anxiety; Eases Post- Operative Recovery
Pediatric Seizure Treatment
"In a study recently completed by an Israeli hospital pediatric
department, it appears that intranasal midazolam is a safe and
effective treatment for febrile seizures in children. The year-long
study looked at 47 children (ages six months to five  years) who had
febrile seizures lasting at least 10 minutes. Intranasal midazolam
(0.2 mg/kg) was compared with intravenous diazepam (0.3 mg/kg)."

Big Wordy Boring Text Outline Version 
Contact: Jim Middleton, Pharmacist and Instructor

  9. Something (relatively) new: 
  MIDAZOLAM (Versed) 
         a. a new benzodiazepine 
         b. mainly for IV use, although 1999 saw the introduction of a
liquid form for pediatric oral dosing
         c. indicated for preoperative sedation 
         d. main advantage: WATER SOLUBILITY 
          --diazepam (Valium) is not--burns on injection, frequently
precipitates in IV fluids
             --midazolam (Versed) can be mixed with other preop
medications and can be administered through IV fluids
         e. amnesia possible through and after procedure 
         f. can cause ideosyncratic hicchoughing (consider the
limitations for outpatient eye surgery)

Article on infant IV infusion from National Institutes of Health:
Intravenous midazolam infusion for sedation of infants in the neonatal
intensive care unit


infant midazolam

preop midazolam pediatric

intranasal pediatric midazolam
Subject: Re: anesthesia
From: surgeon-ga on 06 Dec 2002 10:52 PST
Subject: Re: anesthesia
From: lilacdaffodil-ga on 10 Mar 2005 14:53 PST
A full article about the use of Sevlurothane/nitrous oxide to
anaesthetise children can be found at

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