International Journal of Clinical Pediatric Dentistry

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VOLUME 17 , ISSUE 8 ( August, 2024 ) > List of Articles

ORIGINAL RESEARCH

Comparative Evaluation of Oral and Intranasal Administration of Midazolam as Preanesthetic Medication in Pediatric Dental Patients Treated under General Anesthesia

Swati Choudhary, Ruby K Shah, Sandeep Tandon, Rinku Mathur, Tripti Sharma, Ambika S Rathor

Keywords : Behavior management, General anesthesia, Intranasal midazolam sedation and dental treatment, Midazolam sedation, Oral midazolam, Pharmacological management, Premedication

Citation Information : Choudhary S, Shah RK, Tandon S, Mathur R, Sharma T, Rathor AS. Comparative Evaluation of Oral and Intranasal Administration of Midazolam as Preanesthetic Medication in Pediatric Dental Patients Treated under General Anesthesia. Int J Clin Pediatr Dent 2024; 17 (8):881-886.

DOI: 10.5005/jp-journals-10005-2941

License: CC BY-NC 4.0

Published Online: 23-09-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aims and background: Midazolam is commonly used as a preanesthetic medication for behavior management of children. The current study is conducted to find out the effect of midazolam through nasal and oral routes as a premedicament in pediatric patients treated under general anesthesia. The main aims of the study were: to compare the effect of oral syrup and intranasal spray as preanesthetic medication; to record the undesirable side effects of midazolam by both routes. Materials and methods: The patients aged 2–6 years of either sex were randomly divided into two equal groups of 30 each—group I: oral; group II: intranasal. Results: The oral and intranasal routes of midazolam were found to be equally effective and provided adequate sedation for easy separation from the parents and cooperation from children during the induction of anesthesia with minimal side effects. Conclusion: Based on the study results, we can conclude that both oral and intranasal midazolam can be used as preanesthetic medication for pediatric dental patients treated under general anesthesia. Clinical significance: In pediatric patients, the oral route should be preferred for midazolam premedication in comparison to the intranasal route.

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  1. Klingberg G, Berggren U, Carlsson SG, et al. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci 1995;103(6):405–412. DOI: 10.1111/j.1600-0722.1995.tb01865.x
  2. Enger DJ, Mourino AP. A survey of 200 pediatric dental general anaesthesia cases. J Dent Child 1985:52:36–41.
  3. Damle SG, Gandhi M, Laheri V. Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry. J Indian Soc Pedod Prev Dent 2008;26:97–101.
  4. Beeby DG, Huges JOM. Behaviour of unsedated children in the anaesthetic room. Br J Anaesth 1980;52:279–281. DOI: 10.1093/bja/52.3.279
  5. Korsch BM. The child and operating room. Anesthesiology 1975;431:251–257. DOI: 10.1097/00000542-197508000-00010
  6. Kain ZN. Perioperative Psychological Trauma in Children, 1st edition. Philadelphia: WB Saunders; 1990.
  7. Kain ZN, Mayes LC, O'Connor TZ, et al. Preoperative anxiety in children: predictors and outcomes. Arch Pediatr Adolesc Med 1996;150:1238–1245. DOI: 10.1001/archpedi.1996.02170370016002
  8. Rita L, Cox JM, Seleny FL, et al. Ketamine hydrochloride for pediatric premedication: comparison to pentazocine. Anesth Analg 1974;53:375.
  9. Clerk RSJ. Intravenous anaesthetic agents: induction and maintenance. In: Healy TEJ, Cohen PJ (Eds). Wylie and Churchill-Davidson's A Practice of Anaesthesia, 6th edition. London: Edward Arnold; 1995. p. 98.
  10. Rita L, Seleny FL, Mazurek A, et al. Intramuscular midazolam for pediatric preanethestic sedation: a double blind controlled study with morphine. Anesthesiology 1985;63:528–531. DOI: 10.1097/00000542-198511000-00009
  11. Taylor MB, Vine PR, Hatch DJ. Intramuscular midazolam premedication in small children. A comparison with papaveretum and hyoscine. Anaesthesia 1986;41:21–26. DOI: 10.1111/j.1365-2044.1986.tb12698.x
  12. Saint-Maurice C, Meistleman C, Rey E, et al. The pharmacokinetics of rectal midazolam for premedication in children. Anesthesiology 1986;65:536–538. DOI: 10.1097/00000542-198611000-00019
  13. Raybould D, Bradshaw EG. Premedication for day case surgery. Anaesthesia 1987;42:591–595. DOI: 10.1111/j.1365-2044.1987.tb03081.x
  14. Abrams R, Morrison JE, Villasenor A, et al. Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam or sufentanil) for urgent brief pediatric dental procedures. Anesth Prog 1993;40:63–66.
  15. Wilton NCT, Leigh J, Rosen DR, et al. Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology 1988;69:972–975. DOI: 10.1097/00000542-198812000-00032
  16. Karl HW, Rosenburger JL, Lrach MG, et al. Transmucosal administration of midazolam for premedication of pediatric patients. Comparison of nasal and sublingual routes. Anesthesiology 1993;78:885–891. DOI: 10.1097/00000542-199305000-00013
  17. Khalil S, Philbrook L, Rabb M, et al. Sublingual midazolam premedication in children: a dose response study. Pediatr Anesth 1998;8:461–465. DOI: 10.1046/j.1460-9592.1998.00286.x
  18. Pandit UA, Collier PJ, Malviya S, et al. Oral tranmucosal midazolam premedication for preschool children. Can J Anesth 2001;48(2):191–195. DOI: 10.1007/BF03019734
  19. Cox RG, Nemish U, Ewen A, et al. Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children? Can J Anesth 2006;53(12)1213–1219. DOI: 10.1007/BF03021583
  20. Bojrkman S, Rigemar G, Idvall J. Pharmacokinetics of midazolam given as intranasal spray to adult surgical patients. Br J Anaesth 1997;79:575–580. DOI: 10.1093/bja/79.5.575
  21. Karl HW, Keifer AT, Rosenberger JL, et al. Comparison of the safety and efficacy of intranasal midazolam or sufentanil for premedication of anaesthesia of paediatric patients. Anaesthesiology 1992;76:209–215. DOI: 10.1097/00000542-199202000-00009
  22. Davis PJ, Tome JA, McGowan FX Jr, et al. Preanaesthetic mediation with intranasal midazolam for brief paediatric surgical procedures. Effect on recovery and hospital discharge times. Anaesthesiology 1995;82:2–5. DOI: 10.1097/00000542-199501000-00002
  23. Weksler N, Ovadia L, Muati G, et al. Nasal ketamine for pediatric premedication. Can J Anesth 1993;40:119–121. DOI: 10.1007/BF03011307
  24. McMillan CO, Spahr-Schopfer IA, Sikich N, et al. Premedication of children with oral midazolam. Can J Anaesth 1992;39(6):545–550. DOI: 10.1007/BF03008315
  25. Bhakta P, Ghosh BR, Mukherjee G, et al. Evaluation of intranasal midazolam for preanasthetic sedation in paediatric patients. Ind J Anaesth 2007;51(2):111–116.
  26. Primosch RE, Guelmann M. Comparison of drops versus spray administration of intranasal midazolam in two- and three-year-old children for dental sedation. Pediatr Dent 2005;27(5):401–408.
  27. Koppal R, Adarsh ES, Ambi U, et al. Comparison of the midazolam transnasal atomizer and oral midazolam for sedative premedication in paediatric Cases. JCDR 2011;5(5):932–934.
  28. Alex S, Coelho B, Ambareesha M. Comparison of intranasal and oral midazolam as premedicant drug in preschool children. J Anaesth Clin Pharmacol 2008;24(3):333–336.
  29. Chhibber AK, Fickling K, Lustik SJ. Pre-anesthetic midazolam: a randomized trial with three different routes of administration. J Anesth Clinic Res 2011;2:1. DOI: 10.4172/2155-6148.1000118
  30. Wermeling DP, Record KA, Kelly TH, et al. Pharmacokinetics and pharmacodynamics of a new intranasal midazolam and formulation in healthy volunteers. Anesth Analg 2006;103:344–349. DOI: 10.1213/01.ane.0000226150.90317.16
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