Investigating The Effect of Midazolam on Pediatric's Sedation and Anxiety
(A new reading in the comparison between the creations of Meyerhold and Brecht)
Keywords:
Intranasal, Sublingual, Midazolam, Anxiety, PediatricAbstract
One of the essential experiences in life is surgical events anesthesia. This experience may cause physiological and psychological disorders such as anxiety and stress, especially in children. The anxiety problem appears without appropriate treatment, and many cause impactive physical or psychological complications in children. Procedural sedation methods for children and adults are different, and a successful method for anxiety control in adults may not be effective in children. Few studies have specifically studied performing the preoperative midazolam therapy and method of consumption on postoperative children’s anxiety. Hence, this study was conducted to compare intranasal and sublingual midazolam as premedication for sedation and reduction of anxiety in pediatric patients. Material and method: This study was conducted as a randomized controlled trial study. A list of patients was prepared from the clinical part of the Nasiriyah hearth center. The list was inputted into the software randomly, and 107 persons were selected. The type of administration was randomly chosen for each patient prescribed midazolam. Participants who have general anesthesia and midazolam prescribed for them between July 2022 in the Nasiriyah Cardiac heart center will be included in this study. Half of the participants (n=107) received sublingual midazolam, and others (n=107) received intranasal midazolam. This study's outcome is the anxiety score in children (quantitative and qualitative). The exposure of the study is the consumption of midazolam before general anesthesia. The measurement for all participants was in the same method. Result: Totally, of 214 patients were included in this study. Among them, 50.9% (n=109) were male, and 49.1% (n=105) were female. The mean age was 10.15 ± 1.87 years (95% Confidence Interval 9.90 - 10.40 years). Our result showed that the anxiety of patients who received intranasal midazolam was significantly lower than patients who received sublingual midazolam at 10 (P=0.006) and 20 (P=0.020) minutes. However, this difference was not statistically significant in min 30 (P=0.644) and 60 (P=0.655). In addition, the pain of participants who received intranasal midazolam was significantly lower than patients who received sublingual. While this difference was not statistically significant, it was borderline significant (p=0.078). In addition, our results showed that the mean time for sedation of participants in the nasal midazolam intervention group was 9.47±2.01years. In the sublingual midazolam intervention group, it was 16.38±2.99 years. The difference was statistically significant (p<0.001), which means the mean sedation time in patients who received sublingual midazolam was significantly higher than in those who received intranasal midazolam. Discussion: We concluded from our study that intranasal midazolam has superiority compared with sublingual midazolam in premedication in children for sedation and anxiety score and some other factors, including pulse rate and o2 saturation before anesthesia. The anxiety scores after premedication are significantly lower in the intranasal compared are sublingual. In addition, the onset time for sedation was significantly lower in intranasal inter, which nation group means this method may have a faster effect. The adverse effect was similar in both groups. Thus, intranasal midazolam is a fallow-danger, low-danger method for children undergoing anesthesia.
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References
Concepcion T, Mohamed M, Dahir S, Ismail EA, Poenaru D, Rice HE, et
al. Prevalence of pediatric surgical conditions across Somaliland.
JAMA Network Open. 2019;2(l):el86857-e.
Stewart E, Algren C, Arnold S. Preparing children for a surgical
experience. Today, OR nurse. 1994;16(2):9-14.
Kumar A, Das S, Chauhan S, Kiran U, Satapathy S. Perioperative anxiety
and stress in children undergoing congenital cardiac surgery and
their parents: Effect of brief intervention—A randomized control
trial. Journal of cardiothoracic and vascular anesthesia.
;33(5):1244-50.
American Society of Anesthesiologists. (2014) Continuum of Depth of
Sedation: Definition of General Anesthesia and Levels of
Sedation/Analgesia (pp. 1-2).
Jordan BD, Wright ELJAJ. Xenon as an anesthetic agent 2010;78(5):387-92.
Robinson DH, Toledo AHJJoIS. Historical development of modern
anesthesia. 2012;25(3):141-9.
Guerrini G, Ciciani GJEOoTP. Benzodiazepine receptor ligands: a patent
review (2006-2012). 2013;23(7):843-66.
Wick JJTCP. The history of benzodiazepines. 2013;28(9):538-48.
Powers III AR, Gancsos MG, Finn ES, Morgan PT, Corlett PRJP.
Ketamine-induced hallucinations. 2015;48(6):376-85.
Allolio B, Stuttmann R, Leonhard U, Fischer H, Winkelmann WJKW.
Adrenocortical suppression by a single induction dose of etomidate.
;62(21):1014-7.
St Pierre M, Dunkel M, Rutherford A, Hering WJEJoa. Does etomidate
increase post-operative nausea? A double-blind controlled
comparison of etomidate in lipid emulsion with propofol for
balanced anesthesia. 2000;17(10):634-41.
Hemmings Jr HC, Akabas MH, Goldstein PA, Trudell JR, Orser BA,
Harrison NLJTips. Emerging molecular mechanisms of general
anesthetic action. 2005;26(10):503-10.
Rudolph U, Antkowiak BJNRN. Molecular and neuronal substrates for
general anesthetics. 2004;5(9):709-20.
Jessner L, Blom GE, Waldfogel SJTpsotc. Emotional implications of
tonsillectomy and adenoidectomy on children. 1952;7(1):126-69.
Jessner L, Blom GE, Waldfogel SJTpsotc. Emotional implications of
tonsillectomy and adenoidectomy on children. 1952;7(1):126-69.
Rollins JH, Bolig R, Mahan CC. Meeting children's psychosocial needs
across the health-care continuum: Pro-ed Austin, TX; 2005.
Gross YJTWEoP, Models ID, Theories. Erikson's stages of psychosocial
development. 2020:179-84.
Goodyear MD, Krleza-Jeric K, Lemmens TJB. The declaration of
Helsinki. British Medical Journal Publishing Group; 2007. p. 624-5.
Dave NMJIJoA. Premedication and induction of anaesthesia in
paediatric patients. 2019;63(9):713.
Palasamudram S, Shroff M. Principles and Practice of Radiological
Investigations for the Diagnosis of Pediatric Head and Neck Diseases.
Pediatric Head and Neck Textbook:Springer; 2021. p. 9-32.
Verma I, Sharma RN, Trivedi V, Dhaked SSJTEJoCA. Comparison of
intranasal Ketamine and intranasal midazolam for pediatric
premedication in patients undergoing congenital heart disease
surgery. 2021;15(3):61.Karl HW, Rosenberger JL, Larach MG, Ruffle JMJTJotASoA.
Transmucosal administration of midazolam for premedication of
pediatric patients: comparison of the nasal and sublingual routes.
;78(5):885-91.
ado-Filho J, Viana KA, Correa-Faria P, Costa LR, Costa PSJPo.
Randomized clinical trial on the efficacy of intranasal or oral
ketamine-midazolam combinations compared to oral midazolam for
outpatient pediatric sedation. 2019;14(3):e0213074.
Shereef KM, Chaitali B, Swapnadeep S, Gauri MJIJoA. Role of nebulized
dexmedetomidine, midazolam or Ketamine as premedication in
preschool children undergoing general anesthesia—A prospective,
double-blind, randomized study. 2022;66(Suppl 4):S200
Heikal S, Stuart GJBe. Anxiolytic premedication for children.
;20(7):220
Arnawa IWEJISM. Intranasal premedication: special consideration in
children. 2018;9(3).
Kanto JHJPTJoHP, Therapy D. Midazolam: The First Water soluble
Benzodiazepine; Pharmacology, Pharmacokinetics, and Efficacy in
Insomnia and Anesthesia. 1985;5(3):138-55.
Wilton NC, Leigh J, Rosen DR, Pandit UAJTJotASoA. Preanesthetic
sedation of preschool children using intranasal midazolam.
;69(6):972-4.
Sayany Z, Nazif M, Burckart G, McKibben D, Hadeed JJPD. Plasma
levels of intranasal midazolam at 0.4 mg/kg and 0.2 mg/kg doses.
;18:320-1.
Udani SJIPAS-wA, Vol II. 35 Status Epilepticus. 2020:355.
Zaporowska-Stachowiak I, Szymanski K, Oduah M-T, StachowiakSzymczak K, Luczak J, Sopata MJB, et al. Midazolam:Safety of use in
palliative care: A systematic critical review. 2019;114:108838.
Karim N, AfroJ S, Lloyd K, Oaten LC, Andreeva DV, Carr C, et al.
Sustainable personal protective clothing for health-care applications:
a review. 2020;14(10):12313-40.
Breschan C, Platzer M, Jost R, Stettner H, Likar RJPA. Midazolam does
not reduce the emergence of delirium after sevoflurane anesthesia in
children. 2007;17(4):347-52.
Mahgoub AEO. The comparison of two doses of intranasal midazolam
sedation in a pediatric dental emergency clinic: University of
Western Cape; 2011.
Musani I, Chandan NJEAoPD. A comparison of the soothing effect of
oral versus nasal midazolam combined with nitrous oxide in
uncooperative children. 2015;16(5):417-24.
Bailey AM, Baum RA, Horn K, Lewis T, Morizio K, Schultz A, et al.
Review of intranasally administered medications for use in the
emergency department. 2017;53(l):38-48.
Lee Y, Kim J, Kim S, Kim JJJoda, medicine p. Intranasal administration
of dexmedetomidine (DEX) as a premedication for pediatric patients
undergoing general anesthesia for dental treatment. 2016;16(l):25-9.
Ku L, Simmons C, Smith P, Greenberg R, Fisher K, Hornik C, et al.
Intranasal midazolam and fentanyl for procedural sedation and
analgesia in infants in the neonatal intensive care unit.
;12(2):143-8.
Alp H, Elmaci AM, Alp EK, Say BJCitY. Comparison of intranasal
midazolam, intranasal Ketamine, and oral chloral hydrate for
conscious sedation during paediatric echocardiography: results of a
prospective randomized study. 2019;29(9):1189-95.
Al Rakaf H, Bello L, Turkustani A, Adenubi JJIJoPD. Intranasal
midazolam in conscious sedation of young pediatric dental patients.
;ll(l):33-40.
Preethy NA, Somasundaram SJCCD. Sedative and behavioral effects of
intranasal midazolam in comparison with other administrative
routes in children undergoing dental treatment-A systematic review.
;12(2):105.
Narendra P, Naphade RW, Nallamilli S, Mohd SJA, essays, researches. A
comparison of intranasal ketamine and intranasal midazolam for
pediatric premedication. 2015;9(2):213.
Patel T, Kurdi MSJJoa, clinical pharmacology. A comparative study
between oral melatonin and oral midazolam on preoperative anxiety,
cognitive, and psychomotor functions. 2015;31(l):37.
Naguib M, Samarkandi AHJA, Analgesia. The comparative dose¬
response effects of melatonin and midazolam for premedication of
adult patients: a double-blinded, placebo-controlled study.
;91(2):473-9.
Gitto E, Karbownik M, Reiter RJ, Tan DX, Cuzzocrea S, Chiurazzi P, et
al. Effects of melatonin treatment in septic newborns.
;50(6):756-60.
Alex S, Coelho B, Ambareesha MJJoACP. Comparison of intranasal and
oral midazolam as premedicant drug in preschool children.
;24(3):333-6
. Lam C, Udin RD, Malamed SF, Good DL, Forrest JLJAp. Midazolam
premedication in children: a pilot study comparing intramuscular
and intranasal administration. 2005;52(2):56-61.
Karl HW, Rosenberger JL, Larach MG, Ruffle JMJTJotASoA.
Transmucosal administration of midazolam for premedication of
pediatric patients: comparison of the nasal and sublingual routes.
;78(5):885-91.
O.Parhizkar E, Emadi L, Alipour SJIJPSR, b. Midazolam solubility
enhancement pre-formulation techniques at nasal physiological pH.
;8(5):2315-22.
Kogan A, Katz J, Efrat R, Eidelman LAJPA. Premedication with
midazolam in young children: a comparison of four routes of
administration. 2002;12(8):685-9
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