Evaluation of Intra Nasal Midazolam as Pre Anesthetic Medication for Pediatric Surgical Procedures

Introduction: Operation theater environment, surgery and anesthesia causes 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. Aim: The 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 anesthesia recovery characteristics and side-effects if any. Materials and Methods: A total of 90 patients in the age group of 3-6 years of either sex are belonging to American Society of Anesthesiologist (ASA) Grade I or II posted for elective surgery under general anesthesia were studied. The patients were randomly divided into three groups of 30 each. The patients in group M1 (midazolam) received 0.2 mg/kg of intranasal midazolam. The patients in group M2(midazolam) received 0.3 mg/kg of intranasal midazolam and patients in group normal saline (NS) received 0.04 mI/kg of NS. At 5 min after administration of the drug, degree of sedation was assessed. The patients were followed up for 24 h post-operatively. Results: All the groups were comparable in age, sex, weight and ASA distribution. In M1 group, 24 (80%) children and in M2 group, 22 (65%) children were satisfactorily sedated at 5 min after administration of the drug whereas in NS group only 15 (50%) were satisfactorily sedated. In M1 group, at 10 min, parental separation in 27 (90%) children and in M2 group, parental separation in 25 (75%) children was much easier when compared to 4 (13.3%) children in NS group. Conclusion: 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.