Source: DGNews  |  Posted 1 year ago

By Sandra Distelhorst

VANCOUVER -- May 4, 2010 -- Intranasal midazolam performed better than both oral and buccal midazolam in controlling pain in children undergoing laceration repair, according to a study presented here at the 2010 Pediatric Academic Societies (PAS) Annual Meeting.

A randomised controlled trial compared 3 different administration routes of midazolam, a sedative commonly used in paediatric laceration repair. Sedatives can help reduce anxiety in children before laceration repair.

"Anxiety can prevent optimal results; children are too young to understand explanations, and research has shown that anxiety during a procedure can lead to heightened anxiety during a [subsequent] procedure," said Eileen J. Klein, MD, MPH, University of Washington School of Medicine, Seattle, Washington, who presented the research findings on May 1.

The study included 177 children, aged 6 months to 7 years, who were treated for lacerations in emergency departments. Children were randomised into 3 groups (n = 59 for all groups) to receive oral midazolam 0.5 mg/kg (maximum 15 mg), aerosolised intranasal midazolam 0.3 mg/kg (maximum 10 mg), or aerosolised buccal midazolam 0.3 mg/kg (maximum 10 mg).

Effectiveness of sedation was rated by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores, activity scores, and adequacy of sedation as documented by a nurse blinded to the study goals. Immediately after the start of the procedure, median CHEOPS score was 9 in the oral group, 7 in the buccal group (P = .04 vs oral), and 8 in the nasal group (P = .08 vs oral). Activity scores of 3 to 4 (optimal sedation) in the oral, buccal, and nasal groups were 56%, 59%, and 75%, respectively (P = .09). Median times to adequate sedation were 20 minutes in the oral group, 22 minutes in the buccal group, and 10 minutes in the nasal group (P < .001). Adequacy of sedation before the procedure was rated as 67% for oral, 60% for buccal, and 85% for nasal cases (P = .02). No complications occurred.

Physicians who were blinded to the enrolment group rated intranasal midazolam as giving a higher level of sedation than the other treatments. Parents were satisfied/very satisfied with sedation in 89% of intranasal cases, 76% of oral cases, and 73% of buccal cases (P = .09). However, 40% of children treated with intranasal midazolam had significant but temporary nasal irritation.

"Implications of the study are that intranasal midazolam has many advantages over oral and buccal administration of midazolam, and the timeliness of onset of intranasal midazolam can positively impact flow in a busy clinical setting such as an emergency department," said Dr. Klein. "Intranasal midazolam has the potential to become the preferred method," she added.

[Presentation title: A Randomized Controlled Trial of Oral Midazolam Versus Aerosolized Nasal Midazolam Versus Aerosolized Buccal Midazolam for Sedation for Laceration Repair in Children. Abstract 1172.6]