Original Research Article
Year: 2019 | Month: October | Volume: 9 | Issue: 10 | Pages: 9-18
A Comparative Evaluation of Two Doses of Intranasal Midazolam as a Premedicant for Paediatric Patients by Two Delivery Methods
Dr. Geeta Ahlawat1, Dr. Jaswant2, Dr. Kirti Kamal1, Dr. Raj Mala3, DR. Susheela1, Dr. Savita Saini4
1Professor, 2Ex- Junior Resident (PG), 3Sr. Professor, 4Sr. Professor & Head,
Department of Anaesthesiology & Critical Care, Pt. B. D. Sharma, Postgraduate Institute of Medical Sciences, Rohtak- 124001, Haryana, (INDIA).
Corresponding Author: Dr. Jaswant
ABSTRACT
Introduction: Intranasal midazolam as a Premedication in paediatric patients has advantage of rapid absorption directly into the systemic circulation. Our study compared two doses (0.2 mg/kg and 0.25 mg/kg) of intranasal midazolam administered by two different methods (drops and spray) to find safe dose and administration method.
Material and method: A prospective, randomized, double blind study was conducted in the department of Anaesthesiology at PGIMS Rohtak after Ethical clearance. 120 patients of either sex and age 2-8 years, ASA status I/II, posted for elective surgery under general anaesthesia were enrolled during 2015-17. Patients were randomly allocated to one of the four groups: Group A (n=30) – received 0.20 mg/kg intranasal midazolam drops. Group B (n=30) - received 0.25 mg/kg intranasal midazolam drops. Group C (n=30) - received 0.20 mg/kg intranasal midazolam spray. Group D (n=30) - received 0.25 mg/kg intranasal midazolam spray. The response to drug administration was assessed as satisfactory or unsatisfactory. Heart rate, oxygen saturation, respiratory rate and sedation level (Ramsay sedation score) were assessed immediately prior to and at 5, 10, 15, 20, and 25 minutes of drug administration. Parent-child separation was assessed at 20 minutes using ease of separation score system. The response to mask acceptance /or iv. cannulation was assessed at 25 minutes using induction score system.
Results: The satisfactory response was greatest and statistically significant in study group D (80%) compared to group A (56.70%), B (66.70%), and C (73.30%). The mean sedation score achieved was significantly more with 0.25 mg/kg than 0.2 mg/kg of intranasal midazolam irrespective of method of drug administration and also highest in study group D (3.20) as compared to group B (2.97). The best and significant mean parent-child separation score at 20 minutes was achieved in study group D (1.13 ± 0.43) compared to group A (1.53 ± 0.68), B (1.20 ± 0.48) and C (1.43 ± 0.63). In study group D, 28 out of 30 (93.40%) patients had excellent to good induction score as compared to either of group A or B (25 out of 30) and group C (26 out of 30). The mean induction score was best and statistically significant in study group D (1.30±0.60) compared to group A (2.00±0.59), B (1.40±0.77), and C (1.77±0.77).
Conclusion: Intranasal midazolam spray 0.25 mg/kg is a safe and effective premedication.
Key words: Premedication, intranasal midazolam, drops and spray, Ramsay sedation score, ease of separation and induction score.