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Comparison of intranasal midazolam and sufentanil premedication in pediatric outpatients
Author(s) -
Zedie Nishat,
Amory David W.,
Wagner Bertil K.J.,
O'Hara Dorene A.
Publication year - 1996
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1016/s0009-9236(96)80012-9
Subject(s) - sufentanil , anesthesia , medicine , midazolam , premedication , vomiting , sedation , nausea , promethazine , postoperative nausea and vomiting , surgery
Background Intranasally administered midazolam was compared with sufentanil as a premedicant for 60 patients, aged ½ to 6 years, undergoing outpatient surgery of 2 hours or less. Methods Thirty minutes before anesthetic induction (halothane in 50% nitrous oxide/oxygen), patients were randomly assigned to receive either intranasal midazolam (0.2 mg/kg) or sufentanil (2 μg/kg). A “blinded” observer evaluated preoperative emotional state, response to premedication, induction, and emergence from anesthesia and side effects. Results Children who had not previously cried were more likely to cry when midazolam was administered compared with sufentanil (71% versus 20%, p = 0.0031). Of 31 midazolam patients, 20 experienced nasal irritation. Approximately 15 to 20 minutes after drug administration, most patients in both groups could be comfortably separated from their parents. The sufentanil group appeared to be more sedated and more cooperative during induction of anesthesia. Vital signs and oxygen saturation did not change significantly with either medication before or after surgery, although two sufentanil patients had a moderate reduction in ventilatory compliance after anesthetic induction. Sufentanil was associated with more nausea and vomiting than midazolam (34% versus 6%, p < 0.02). Conclusion Both intranasal midazolam and sufentanil provide rapid, safe, and effective sedation in small children before anesthesia for ambulatory surgery. Sufentanil provided somewhat better conditions for induction and emergence. Midazolam causes more nasal irritation during instillation, and sufentanil causes more postoperative nausea and vomiting. Both drugs enabled patients to be separated from their parents with a minimum of distress. Patients in the midazolam group were discharged approximately 40 minutes earlier ( p < 0.05). Clinical Pharmacology & Therapeutics (1996) 59 , 341–348; doi: