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Oral high‐dose midazolam premedication for infants and children undergoing cardiovascular surgery
Author(s) -
Masue Tatsuhiko,
Shimonaka Hiroyuki,
Fukao Izumi,
Kasuya Shugo,
Kasuya Yukiko,
Dohi Shuji
Publication year - 2003
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.2003.01119.x
Subject(s) - midazolam , medicine , premedication , anesthesia , sedation , heart rate , blood pressure
Summary Background: The purpose of this study was to determine whether oral midazolam 1.5 mg·kg −1 is a safe and effective alternative to standard‐dose midazolam (0.5–1.0 mg·kg −1 ) premedication for infants and children with congenital heart disease. Methods: A total of 193 infants and children (4 months to 2 years) undergoing cardiovascular surgery were studied. Each patient received 0.5, 1.0, or 1.5 mg·kg −1 of oral midazolam. The level of sedation was assessed with a 5‐point scale and vital signs were measured including blood pressure (BP), heart rate (HR) and oxyhaemoglobin saturation (SpO 2 ) before and after the medication. Results: Infants and children premedicated with oral midazolam 1.5 mg·kg −1 were better sedated than those with standard‐dose midazolam: 4% of infants and children given 1.5 mg·kg −1 of midazolam became agitated compared with 14% given 1.0 mg·kg −1 and 26% in those given 0.5 mg·kg −1 . Ninety percentage of infants and children given 1.5 mg·kg −1 of midazolam achieved satisfactory sedation (calm, drowsy, or asleep) in 30 min, whereas 68% in those given 1.0 mg·kg −1 and 35% in those given 0.5 mg·kg −1 . Midazolam 1.5 mg·kg −1 did not cause any statistically significant decrease in BP, HR, or SpO 2 , although eight infants and children showed ≥20% drop in systolic BP and six infants and children showed >5% drop in SpO 2 . No ‘spelling attacks’, seizure‐like activity, apnoea, nor laryngospasm were observed in any infants and children during and after the medication. Conclusions: Oral midazolam 1.5 mg·kg −1 is excellent for preanaesthetic medication for infants and children undergoing cardiovascular surgery.