COMPARISON OF INTRANASAL MIDAZOLAM AND SUFENTANIL PREMEDICATION IN PEDIATRIC OUTPATIENTS

Background: Intranasally administered midazolam was compared with sufe ntanil as a premedicant for 60 patients, aged 1/2 to 6 years, undergoi ng outpatient surgery of 2 hours or less. Methods: Thirty minutes befo re anesthetic induction (halothane in 50% nitrous oxide/oxygen), patie nts were randomly assigned to receive either intranasal midazolam (0.2 mg/kg) or sufentanil (2 mu g/kg). A ''blinded'' observer evaluated pr eoperative 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 admini stered compared with sufentanil (71% versus 20%, P = 0.0031). Of 31 mi dazolam patients, 20 experienced nasal irritation. Approximately 15 to 20 minutes after drug administration, most patients in both groups co uld be comfortably separated from their parents. The sufentanil group appeared to be more sedated and more cooperative during induction of a nesthesia. Vital signs and oxygen saturation did not change significan tly with either medication before or after surgery, although two sufen tanil patients had a moderate reduction in ventilatory compliance afte r anesthetic induction. Sufentanil was associated with more nausea and vomiting than midazolam (34% versus 6%, p < 0.02). Conclusion: Both i ntranasal midazolam and sufentanil provide rapid, safe, and effective sedation in small children before anesthesia for ambulatory surgery. S ufentanil provided somewhat better conditions for induction and emerge nce. Midazolam causes more nasal irritation during instillation, and s ufentanil causes more postoperative nausea and vomiting, Both drugs en abled patients to be separated from their parents with a minimum of di stress, Patients in the midazolam group were discharged approximately 40 minutes earlier (p < 0.05).