EFFICACY OF RECTAL MIDAZOLAM FOR THE SEDATION OF PRESCHOOL-CHILDREN UNDERGOING LACERATION REPAIR

Study objective: To determine the efficacy of rectal midazolam as seda tion for laceration repair in preschool children in the pediatric emer gency department. Design: Randomized, double-blind, placebo-controlled trial. Participants: Thirty-four anxious children aged 14 to 51 month s with face or scalp lacerations 3 cm or less in length requiring two or more sutures and behavior scores of 3 or more. Interventions: Subje cts received 0.45 mg/kg rectal midazolam or saline placebo rectally fo llowed by a topical anesthetic 15 minutes before repair. Results: Sixt een patients received rectal midazolam, and 18 received placebo. The g roups were similar in age, race, gender, laceration length and locatio n, entry behavior score, and entry anxiety score. Ten patients in the rectal midazolam group and 1 in the placebo group achieved adequate se dation (P<.001). Median behavior scores during suturing were more favo rable in the rectal midazolam group (P<.005). The median anxiety score and median effort score during repair also were more favorable for th e rectal midazolam group (P = .003 and P = .08, respectively). Two pat ients in the rectal midazolam group experienced inconsolable agitation after the repair. None of the patients suffered cardiopulmonary compl ications. Conclusion: Rectal midazolam is an effective method of sedat ion for facilitating uncomplicated laceration repair in preschool chil dren. However, physicians must be aware of the possibility of paradoxi cal reactions when using midazolam in children.