Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability

Midazolam is often used for paediatric premedication. We have compared two methods of administering midazolam intranasally in 44 surgical day-case chi ldren allocated randomly to receive midazolam 0.2 mg kg(-1) as drops or mid azolam 0.1 mg kg(-1) from an intranasal spray device. Behaviour was recorde d on a four-point scale by the parent, nurse and anaesthetist. Coefficients were obtained representing the change in behaviour score. There was no sig nificant difference in method of administration (coefficient 0.13, P=0.39). Children were significantly more distressed at the time of premedication a nd at the time of venous cannulation (coefficients 1.31 and 0.70) than at b aseline. There was no significant difference in the assessments between obs ervers. Midazolam by either method was equally effective but acceptability of the premedication was poor in both groups. Intranasal midazolam cannot b e recommended as a method for routine premedication of young children.