MIDAZOLAM FOR PREMEDICATION IN CHILDREN - NASAL VS RECTAL ADMINISTRATION

The authors compared the acceptance and efficacy of rectal and nasal a dministration of midazolam (MDZ) for premedication. Ninety-five ASA I and II paediatric patients (8 months to 12 years) scheduled for electi ve surgery were randomly allocated to two groups. Group R received 0.3 mg kg(-1) of rectal midazolam (in 5 mt saline). Group N received 0.2 mg kg(-1) of nasal midazolam (5 mg ml(-1)). Both groups were divided i n two subgroups according to age (group RA (less than or equal to 6 ye ars, n=33), group RE (>6 years, n=18), group NA(less than or equal to 6 years, n=28), group NE (>6 years, n=16)). At the time of premedicati on, tolerance to the administration was confirmed. Twenty min after re ctal or 10 min after nasal administration the quality of sedation was recorded. The nasal midazolam, in commonly used dosages, induced a sed ation similar to that following rectal administration with a shorter d elay of onset. Nasal administration was more often painful than rectal administration. Swallowing (nasal midazolam) and concerns about modes ty (rectal midazolam) were more frequent in older children. Because of its poor tolerance, nasal premedication should be reversed for cases where there is no alternative. Rectal premedication should be avoided in older children.