Oral transmucosal midazolam premedication for preschool children

Purpose: To evaluate the acceptance and effectiveness of 0.2 mg.kg(-1) of o ral transmucosal midazolam as a premedicant in infants and preschool childr en. Method: In a randomized, prospective double-blind placebo controlled study, 44 healthy children, between the ages of eight months to six years, presen ting for elective surgery were divided in two groups. The medicated group r eceived 0.2 mg.kg(-1) of injectable midazolam mixed with an equal volume of strawberry syrup and the placebo group received plain syrup 0.08 ml.kg(-1) . Medications were placed on the anterosuperior aspect of the child's tongu e in 3-5 aliquots of 0.2-0.4 ml. A blinded observer assessed the acceptance of the medication by willingness to open the mouth for the next aliquot an d the efficacy of the medication was assessed by ease of separation from th e parent. Results: Ninety-six percent of the children in the placebo group and 95% in the midazolam group willingly accepted the medication. Separation of child ren from parents was successful in 95% of the medicated children compared w ith 59% in the placebo group (P = 0.006). Conclusion: Oral midazolam in thick strawberry syrup, administered in small aliquots via the oral transmucosal route was well accepted and proved to b e an effective premedicant in infants and preschool children.