EVALUATION OF INTRANASAL MIDAZOLAM IN CHILDREN UNDERGOING ESOPHAGOGASTRODUODENOSCOPY

Background: Intravenous midazolam and opioids are used to produce cons cious sedation in children undergoing esophagogastroduodenoscopy (EGD) . However, children may experience significant fear and anxiety before receiving these medications, especially during separation from parent s and during venipuncture. Intranasal administration of midazolam repr esents a noninvasive method of sedating children before anxiety-produc ing events. The objective of this study was to determine whether preme dication with intranasal midazolam reduces stress and anxiety of separ ation from parents and of undergoing venipuncture, while maintaining a dequate sedation during EGD. Methods: This was a prospective, randomiz ed, double-blind study in 40 children, aged 2 to 12 years, who were un dergoing EGD. Patients in group I were premedicated with intranasal pl acebo (0.9% NaCl) followed 10 minutes later by intravenous midazolam ( 0.05 mg/kg) and intravenous meperidine (1 mg/kg). Patients in group II were premedicated with intranasal midazolam (0.2 mg/kg) followed by i ntravenous placebo (0.9% NaCl) and intravenous meperidine (1 mg/kg). A nxiolysis and sedation were scored by a blinded observer, who identifi ed minor and major negative behaviors during four observation periods: intranasal drug administration, separation from parents, venipuncture , and EGD. Results: Premedication with intranasal midazolam significan tly reduced negative behaviors during separation from parents (p < 0.0 5); however, no difference between regimens was noted during venipunct ure or EGD. Negative behaviors appeared to increase during administrat ion of intranasal midazolam or placebo. Conclusions: Premedication wit h intranasal midazolam is effective in reducing negative behaviors dur ing separation from parents, while it maintains sedation during the en doscopic procedure. The benefits of intranasal administration may be n egated, however, by irritation, and discomfort caused by intranasal dr ug delivery. (C) 1997 Lippincott-Raven Publishers.