The use of nasal midazolam in reducing preoperative a nxiety in children

Abstract EN

Background : surgery and anesthesia can cause a considerable distress with psychological consequences for children.

This preoperative anxiety can lead to post-operative emergence delirium, maladaptive behavioral changes such as night time crying, enuresis, feeding difficulties, apathy, and withdrawal.

Objectives : the aim of this study is to investigate the effect of nasal midazolam as a routine intervention to reduce pre-operative anxiety and inducing anxiolysis in children undergoing day case procedure.

Method: One hundred children were randomly allocated into two groups.

The study group (N = 50) were premedicated with nasal midazolam 0.2mg / kg and the control group (N = 50) who received 0.04 ml of normal saline.

The children response to nasal administration was noticed and after 15 minutes children were taken to operating room.

Anxiety at parental separation and at induction of anesthesia was measured using modified-Yale Preoperative Anxiety Scale.

Results : Children who received nasal midazolam had a significantly better parental separation and induction of anesthesia.

88% of children who received nasal midazolam scored below 30-indicating absence of anxiety- on modified-Yale Preoperative Anxiety Scale compared to 32 % in the control group.

More than half of patients in both groups found nasal route to be unpleasant and stressful.

Conclusion : For children undergoing elective brief surgical procedure, nasal midazolam is effective in reducing preoperative anxiety.

Nasal midazolam was associated in more than half of patients with nasal irritation and crying, a route cannot be recommended in children.