The authors evaluated the efficacy of rectally administered midazolam for preinduction (i.e., premedication/induction) of anesthesia in 67 pediatric patients, ASA physical status 1 or 2, undergoing a variety of elective surgical procedures. In phase 1, 41 children weighing 12 ± 3 kg (range 7-20 kg) and 31 ± 16 months (range 8-67 months) of age (mean ± SD) received midazolam, 0.4-5.0 mg · kg-1, in an attempt to produce unconsciousness. Only one child lost consciousness (4.5 mg · kg-1). However, at all doses, inhalational induction of anesthesia was facilitated because children were tranquil and calmly separated from their parent(s). There were no clinically significant changes in arterial blood pressure, heart rate, oxyhemoglobin saturation, and end-tidal carbon dioxide concentration, 10 min after drug administration. In phase 2, 26 children weighing 17 ± 4 kg (range 10-26 kg) and 44 ± 19 months (range 17-84 months) months of age undergoing tonsil and/or adenoid surgery were studied to determine the optimal sedative dose of rectally administered midazolam. Patients received 0.3, 1.0, 2.0, or 3.0 mg · kg-1 of midazolam in a randomized, double-blind fashion. One third (3 of 9) of patients receiving 0.3 mg · kg-1 struggled during mask induction. All patients receiving ≥1.0 mg · kg-1 were adequately sedated (P < 0.008). Discharge from the postanesthesia care unit (PACU), however, was delayed (>60 min) in children receiving ≥2.0 mg · kg-1 (P < 0.03). Therefore, the authors conclude that rectally administered midazolam in a dose of 1.0 mg · kg-1 is effective for preinduction of anesthesia and does not delay discharge from the PACU.
- Anesthesia: pediatric
- Anesthetic techniques: rectal
- Anesthetics, rectal: midazolam
- Induction: anesthesia
- Premedication: midazolam
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine