Abu Kamar Maisa, Ghazi Aldehayat, Al Madain Saba.
Preanesthetic medication using midazolam in children undergoing dental surgery: comparing rectal and intranasal administration.
Pak J Surg Jan ;28(3):222-5.

Objective: To compare the effectiveness of rectal and intranasal midazolam in sedation level of children undergoing dental surgical procedures under general anesthesia. Methodology: 80 patients ranged in age from 1 to 8 years who were scheduled to receive dental treatment were randomly allocated into two groups to receive either 0.3 mg/kg of rectal midazolam or 0.2 mg/kg of intranasal midazolam. The sedation level was evaluated at the following time points: immediately before the drug was administered, 20 and 30 minutes after drug administration. Pulse rate, respiratory rate, arterial blood pressure, oxygen saturation also were recorded. Results: Rectal midazolam was found to be statistically more effective in providing a bett er sedation level than intranasal administration. 37(92.5%) and 38(95%) of the forty patients who received rectal midazolam were either drowsy or asleep at 20 minutes and 30 minutes after drug administration, respectively. For Patients who were recieved intranasal midazolam 27(67.5%) of the forty patients were drowsy or asleep and 13(32.5%) were fully awake (rated as agitated, alert and calm) at 20 minutes, However, the number of drowsy sedation patients decreased to 26(65%) and the number of awake patients increased to 14(35%) at 30minutes. None of the patients from the intranasal group were rated as being asleep. Conclusion: The study illustrates that rectal midazolam to be more effective in ensuring preoperative sedation in children than intranasal route.

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