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Abstract
We performed a retrospective chart review to determine the onset, duration, safety,
and clinical sedative effects of 0.2 to 0.5 mg/kg intranasal midazolam in young children
during laceration repair. Of 408 children treated for lacerations during an 8-month
period, 42 (10%) received intranasal midazolam. Documentation was adequate for detailed
analysis in 40 cases. Data are reported as mean ± standard deviation and the frequency
with 95% confidence limit (CL) estimates. The mean age of the study population was
32 ± 9 months (range 12 months to 6 years), and the mean body mass was 14.5 ± 3 kg.
Topical or injected local anesthesia was used in 37 cases. Overall, 73% (CL 56% to
85%) of the children achieved adequate sedation. However, those receiving 0.2 to 0.29
mg/kg had adequate sedation in only 27% (CL 6% to 60%) of the cases compared with
80% (CL 52% to 95%) and 100% (CL 79% to 100%) when 0.3 to 0.39 and 0.4 to 0.5 mg/kg
respectively were administered. When achieved, sedation occurred within 12 ± 4 minutes,
recovery occurred at 41 ± 9 minutes, and discharge occured at 56 ± 11 minutes. No
vomiting or clinically significant oxygen desaturation (defined as a drop of >4% or
to <91%) was observed. We conclude that intranasal midazolam is a safe and effective
sedative for laceration repair under local anesthesia in preschool-aged children.
We recommend a dose of 0.3 to 0.5 mg/kg, with treatment failure less likely after
0.4 to 0.5 mg/kg compared with less than 0.3 mg/kg.
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Article Info
Publication History
Accepted:
June 3,
1992
Received:
March 25,
1992
Footnotes
☆Presented at the 1992 Society for Academic Emergency Medicine Annual Meeting, Toronto, Ontario, Canada.
Identification
Copyright
© 1992 Published by Elsevier Inc.
