Background: Oral or intranasal midazolam is commonly used as a single agent for procedural sedation in children. However, the effectiveness of oral midazolam has never been examined in pediatric emergency medicine. We aimed to evaluate the effectiveness of midazolam for procedural sedation.
Methods: We conducted a retrospective cohort study of all children who received oral or intranasal midazolam between 01 January 2011 and 31 June 2016 in the emergency department of a tertiary children hospital. Effectiveness was defined as the proportion of procedures completed with a single dose of midazolam.
Results: Overall, 1973 children with a mean age of 3±2.4 years were treated with midazolam, 1469 patients received it orally at a mean dosage of 0.6±0.1 mg/kg, and 504 patients received it intranasal at a mean dosage of 0.4±0.1 mg/kg. Approximately one quarter of the patients received midazolam for laceration repairs, 24.8% in the oral group, and 23.8% in the intranasal group. Urethral catheterization and intravenous catheterization were the most common indications in the oral group (32.5% and 28.3%, respectively). In the intranasal group, Urethral catheterization and intravenous catheterization were equally distributed (25%). 1890 (95.8%) patients completed the procedure with a single dose of midazolam. A second dose of midazolam or another sedative was required in 59 (4.4%) patients in the oral group, and 19 (3.7%) in the intranasal group. No patient was admitted to the hospital due to midazolam-related adverse reaction.
Conclusions: In this cohort of pediatric emergency department, procedural sedation with oral or intranasal midazolam was highly effective.
