Enhancing Cooperation During Pediatric Ultrasound: Oral Midazolam Versus Conventional Techniques

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2020 Oct 5

PMID 33013029

Authors

Rachna Chaurasia

Anshul Jain

Narendra Singh Sengar

Shivali Pandey

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Ultrasound is a safe and non-invasive method for detecting numerous pathologies. Pediatric patients are often uncooperative which leads to decreased quality and increased time of scan. We compared the conventional means alone and combination of oral midazolam for the above cited purpose.

Material And Methods: This double blind prospective study (CTRI/2016/06/007030) was conducted after obtaining due approval from institutional ethical committee. One hundred Children aged 2-6 years belonging to ASA class 1 or 2, posted for high resolution ultrasonography of abdomen were included in the study. They were randomised to receive midazolam 0.3 mg/kg mixed in 20 mL of apple juice (Group I) or 20 mL of apple juice alone (Group II) 20 minutes prior to the procedure. The parameters assessed were level of cooperation, sonologist's satisfaction, total scan time, heart rate and SpO.

Results: Out of 100 patients, 44 patients of group I and 42 of group II were analysed. The cooperation score was significantly higher in Group I (35%) than Group II (19%). Likert scale revealed very satisfied and satisfied rating in 61.3% (Group I) and 21.4% (Group II). The time taken by sonologist and number of attempts were significantly less in Group I than Group II. There was no difference in discharge time between the groups. There was no reportable adverse event in either group.

Conclusion: Oral midazolam is a safe and effective agent to aid routine abdominal ultrasonography in pediatric patients.

References

Levati A, Paccagnella F, Pietrini D, Buscalferri A, Calamandrei M, Grossetti R . SIAARTI-SARNePI Guidelines for sedation in pediatric neuroradiology. Minerva Anestesiol. 2004; 70(10):675-97. View

Klein E, Brown J, Kobayashi A, Osincup D, Seidel K . A randomized clinical trial comparing oral, aerosolized intranasal, and aerosolized buccal midazolam. Ann Emerg Med. 2011; 58(4):323-9. PMC: 3183391. DOI: 10.1016/j.annemergmed.2011.05.016. View

Tavassoli-Hojjati Dds MSc S, Mehran Dds MSc M, Haghgoo Dds MSc R, Tohid-Rahbari Dds MSc M, Ahmadi Dds MSc R . Comparison of oral and buccal midazolam for pediatric dental sedation: a randomized, cross-over, clinical trial for efficacy, acceptance and safety. Iran J Pediatr. 2014; 24(2):198-206. PMC: 4268841. View

Shabbir A, Bhat S, Hegde K, Salman M . Comparison of oral midazolam and triclofos in conscious sedation of uncooperative children. J Clin Pediatr Dent. 2012; 36(2):189-96. DOI: 10.17796/jcpd.36.2.0346178414pvw865. View

Malviya S, Voepel-Lewis T, Prochaska G, Tait A . Prolonged recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics. 2000; 105(3):E42. DOI: 10.1542/peds.105.3.e42. View

Dechartres A, Boutron I, Roy C, Ravaud P . Inadequate planning and reporting of adjudication committees in clinical trials: recommendation proposal. J Clin Epidemiol. 2009; 62(7):695-702. DOI: 10.1016/j.jclinepi.2008.09.011. View

Furlow B . Radiation protection in pediatric imaging. Radiol Technol. 2011; 82(5):421-39. View

Ghajari M, Ansari G, Hasanbeygi L, Shayeghi S . Conscious Sedation Efficacy of 0.3 and 0.5 mg/kg Oral Midazolam for Three to Six Year-Old Uncooperative Children Undergoing Dental Treatment: A Clinical Trial. J Dent (Tehran). 2016; 13(2):101-107. PMC: 5139927. View

Levine M, HARTLEY E, Lerman J, MacPherson B . Oral midazolam premedication in children: the minimum time interval for separation from parents. Can J Anaesth. 1993; 40(8):726-9. DOI: 10.1007/BF03009769. View

10.

Ashrafi M, Malamiri R, Zamani G, Mohammadi M, Hosseini F . Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate. Iran J Child Neurol. 2014; 7(1):15-9. PMC: 3943082. View

11.

Anupindi S, Halverson M, Khwaja A, Jeckovic M, Wang X, Bellah R . Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol. 2014; 202(5):946-59. DOI: 10.2214/AJR.13.11661. View

12.

Lobo M, Roque M . Gastrointestinal ultrasound in neonates, infants and children. Eur J Radiol. 2014; 83(9):1592-600. DOI: 10.1016/j.ejrad.2014.04.016. View

13.

Feld L, Negus J, White P . Oral midazolam preanesthetic medication in pediatric outpatients. Anesthesiology. 1990; 73(5):831-4. DOI: 10.1097/00000542-199011000-00006. View

14.

Darge K, Anupindi S, Keener H, Rompel O . Ultrasound of the bowel in children: how we do it. Pediatr Radiol. 2010; 40(4):528-36. DOI: 10.1007/s00247-010-1550-9. View

15.

Cote C, Cohen I, Suresh S, Rabb M, Rose J, Weldon B . A comparison of three doses of a commercially prepared oral midazolam syrup in children. Anesth Analg. 2002; 94(1):37-43, table of contents. DOI: 10.1097/00000539-200201000-00007. View

16.

Zielinska M, Bartkowska-Sniatkowska A, Becke K, Hohne C, Najafi N, Schaffrath E . Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Paediatric Anaesthesiology. Paediatr Anaesth. 2019; 29(6):583-590. DOI: 10.1111/pan.13615. View

17.

Fallah R, Ataee Nakhaei M, Behdad S, Moghaddam R, Shamszadeh A . Oral chloral hydrate vs. intranasal midazolam for sedation during computerized tomography. Indian Pediatr. 2012; 50(2):233-5. DOI: 10.1007/s13312-013-0065-5. View

18.

Mahajan C, Dash H . Procedural sedation and analgesia in pediatric patients. J Pediatr Neurosci. 2014; 9(1):1-6. PMC: 4040023. DOI: 10.4103/1817-1745.131469. View

19.

McMillan C, Sikich N, HARTLEY E, Lerman J . Premedication of children with oral midazolam. Can J Anaesth. 1992; 39(6):545-50. DOI: 10.1007/BF03008315. View

20.

Gale H, Gee M, Westra S, Nimkin K . Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol. 2016; 8(7):656-67. PMC: 4965350. DOI: 10.4329/wjr.v8.i7.656. View