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Comparative study of intravenous and oral midazolam in pediatric CT scans for non CNS pathology

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Original Article

Author Details : Jitin George, Anupama M K*

Volume : 6, Issue : 3, Year : 2019

Article Page : 359-365

https://doi.org/10.18231/j.ijca.2019.069

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Abstract

Introduction: There has been a dramatic increase in the use of computed tomography (CT) scan to diagnose conditions and to monitor treatment in the pediatric setting. Infants and children require sedation during procedure to maintain a motionless state to ensure high quality imaging.
The target sedation depth required depends on imaging procedure and individual patient characteristics. CT scans with modern multislice scanners do rapid image acquisition and procedure may require minimal sedation. But some children need to be asleep to tolerate the study scan. Procedures may be rescheduled and repeated if the movement is excessive which leads to additional radiation burden which leads to increasing the cost of the procedure and patient stress. Careful planning of sedation is important in such scenarios.¹
Many drug regimens have been recommended to achieve satisfactory sedation for such painless procedure. Most of these medications can be administered through various routes and selecting the drug varies on the procedure, level of pain, optimum depth of sedation required and the patient’s condition.² Midazolam has been widely used as a sedative in children for a long time.³

This study compares the effect of intravenous and oral Midazolam in paediatric age group with respect to degree of sedation levels achieved, and the need for a rescue dose for non CNS Computed Tomography scans.
Materials and Methods: In this prospective study, oral Midazolam verses IV Midazolam was studied for sedation in paediatric patients of 2 to 6 years of age for non CNS CT scan. 0.5mg/kg of oral Midazolam and 0.01mg/kg of IV Midazolam was used. 1mg/kg Propofol used as the rescue drug and 0.5mg/kg subsequently till the desired sedation score was achieved.
70 patients were divided into 2 groups of 35in each group. 1: Group A received oral 0.5 mg/kg body weight Midazolam 20 minutes prior to the scan (a maximum dose of 10 mg); 2: Group B received IV 0.01mg/kg body weight Midazolam 5 minutes prior to scan.
Statistical Analysis: Calculation of sample size using the Open Epi software considering ? error 5% and β error 20% was 66 (Kelsey). The statistical analysis done by SPSS-20, unpaired ‘t’ test and Chi-Square test.
Results: In oral midazolam group:
At the end of 20 minutes 54% achieved the desired sedation score. At the beginning of scan i.e. at 25 minutes from the drug administration, 60% achieved desired sedation score.
40% required the rescue drug. There was no incidence of haemodynamic or respiratory disturbances after giving the rescue drug.
In IV Midazolam group: At the end of 5 minutes (sedation end point) 8.5% achieved required sedation level. At the beginning of scan i.e 5 minutes later 11.4% of the study population achieved sedation level. 88.6% required the rescue drug with multiple subsequent doses.
There was no incidence of haemodynamic or respiratory disturbances after giving the rescue drug.
Conclusion: 1: As compared to IV route, Midazolam by oral route in the dose of 0.5mg/kg was effective in achieving desired sedation level with slower onset time but lesser incidence of rescue drug requirement; 2: The recovery with oral Midazolam was comparatively of longer duration than with IV Midazolam; 3: The incidence of haemodynamic and respiratory disturbances such as desaturation was not observed in either the groups.

Keywords: Paediatric sedation, Midazolam, Computed tomography (CT) scan.

How to cite : George J, Anupama M K, Comparative study of intravenous and oral midazolam in pediatric CT scans for non CNS pathology. Indian J Clin Anaesth 2019;6(3):359-365

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