What are Alternatives to Using Midazolam as Anaesthetic Premedication in Children?

Recently published paper explores the use of midazolam as a premedication in pediatric surgery, discussing its benefits in reducing preoperative anxiety and its potential adverse effects. It highlights the prevalence of preoperative anxiety in pediatric patients and emphasizes the importance of addressing it to improve outcomes. The paper presents both pharmacological and non-pharmacological options for preoperative anxiety treatment, discussing the efficacy of midazolam, its side effects, and the potential long-term neurodevelopmental impact of prolonged exposure to benzodiazepines.

Pharmacokinetics and Effects of Midazolam

The authors review the pharmacokinetics and effects of midazolam, including its mode of action, dosing, and potential side effects such as respiratory depression and paradoxical reactions. They acknowledge the strong anxiolytic and sedative effects of midazolam, which have been widely used in pediatric surgery but also raise concerns about potential neurodevelopmental changes and the FDA warning labels for anesthetic drugs in children under three years of age.

Evidence for and Against Midazolam Use in Pediatric Surgery

The paper discusses the evidence for and against using midazolam, considering its efficacy in reducing preoperative anxiety and adverse outcomes, as well as the emerging concerns about its potential neurotoxic effects. It also examines non-pharmacologic alternatives such as parental presence at induction of anesthesia, distraction techniques, and preprocedural educational programs. The authors also compare midazolam with alternative medications like clonidine, dexmedetomidine, and ketamine, as well as opioids.

Weighing Benefits and Risks of Midazolam Use

The paper emphasizes the need to weigh the benefits of midazolam in reducing anxiety and facilitating anesthesia induction in pediatric patients against the potential risks associated with its use. It acknowledges the evolving understanding of the risks and benefits of midazolam and other anesthetic options and highlights the importance of individualized patient care and a patient-centered approach in pediatricanesthesia.

Reference –

Lethin M, Paluska M R, Petersen T R, et al. (December 11, 2023) Midazolam for Anesthetic Premedication in Children: Considerations and Alternatives. Cureus 15(12): e50309. doi:10.7759/cureus.50309.