Midazolam via intranasal route preferred sedative premedication for pediatric patients compared to ketamine
Intranasal midazolam yields better results than ketamine as sedative premedication in children suggests a recent study published in the BMC Anesthesiology
Intranasal midazolam and ketamine have been widely used as sedative premedication in children. It is difficult to determine which one yields better sedative effects for clinical practice. They conducted the present meta-analysis by summarizing the evidences to evaluate the efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients.
They searched PubMed, Embase, and Cochrane Library from inception to April 2022. All randomized controlled trials (RCTs) used intranasal midazolam and ketamine as sedatives in children were enrolled. The risk of bias in RCTs was assessed by Cochrane risk of bias tool. Condition of parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as the outcomes in our study.
Results
• A total of 16 studies with 1066 patients were enrolled.
• Compared with midazolam, administration of intranasal ketamine might be associated with severer changes in hemodynamics parameters including mean blood pressure and heart rate (HR)
• Meanwhile, administration of intranasal midazolam was associated with more satisfactory sedation level, more rapid onset of sedation and more rapid recovery
• Current evidences also indicated that the differences of various adverse effects between two groups were not significant.
Given that administration of midazolam via intranasal route provides more satisfactory sedative level with less fluctuation of hemodynamics parameters and more rapid onset and recovery, it might be considered as the preferred sedative premedication for pediatric patients compared to ketamine. However, the widespread evidences with low or moderate quality indicated that superiority of intranasal midazolam in pediatric sedation needs to be confirmed by more studies with high quality and large sample size in future
Reference:
Lang, B., Wang, H., Fu, Y. et al. Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials. BMC Anesthesiology 22, 399 (2022). https://doi.org/10.1186/s12871-022-01892-2
Keywords:
Lang, B., Wang, H., Fu, Y, Efficacy, and safety, intranasal, midazolam, intranasal, ketamine, sedative, premedication, pediatric, patients, meta-analysis, randomized, controlled trials. BMC Anesthesiology
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