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Xue Q, Xia J, Lu J, Shen X. Added Syrup as a Flavoring to Oral Midazolam Intravenous Solution Premedication Improves Tolerability in Pediatric Patients. Drug Des Devel Ther 2022; 16:1211-1216. [PMID: 35509491 PMCID: PMC9060539 DOI: 10.2147/dddt.s357660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the tolerability of midazolam intravenous (IV) solution by masking its bitter taste through the addition of syrup. Methods In the waiting area before surgery at our institution, Eye and ENT Hospital, from May to November of 2021, pediatric patients scheduled for anterior ear fistula removal or eardrum catheterization were randomly assigned to receive a mixture of IV midazolam and water (Group C) or IV midazolam and syrup (Group S) in equal volumes. We measured the difference between the groups in terms of drug tolerability with a 5-point facial hedonic scale given to every patient, parent, and nurse involved in the study. Secondary outcomes included sedation and anxiety levels, which were assessed at separation from the parents and general anesthesia induction via a mask. Results In total, 180 patients were enrolled. The facial hedonic scales were higher in Group S as evaluated by the children (p=0.046), parents (p=0.020), and nurses (p=0.026). More patients were willing to take the same solution again in Group S than in Group C (p=0.024). The levels of sedation and anxiety at two timepoints were similar between the groups (all p>0.05). No adverse events were noted preoperatively. Conclusion The tolerability of IV midazolam administered orally was increased in a pediatric population by adding syrup. The sedative and anxiolytic effects were comparable for both midazolam mixtures. Trial Registry Number China Clinical Research Information Service, ChiCTR2000040229.
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Affiliation(s)
- Qineng Xue
- Department of Anesthesiology, Eye & and ENT Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Junming Xia
- Department of Anesthesiology, Eye & and ENT Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jin Lu
- Department of Anesthesiology, Eye & and ENT Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xia Shen
- Department of Anesthesiology, Eye & and ENT Hospital, Fudan University, Shanghai, People’s Republic of China
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Cai YH, Wang CY, Li Y, Chen J, Li J, Wu J, Liu HC. Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries. Front Pharmacol 2021; 12:648699. [PMID: 34975463 PMCID: PMC8714926 DOI: 10.3389/fphar.2021.648699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction. Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time. Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p < 0.001). Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.
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Affiliation(s)
- Yu-Hang Cai
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cheng-Yu Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Li
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jun Li
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junzheng Wu
- Department of Anesthesiology, Cincinnati Children’s Hospital, Cincinnati, OH, United States
- Correspondence: Junzheng Wu, ; Hua-Cheng Liu,
| | - Hua-Cheng Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Correspondence: Junzheng Wu, ; Hua-Cheng Liu,
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Jeon A, Han E, Lee K, Sommerfield A, Lim LY, Sommerfield D, von Ungern-Sternberg BS. Parents' perspectives towards paediatric confectionary masked medications: a qualitative study. Int J Clin Pharm 2021; 44:374-380. [PMID: 34813028 DOI: 10.1007/s11096-021-01349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
Background The availability of age-appropriate, taste-masked oral solid medications for the paediatric population is currently inadequate. We have developed a novel chocolate-based drug delivery platform to taste-mask bitter drugs commonly utilised in the hospital setting, but there is limited evidence regarding parent's perspectives on these medications. Aim To identify key themes regarding parents' perspectives on taste-masked medications that look like confectionary. Additionally, to explore and identify the various barriers and facilitators to using oral medication among the paediatric population.Methods Qualitative descriptive study (July to August 2020) at a single tertiary paediatric hospital (Perth Children's Hospital-PCH). Parents with at least one child (2-18 years) that underwent any elective operation at PCH were included in the study, in total 17 were interviewed. Results The two primary themes that underpinned parent's perspectives on taste-masked medications that look like confectionary were medication safety and taste. Majority of parents supported the use of the proposed medication on the basis that the favourable taste profile will facilitate oral consumption, as opposed to their previous experiences with conventional paediatric medications that do not taste mask the bitter flavour. However, medication safety, in the forms of patient education and appropriate packaging, must be considered to minimise harmful misuse of the proposed medication. Conclusion Participants unanimously support the short-term use of taste-masked medications that look like confectionary, particularly in the hospital setting. However, patient education is highly sought after by parents regarding the role of these medications, to ensure medication safety with their children.
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Affiliation(s)
- Andy Jeon
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia.,School of Public Health, The University of Sydney, Sydney, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Ellen Han
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Lee Yong Lim
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - David Sommerfield
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Britta S von Ungern-Sternberg
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia. .,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia. .,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia.
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Bromfalk Å, Myrberg T, Walldén J, Engström Å, Hultin M. Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine. Paediatr Anaesth 2021; 31:1225-1233. [PMID: 34403548 DOI: 10.1111/pan.14279] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 07/14/2021] [Accepted: 08/16/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation. PATIENTS AND METHODS In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively. RESULTS Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group. CONCLUSIONS In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
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Affiliation(s)
- Åsa Bromfalk
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Umeå, Sweden
| | - Åsa Engström
- Department of Health Sciences, Nursing Care, Luleå University of Technology, Luleå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
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Bailey CR. Dexmedetomidine in children - when should we be using it? Anaesthesia 2020; 76:309-311. [PMID: 32578205 DOI: 10.1111/anae.15169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 01/10/2023]
Affiliation(s)
- C R Bailey
- Department of Anaesthesia, Guy's and St, Thomas' NHS Foundation Trust, London, UK
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