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Anesth Analg 2003;96:392-395
© 2003 International Anesthesia Research Society

PEDIATRIC ANESTHESIA

Midazolam Premedication in Children: A Comparison of Two Oral Dosage Formulations on Sedation Score and Plasma Midazolam Levels

Keith K. Brosius, MD, and Carolyn F. Bannister, MD

Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia

Address correspondence to Keith K. Brosius, MD, Children’s Healthcare of Atlanta at Egleston, 1405 Clifton Rd., NE, Atlanta, GA 30322. Address e-mail to keith_brosius{at}emoryhealthcare.org Reprints will not be available from the authors.

We compared two available oral formulations of midazolam with respect to sedation score and plasma midazolam levels in pediatric surgical patients 2–10 yr old. The commercially available oral syrup was compared with a mixture of the IV midazolam preparation in Syrpalta® syrup at an equivalent concentration of 2 mg/mL. ASA status I–II patients were randomly assigned to receive 0.5 mg/kg of either the commercial syrup (Group 1) or the prepared mixture (Group 2) as anesthetic premedication. Observer’s Assessment of Alertness/Sedation scores were obtained by a blinded observer at 15 and 30 min after drug administration. Plasma midazolam levels were acquired exactly 45, 60, and 90 min after administration. Group 2 patients had a significantly lower median Observer’s Assessment of Alertness/Sedation score (Group 1, 17; Group 2, 15) at 30 min (P < 0.03) and significantly higher mean plasma midazolam levels at all three acquisition times (mean ± SD) (45 min: 63.1 ± 23.9 ng/mL, Group 2; 43.4 ± 19.6 ng/mL, Group 1; 60 min: 45.8 ± 18.2 ng/mL, Group 2; 30.8 ± 17.9 ng/mL, Group 1; 90 min: 28.9 ± 12.6 ng/mL, Group 2; 21.0 ± 8.9 ng/mL, Group 1) (P < 0.02). We conclude that IV midazolam mixed in Syrpalta syrup yields more reliable sedation and correspondingly higher plasma levels than an equivalent dose of the commercially formulated and marketed preparation.

IMPLICATIONS: IV midazolam mixed in Syrpalta® syrup produces a greater sedative effect and higher plasma midazolam levels than the commercially available syrup when used as an oral anesthetic premedication in pediatric surgical patients.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.