REVIEW   

Minerva Anestesiologica 2023 April;89(4):331-40

DOI: 10.23736/S0375-9393.22.16937-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Efficacy and safety of oral versus intranasal midazolam as premedication in children: a systematic review and meta-analysis

Shouming CHEN ^{1, 2}, Bingchen LANG ^{2, 3}, Lan WU ^{1, 2}, Wensheng ZHANG ^{4, 5} ✉

¹ Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, China; ² Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China; ³ Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; ⁴ Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China; ⁵ Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China

INTRODUCTION: Midazolam hydrochloride is a widely accepted benzodiazepine for premedication in pediatric patients. However, there is no consistent conclusion regarding which route of administration is best. We performed a meta-analysis to assess the efficacy and safety of oral versus intranasal midazolam premedication in children.
EVIDENCE ACQUISITION: The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched from inception to June 2022, for randomized controlled trials comparing oral versus intranasal midazolam. Primary outcomes included satisfactory mask acceptance for induction and satisfactory sedation at separation from parents. Secondary outcomes included the incidence of postoperative nausea and vomiting, incidence of nasal irritation, postoperative recovery time, and hemodynamic changes.
EVIDENCE SYNTHESIS: Data from 14 studies involving a total of 901 children were obtained. The results indicated that intranasal and oral midazolam premedication in children provided similar satisfactory mask acceptance for induction (RR, 1.02; 95% CI, 0.93-1.13; P=0.64; I²=0%), satisfactory sedation at separation from parents (RR, 0.99; 95% CI, 0.89-1.10; P=0.90; I²=57%), and postoperative recovery time (WMD, -8.01; 95% CI, -20.16-4.14; P=0.20; I²=85%). Additionally, intranasal midazolam premedication was associated with lower incidence of postoperative nausea and vomiting (RR, 0.70; 95% CI, 0.51-0.96; P=0.03; I2=0%) and shorter onset time.
CONCLUSIONS: Differences between intranasal and oral midazolam in satisfactory mask acceptance for induction, satisfactory sedation at separation from parents, and postoperative recovery time were not significant. Intranasal midazolam premedication was associated with shorter onset time and higher incidence of nasal irritation.

KEY WORDS: Midazolam; Premedication; Anesthesia, general; Meta-analysis; Randomized controlled trials as topic