Tolksdorf W, Eick C
Klinik für Anaesthesiologie der Medizinischen Fakultät der RWTH Aachen.
Anaesthesist. 1991 Dec;40(12):661-7.
Midazolam is often used for the premedication of children in the pre-school age group. Different noninvasive routes of administration have been described. In a prospective study we compared the effects of oral, rectal, and nasal midazolam in commonly used dosages. PATIENTS AND METHODS. Ninety children undergoing surgery under general anesthesia were assigned to oral (0.4 mg/kg) (MO), rectal (0.5 mg/kg) (MR), or nasal (0.2 mg/kg) midazolam (MN), according to the child's and/or parent's preferred route of administration, after having obtained the parent's informed consent. It was applied on the ward before transport to the operating room. The following parameters were assessed by the observer and the anesthesiologist at different times: sedation, acceptance (child, anesthesiologist), mood, emotion, resistance, pain, nausea and vomiting, blood pressure, and heart and respiratory rates. The Wilcoxon test (P less than 0.05) was used for statistical analysis. RESULTS. All groups were comparable with respect to age, weight, and surgery experience. There was no difference in the anesthesiologist's acceptance of the premedication or the cooperation of the children. The children accepted MO significantly better compared to MN and MR. The fastest onset of sedation was found after MR. Immediately after MN many children became euphoric, and it turned out that the effect of MN was rather euphoric than sedative. The effect of MO was good in many children, but less predictable. This led to a significant delay in transport to the operating room. MO children experienced more nausea and vomiting (P less than 0.05) in the postoperative period. There were no differences in physiological parameters. DISCUSSION AND CONCLUSIONS. The results can be explained by the different characteristics of absorption and patient acceptance. The route of administration according to the child's or parent's choice can be recommended but does not guarantee success. MR had the fastest onset of sedative action due to faster absorption of the drug. MN had a euphoric effect that resulted almost immediately. Oral premedication was best accepted, nasal administration worst. MO produced more side effects than MR and MN in the postoperative period. If the child accepts the rectal route of administration, this should be preferred because of the high success rate and few side effects.
咪达唑仑常用于学龄前儿童的术前用药。已描述了不同的非侵入性给药途径。在一项前瞻性研究中，我们比较了常用剂量的口服、直肠和鼻内咪达唑仑的效果。患者与方法。90名接受全身麻醉手术的儿童，在获得家长知情同意后，根据儿童和/或家长偏好的给药途径，被分配接受口服（0.4mg/kg）（MO组）、直肠（0.5mg/kg）（MR组）或鼻内（0.2mg/kg）咪达唑仑（MN组）。在转运至手术室之前在病房给药。观察人员和麻醉医生在不同时间评估以下参数：镇静程度、接受度（儿童、麻醉医生）、情绪、情感、抵抗性、疼痛、恶心和呕吐、血压以及心率和呼吸频率。采用Wilcoxon检验（P<0.05）进行统计分析。结果。所有组在年龄、体重和手术经历方面具有可比性。麻醉医生对术前用药的接受度或儿童的配合度没有差异。与MN组和MR组相比，儿童对MO组的接受度明显更好。MR组给药后镇静起效最快。MN组给药后许多儿童立即变得欣快，结果发现MN组的效果更倾向于欣快而非镇静。MO组对许多儿童效果良好，但较难预测。这导致转运至手术室出现显著延迟。MO组儿童术后恶心和呕吐更多（P<0.05）。生理参数无差异。讨论与结论。结果可通过吸收特性和患者接受度的不同来解释。可以推荐根据儿童或家长选择的给药途径，但不能保证成功。由于药物吸收更快，MR组镇静作用起效最快。MN组几乎立即产生欣快效果。口服术前用药接受度最佳，鼻内给药最差。MO组术后产生的副作用比MR组和MN组更多。如果儿童接受直肠给药途径，因其成功率高且副作用少，应优先选择。
