Walbergh E J, Wills R J, Eckhert J
Medical College of Wisconsin, Milwaukee.
Anesthesiology. 1991 Feb;74(2):233-5. doi: 10.1097/00000542-199102000-00007.
Nasally administered midazolam appears to be a useful method for rapidly sedating children prior to the induction of anesthesia. We determined the peak plasma concentrations after intranasal administration of midazolam and compared this to plasma concentrations achieved after intravenously administered midazolam in 18 children between the ages of 14 months and 5 yr, who underwent elective closure of an asymptomatic atrial septal or ventricular septal defect. Preanesthetic medication was at the discretion of the attending anesthesiologist. Induction of anesthesia was with halothane in N2O and O2 via mask, and tracheal intubation was performed after the administration of fentanyl or sufentanil plus pancuronium. Anesthesia was maintained with these agents, and augmented with halothane or isoflurane. As soon as arterial access was established, the patient received 0.1 mg/kg of either intranasal or intravenous midazolam. Midazolam concentrations were measured by gas chromatography-mass spectrometry. Intranasal midazolam achieved its peak plasma concentration of 72.2 +/- 27.3 ng/ml in 10.2 +/- 2 min. Ten minutes after the administration of midazolam, the mean plasma concentration in the intranasal midazolam group was 57% of the concentrations in the group receiving midazolam intravenously. These results confirm the clinical impression that intranasal administration of midazolam rapidly achieves sedative plasma concentrations in children.
鼻腔给予咪达唑仑似乎是在麻醉诱导前快速镇静儿童的一种有用方法。我们测定了18名年龄在14个月至5岁之间、接受无症状房间隔或室间隔缺损择期闭合手术的儿童经鼻给予咪达唑仑后的血浆峰浓度，并将其与静脉给予咪达唑仑后的血浆浓度进行比较。麻醉前用药由主治麻醉师酌情决定。通过面罩以氟烷吸入N₂O和O₂诱导麻醉，在给予芬太尼或舒芬太尼加潘库溴铵后进行气管插管。用这些药物维持麻醉，并加用氟烷或异氟烷。一旦建立动脉通路，患者即接受0.1mg/kg的鼻内或静脉注射咪达唑仑。通过气相色谱-质谱法测定咪达唑仑浓度。经鼻给予咪达唑仑后，在10.2±2分钟内达到其血浆峰浓度72.2±27.3ng/ml。给予咪达唑仑10分钟后，经鼻给予咪达唑仑组的平均血浆浓度为静脉给予咪达唑仑组浓度的57%。这些结果证实了临床印象，即经鼻给予咪达唑仑能在儿童中迅速达到镇静的血浆浓度。
