Induction of general anesthesia in children with midazolam--is there an induction dose?

The pharmacodynamics of midazolam was studied in 27 children undergoing elective surgery at five different dose levels (0.075-0.6 mg/kg) in attempting to find a suitable induction dose for general anesthesia. A comparison of the highest dose was made to thiopentone 5 mg/kg. Even an induction dose of 0.6 mg/kg of midazolam was found to be unreliable in children, but effective enough to cause significant fall in systolic blood pressure after induction (p less than 0.05). In the children premedicated with atropine and pethidine thiopentone resulted in a more rapid closure of the eyes (p less than 0.01) and disappearance of the eye-lid reflex (p less than 0.01) than the high dose of 0.6 mg/kg of midazolam. Moreover, midazolam failed to induce sleep in a considerable fraction of the children even at the highest dose employed. The thiopentone group was more alert in the recovery room at 30 min after wake-up. The amnestic effect of thiopentone and midazolam were equal.