Lejus C, Renaudin M, Testa S, Malinovsky J M, Vigier T, Souron R
Service d'Anesthésie et de Réanimation Chirurgicale, Hôtel-Dieu, Nantes, France.
Eur J Anaesthesiol. 1997 May;14(3):244-9. doi: 10.1046/j.1365-2346.1997.00013.x.
The authors compared the acceptance and efficacy of rectal and nasal administration of midazolam (MDZ) for premedication. Ninety-five ASA I and II paediatric patients (8 months to 12 years) scheduled for elective surgery were randomly allocated to two groups. Group R received 0.3 mg kg-1 of rectal midazolam (in 5 mL saline). Group N received 0.2 mg kg-1 of nasal midazolam (5 mg ml-1). Both groups were divided in two subgroups according to age (group RA (< or = 6 years, n = 33), group RB (> 6 years, n = 18), group NA (< or = 6 years, n = 28), group NB (> 6 years, n = 16)). At the time of premedication, tolerance to the administration was confirmed. Twenty min after rectal or 10 min after nasal administration the quality of sedation was recorded. The nasal midazolam, in commonly used dosages, induced a sedation similar to that following rectal administration with a shorter delay of onset. Nasal administration was more often painful than rectal administration. Swallowing (nasal midazolam) and concerns about modesty (rectal midazolam) were more frequent in older children. Because of its poor tolerance, nasal premedication should be reversed for cases where there is no alternative. Rectal premedication should be avoided in older children.
作者比较了直肠和鼻腔给予咪达唑仑（MDZ）进行术前用药的接受度和效果。95例计划进行择期手术的ASA I级和II级儿科患者（8个月至12岁）被随机分为两组。R组接受0.3 mg/kg的直肠咪达唑仑（溶于5 mL生理盐水中）。N组接受0.2 mg/kg的鼻腔咪达唑仑（5 mg/mL）。根据年龄，两组又各分为两个亚组（RA组（≤6岁，n = 33），RB组（>6岁，n = 18），NA组（≤6岁，n = 28），NB组（>6岁，n = 16））。在进行术前用药时，确认对给药的耐受性。直肠给药20分钟后或鼻腔给药10分钟后记录镇静质量。常用剂量的鼻腔咪达唑仑诱导的镇静效果与直肠给药相似，但起效延迟更短。鼻腔给药比直肠给药更常引起疼痛。年龄较大的儿童中吞咽（鼻腔咪达唑仑）和对隐私的顾虑（直肠咪达唑仑）更常见。由于耐受性差，在没有其他选择的情况下，鼻腔术前用药应进行逆转。年龄较大的儿童应避免直肠术前用药。
