Fishbein M, Lugo R A, Woodland J, Lininger B, Linscheid T
Department of Pediatrics, Columbus Children's Hospital, Ohio, USA.
J Pediatr Gastroenterol Nutr. 1997 Sep;25(3):261-6. doi: 10.1097/00005176-199709000-00004.
Intravenous midazolam and opioids are used to produce conscious sedation in children undergoing esophagogastroduodenoscopy (EGD). However, children may experience significant fear and anxiety before receiving these medications, especially during separation from parents and during venipuncture. Intranasal administration of midazolam represents a noninvasive method of sedating children before anxiety-producing events. The objective of this study was to determine whether premedication with intranasal midazolam reduces stress and anxiety of separation from parents and of undergoing venipuncture, while maintaining adequate sedation during EGD.
This was a prospective, randomized, double-blind study in 40 children, aged 2 to 12 years, who were undergoing EGD. Patients in group I were premedicated with intranasal placebo (0.9% NaCl) followed 10 minutes later by intravenous midazolam (0.05 mg/kg) and intravenous meperidine (1 mg/ kg). Patients in group II were premedicated with intranasal midazolam (0.2 mg/kg) followed by intravenous placebo (0.9% NaCl) and intravenous meperidine (1 mg/kg). Anxiolysis and sedation were scored by a blinded observer, who identified minor and major negative behaviors during four observation periods: intranasal drug administration, separation from parents, venipuncture, and EGD.
Premedication with intranasal midazolam significantly reduced negative behaviors during separation from parents (p < 0.05); however, no difference between regimens was noted during venipuncture or EGD. Negative behaviors appeared to increase during administration of intranasal midazolam or placebo.
Premedication with intranasal midazolam is effective in reducing negative behaviors during separation from parents, while it maintains sedation during the endoscopic procedure. The benefits of intranasal administration may be negated, however, by irritation, and discomfort caused by intranasal drug delivery.
静脉注射咪达唑仑和阿片类药物用于在接受食管胃十二指肠镜检查（EGD）的儿童中产生清醒镇静。然而，儿童在接受这些药物之前可能会经历显著的恐惧和焦虑，尤其是在与父母分离期间和静脉穿刺期间。鼻内给予咪达唑仑是在产生焦虑的事件之前使儿童镇静的一种非侵入性方法。本研究的目的是确定鼻内咪达唑仑预处理是否能减轻与父母分离和静脉穿刺时的压力和焦虑，同时在EGD期间维持足够的镇静。
这是一项针对40名年龄在2至12岁、正在接受EGD的儿童的前瞻性、随机、双盲研究。第一组患者先鼻内给予安慰剂（0.9%氯化钠），10分钟后静脉注射咪达唑仑（0.05 mg/kg）和静脉注射哌替啶（1 mg/kg）。第二组患者先鼻内给予咪达唑仑（0.2 mg/kg），然后静脉注射安慰剂（0.9%氯化钠）和静脉注射哌替啶（1 mg/kg）。由一名盲法观察者对镇静和抗焦虑效果进行评分，该观察者在四个观察期内识别轻微和严重的负面行为：鼻内给药、与父母分离、静脉穿刺和EGD。
鼻内咪达唑仑预处理显著减少了与父母分离期间的负面行为（p < 0.05）；然而，在静脉穿刺或EGD期间未观察到不同治疗方案之间的差异。在鼻内给予咪达唑仑或安慰剂期间，负面行为似乎有所增加。
鼻内咪达唑仑预处理可有效减少与父母分离期间的负面行为，同时在内镜检查过程中维持镇静。然而，鼻内给药的益处可能会被鼻内给药引起的刺激和不适所抵消。
