Oral midazolam versus meperidine, atropine, and diazepam: a comparison of premedicants in pediatric outpatients

Abstract

An effective premedicant minimizes the emotional trauma children experience when facing surgery and may facilitate a smoother induction with fewer airway complications. In a randomized, double-blind study, the preoperative sedative effects and the postoperative recovery profiles of two oral pediatric premedicants were compared. Children (n = 102) were randomly assigned to receive 0.5 mg/kg midazolam or .2 mL/kg of a combination of meperidine 6.0 mg/mL, atropine 0.08 mg/mL, and diazepam 0.6 mg/mL 15-45 minutes before separation from parents. A five-point behavioral score was assigned at premedication, separation, and induction. Demographic data, preoperative preparation, analgesics, side effects, and recovery times were recorded. Scoring was continued at 15 and 30 minute intervals in the postanesthesia care unit (PACU). A majority of children in both groups achieved acceptable separation and induction scores; however, the midazolam subjects showed significantly better improvement in scores at both separation and induction (P < .01). In midazolam subjects, the age of the child did not influence induction scores; but in the meperidine/atropine/diazepam group, unacceptable scores were strongly associated with younger subjects (P < .01). Attendance at a children's preoperative preparation program did not affect scores. Midazolam subjects initially arrived in the PACU sleepier than pediatric anesthesia medicine subjects, but all other recovery scores were similar. There were no differences in analgesic requirements, side effects, or time to discharge between groups. We conclude that both premedicants are effective in most children, but that midazolam may offer more effective sedation in younger, distressed children.