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Oral premedication with fentanyl may be a safe and effective alternative to oral midazolam

Published online by Cambridge University Press:  11 July 2005

M. Tamura ,
K. Nakamura ,
R. Kitamura ,
S. Kitagawa ,
N. Mori  and
Y. Ueda
M. Tamura
Affiliation:
Osaka Dental University, Department of Anaesthesiology, Osaka, Japan
K. Nakamura
Affiliation:
Kyoto City Hospital, Department of Anaesthesia, Kyoto, Japan
R. Kitamura
Affiliation:
Kyoto City Hospital, Department of Anaesthesia, Kyoto, Japan
S. Kitagawa
Affiliation:
Kyoto City Hospital, Department of Anaesthesia, Kyoto, Japan
N. Mori
Affiliation:
Osaka Dental University, Department of Anaesthesiology, Osaka, Japan
Y. Ueda
Affiliation:
Osaka Dental University, Department of Anaesthesiology, Osaka, Japan
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Extract

Summary

Background and objective: Although midazolam is commonly given orally to infants and small children for premedication, the taste is sometimes unacceptable even when mixed with syrup. We tested the efficacy and safety of oral fentanyl compared with oral midazolam in a randomized open-label study.

Methods: Fifty-one children, aged 12–107 months and weighing 10–25 kg, were randomly assigned to fentanyl or midazolam treatment groups. Midazolam (5 mg) or fentanyl (0.1 mg) was given orally from a small bottle with a small orifice 30 min before transfer to the preoperative holding room. The excitation–sedation conditions of the patients were assessed before and after general anaesthesia.

Results: The preoperative scores did not differ significantly between the two groups. No major complications were observed in either group. Postoperative vomiting occurred in 5 of 27 (18.5%) patients treated with oral fentanyl and in none of 24 of those treated with midazolam.

Conclusions: Oral administration of fentanyl 30 min before entrance to the holding room for an operation from a bottle with a small orifice is a premedication option for children between 1 and 8 yr of age.

Keywords

ADJUVANTS, ANAESTHESIA, fentanyl, midazolamANAESTHESIADRUG THERAPY, premedicationPAEDIATRICS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 6 , June 2003 , pp. 482 - 486
Copyright
© 2003 European Society of Anaesthesiology

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References

Anderson BJ, Exarchos H, Lee K, Brown TC. Oral premedication in children: a comparison of chloral hydrate, diazepam, alprazolam, midazolam and placebo for day surgery. Anaesth Intensive Care 1990; 18: 185–193.Google Scholar
Shigemi K, Kanbayashi Y, Ohta T, et al. Midazolam– atropine lollipop for pediatric premedication. Masui 2000; 49: 496–503.Google Scholar
Friesen RH, Carpenter E, Madigan CK, Lockhart CH. Oral transmucosal fentanyl citrate for preanaesthetic medication of paediatric cardiac surgery patients. Paediatr Anaesth 1995; 5: 29–33.Google Scholar
Epstein RH, Mendel HG, Witkowski TA, et al. The safety and efficacy of oral transmucosal fentanyl citrate for preoperative sedation in young children. Anesth Analg 1996; 83: 1200–1205.Google Scholar
Dsida RM, Wheeler M, Birmingham PK, et al. Premedication of pediatric tonsillectomy patients with oral transmucosal fentanyl citrate. Anesth Analg 1998; 86: 66–70.Google Scholar
Esuvaranathan VV, Mukherjee K, Streets C, et al. A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children. Paediatr Anaesth 2000; 10: 697.Google Scholar
Hanaoka K, Tachibana N, Tanifuji Y. Application of midazolam for sedation during local anesthesia. Igaku-to-Yakugaku 1985; 14: 840–846.Google Scholar
Gillerman RG, Hinkle AJ, Green HM, Cornell L, Dodge CP. Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children. J Clin Anesth 1996; 8: 480–485.Google Scholar
Lyons B, Cregg N, Conway F, Casey W, Doherty P, Moore KP. Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone. Can J Anaesth 1995; 42: 473–478.Google Scholar
Cray SH, Dixon JL, Heard CM, Selsby DS. Oral midazolam premedication for paediatric day case patients. Paediatr Anaesth 1996; 6: 265–270.Google Scholar
Mitchell V, Grange C, Black A, Train J. A comparison of midazolam with trimeprazine as an oral premedicant for children. Anaesthesia 1997; 52: 416–421.Google Scholar
Riva J, Lejbusiewicz G, Papa M, et al. Oral premedication with midazolam in paediatric anaesthesia. Effects on sedation and gastric contents. Paediatr Anaesth 1997; 7: 191–196.Google Scholar
Patel D, Meakin G. Oral midazolam compared with diazepam–droperidol and trimeprazine as premedicants in children. Paediatr Anaesth 1997; 7: 287–293.Google Scholar
Pywell CA, Hung YJ, Nagelhout J. Oral midazolam versus meperidine, atropine, and diazepam: a comparison of premedicants in pediatric outpatients. AANA J 1995; 63: 124–130.Google Scholar
Streisand JB, Stanley TH, Hague B, van Vreeswijk H, Ho GH, Pace NL. Oral transmucosal fentanyl citrate premedication in children. Anesth Analg 1989; 69: 28–34.Google Scholar
Ashburn MA, Streisand JB, Tarver SD, et al. Oral transmucosal fentanyl citrate for premedication in paediatric outpatients. Can J Anaesth 1990; 37: 857–866.Google Scholar
Schutzman SA, Burg J, Liebelt E, et al. Oral transmucosal fentanyl citrate for premedication of children undergoing laceration repair. Ann Emerg Med 1994; 24: 1059–1064.Google Scholar
Egan TD, Sharma A, Ashburn MA, et al. Multiple dose pharmacokinetics of oral transmucosal fentanyl citrate in healthy volunteers. Anesthesiology 2000; 92: 665–673.Google Scholar
Streisand JB, Varvel JR, Stanski DR, et al. Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 1991; 75: 223–229.Google Scholar
DeLorey TM, Kissin I, Brown P, Brown GB. Barbiturate–benzodiazepine interactions at the gamma-aminobutyric acid A receptor in rat cerebral cortical synaptoneurosomes. Anesth Analg 1993; 77: 598–605.Google Scholar
Wesselman JP, van Wilgenburg H, Long SK. The effects of pentobarbital and benzodiazepines on GABA-responses in the periphery and spinal cord in vitro. Neurosci Lett 1991; 128: 261–264.Google Scholar