DISSERTATION MEET

APRIL - 2023

DR KAVIYA
FIRST YEAR M.D PAEDIATRICS
UNIT 2
MADUARI MEDICAL COLLEGE
UNDER THE GUIDANCE OF

DIRECTOR AND HOD DR.BALASANKAR M.D, DCH,

UNIT CHIEF

PROF DR.NANDINI KUPPUSAMY

ASSISTANT PROFESSORS

DR. R.VENKATARAMANAN M.D,DCH

DR. S.PRASANNA MD
TOPIC

Pre procedure midazolam nasal spray for

pain relief and anxiolysis for intravenous
catheter insertion in children

- a case control study

 A
• To asses the use of MIDAZOLAM

NASAL SPRAY as a pre procedure pain

I
relief and anxiolytic drug for iv catheter
M
insertion in children
• Place of study – institute of child health and research center,
govt. Rajaji hospital, Madurai

• Study design – case control study

• Study time - October 2023- October 2024

• Study population – children aged 2- 8 years attending pediatric

casualty , needing iv line insertion

• Case definition - children aged 2 – 8 years getting admitted in

pediatric ward a, who need iv line insertion
CASES
• Inclusion criteria • Exclusion criteria

• Patients of age group 5- 12 years

• Patients less than 5 and more than 12
years
• Children in need of first time iv line
insertion on admission to the hospital • Children already on AEDs

• Children with allergic rhinitis

• Children not on any sedative drugs, AEDs
• Children with known drug allergy

• Children with GCS 15/15 • GCS less than 15/15

CONTROL

INCLUSION CRITERIA EXCLUSION CRITERIA

• Patients of age group 5- 12 years
• Patients less than 5 and more than 12 years

• Children in need of first time iv line

• Children already on aeds
insertion on admission to he hospital
• Children with allergic rhinitis

• Children not on any sedative drugs, AEDs • Children with known drug allergy

• Gcs less than 15/15

• Children with gcs 15/15
METHODOLOGY
S.NO NAME AGE SEX IP NO PLACE WEIGT ORDER OF BIRTH PREVIOUS IV ALLERGIES
LINE
INSERTIOM
PRESENT INTRANASAL TIME TIME TIME CO OPERATION SCORE ANXIOLYSIS SCORE PAIN PAIN ADVERSE
MEDICATIO MIDAZOLAM OF DOSING OF OF SCALE SCALE REACTIONS
N ONSET VENIPUN USED SCORE
OF CTURE
SEDATION

10 20 30 10 20 30
PROCEDURE
OBSERVATIONS
• Time of Onset of Sedation

• Sedation Score at various points of time (10 minutes intervals for 30 minutes)

• Anxiolysis score at various points of time (10 minutes intervals for 30 minutes)

• Co-operation score at the time of separation from parents

• Co-operation score at the time of venepuncture.

• Age appropriate pain scale score at the time of iv line insertion

 OBSERVATIONS CONTD…
• The presence or absence of the following side effects and complications from the time of
instillation to 24 hours postoperatively, were noted.

• Nasal irritation

• Postoperative – nausea and vomiting

• Respiratory depression

• Laryngospasm/ Bronchospasm

• Other complications
BIBILIOGRAPHY
• Gustaf Ljungman, Anders Kreuger, Torsten Gordh- Midazolam nasal spray
reduces procedural anxiety in children. American academy of Pediatrics vol.
105 No.1 Jan 2000; pp.73-78
• ND Shasikiran, Subba V.V. Reddy, CM Yavagal- Concsious Sedation- An
artist’s science! An Indian experience with midazolam. J ournal of Indian Soc
Pedod Prev Dent 2006; 24: 7-14
• Levent V. Karabas, Orhan Elibal,Yusuf Caglar- Probing for nasolacrimal duct
obstruction using intranasal midazolam sedation as an alternative to general
anaesthesia. Journal of Paediatric Ophthalmology and Strabismus Vol.43 .no 2;
2006
• Wilton NCT, Leigh J, Rosen DR et al.,- Pre anaesthetic sedation of preschool
children using intranasal midazolam. Anaesthesiology, 69:972-975,1998.
• Ravi K Verma, Anil peshwan Premedication With Midazolam Nasal Spray: An Alternative to Oral
Midazolam in Children. Anesth pain medicine. 2012 Spring; 1(4): 248–251
• Hossein Khoshrang, MD,1 Cyrus Emir Alavi, MD,1 Siamak Rimaz, MD,1 Ali Mirmansouri, MD,1 Efficacy of
intranasal ketamine and midazolam for pediatric sedation: A double-blind, randomized clinical trial.
Caspian J Intern Med. 2021 Autumn
• Midazolam Nasal Spray Reduces Procedural Anxiety in Children. January 2000 PEDIATRICS 105(1 Pt
1):73-8 DOI:10.1542/peds.105.1.73
• Shyam Chandrasekar, Bhagirathi Dwibedi, Rashmi Ranjan Das, Biswa Mohan Padhy &
Bikram Kishore Behera Comparison of oral triclofos and intranasal midazolam and
dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an
open-label, three-arm, randomized trial European Journal of Pediatrics volume 182, pages1385–1391
(2023)

•
NELSON TEXTBOOK OF PAEDIATRICS 21ST EDITION
Chapter 74 ◆ Anesthesia and Perioperative Care 459
NELSON TEXTBOOK OF PAEDIATRICS 21ST EDITION
2798 Part XXIII ◆ Urologic Disorders in Infants and Children
NELSON TEXTBOOK OF PAEDIATRICS 21ST EDITION
Chapter 74 ◆ Anesthesia and Perioperative Care 468.e1
NELSON TEXTBOOK OF PAEDIATRICS 21ST EDITION
Chapter 74 ◆ Anesthesia and Perioperative Care 463
NELSON TEXTBOOK OF PAEDIATRICS 21ST EDITION
THANK YOU
Pre procedure midazolam nasal spray for pain relief and
anxiolysis for intravenous catheter insertion in children - a
case control study