Abstract Objective To compare intranasal midazolam and intramuscular phenobarbital sodium for their sedative effect in neonates undergoing magnetic resonance imaging (MRI). Methods A total of 70 neonates who underwent cranial MRI from September 2017 to March 2019 were randomized into an observation group and a control group, with 35 cases in each group. The observation group received intranasal drops of midazolam (0.3 mg/kg), and the control group received intramuscular injection of phenobarbital sodium (10 mg/kg). The sedation status of the neonates was evaluated using the Ramsay Sedation Scale. Meanwhile, the two groups were compared for the success rate of MRI procedure and incidence of adverse reactions. Results In the observation group, the sedation score was the highest at 20 minutes post administration, then was gradually decreasing, and decreased to the lowest level at 70 minutes post administration. In the control group, the sedation score was the lowest at 10 minutes post administration, then was gradually increasing, and increased to the highest level at 40 minutes and 50 minutes post administration, followed by a gradual decrease. Comparison of the sedation score at each time period suggested that the sedation score was significantly higher in the observation group than in the control group within 40 minutes post administration (P < 0.05), while there were no significant differences between the two groups in the sedation score after 40 minutes post administration (P > 0.05). The success rate of MRI procedure was significantly higher in the observation group than in the control group (89% vs 69%, P < 0.05). There was no significant difference between the two groups in the incidence of adverse reactions (P > 0.05). Conclusions Intranasal midazolam is superior to intramuscular phenobarbital sodium in the sedative effect in neonates undergoing MRI, with the benefits of being fast, convenient, safe, and effective.
WANG Fang-Hui,ZHANG Jie,XIAO Mi et al. Sedative effect of intranasal midazolam in neonates undergoing magnetic resonance imaging: a prospective single-blind randomized controlled study[J]. CJCP, 2020, 22(5): 441-445.
WANG Fang-Hui,ZHANG Jie,XIAO Mi et al. Sedative effect of intranasal midazolam in neonates undergoing magnetic resonance imaging: a prospective single-blind randomized controlled study[J]. CJCP, 2020, 22(5): 441-445.
Sulton C, Kamat P, Mallory M, et al. The use of intranasal dexmedetomidine and midazolam for sedated magnetic resonance imaging in children:a report from the pediatric sedation research consortium[J]. Pediatr Emerg Care, 2020, 36(3):138-142.
[5]
Sado-Filho J, Viana KA, Corrêa-Faria P, et al. Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation[J]. PLoS One, 2019, 3:e0213074.
[6]
Ghai B, Jain K, Saxena AK, et al. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging:a randomized, double-blind, and controlled study[J]. Paediatr Anaesth, 2017, 27(1):37-44.
[7]
Lim EY, Tang IP, Peyman M, et al. 3 Tesla magnetic resonance imaging noise in standard head and neck sequence does not cause temporary threshold shift in high frequency[J]. Eur Arch Otorhinolaryngol, 2015, 272(11):3109-3113.
[8]
Jin C, Li H, Li X, et al. Temporary hearing threshold shift in healthy volunteers with hearing protection caused by acoustic noise exposure during 3-T multisequence MR neuroimaging[J]. Radiology, 2018, 286(2):602-608.
[9]
Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures[J]. Pediatr Dent, 2019, 41(4):26E-52E.
[10]
Boriosi JP, Eickhoff JC, Klein KB, et al. A retrospective comparison of propofol alone to propofol in combination with dexmedetomidine for pediatric 3T MRI sedation[J]. Paediatr Anaesth, 2017, 27(1):52-59.
[11]
Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children[J]. Curr Opin Anaesthesiol, 2010, 23(4):513-517.
[12]
Carter BS, Brunkhorst J. Neonatal pain management[J]. Semin Perinatol, 2017, 41(2):111-116.
[13]
Sahoo S, Kaur M, Tripathy HK, et al. Comparative evaluation of midazolam and clonidine as pediatric oral premedication[J]. Anesth Essays Res, 2013, 7(2):221-227.
[14]
Gupta A, Dalvi NP, Tendolkar BA. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients:a prospective randomized double blind trial[J]. J Anaesthesiol Clin Pharmacol, 2017, 33(2):236-240.
[15]
Baleine J, Milési C, Mesnage R, et al. Intubation in the delivery room:experience with nasal midazolam[J]. Early Hum Dev, 2014, 90(1):39-43.
[16]
Yildirim SV, Guc BU, Bozdogan N, et al. Oral versus intranasal midazolam premedication for infants during echocardiographic study[J]. Adv Ther, 2006, 23(5):719-724.
Irikura M, Minami E, Ishitsuka Y, et al. Abnormal movements of Japanese infants following treatment with midazolam in a neonatal intensive care unit:incidence and risk factors[J]. ISRN Pharmacol, 2012, 2012:950603.