History

Introduction and Aim: One of the essential experiences in life is surgical events anesthesia. This experience may cause physiological and psychological disorders such as anxiety and stress, especially in children. The anxiety problem appears without appropriate treatment, and many cause impactive physical or psychological complications in children. Procedural sedation methods for children and adults are different, and a successful method for anxiety control in adults may not be effective in children. Few studies have specifically studied performing the preoperative midazolam therapy and method of consumption on post-operative children’s anxiety. Hence, this study was conducted to compare intranasal and sublingual midazolam as premedication for sedation and reduction of anxiety in pediatric patients. Material and method: This study was conducted as a randomized controlled trial study. A list of patients was prepared from the clinical part of the Nasiriyah hearth center. The list was inputted into the software randomly, and 107 persons were selected. The type of administration was randomly chosen for each patient prescribed midazolam. Participants who have general anesthesia and midazolam prescribed for them between July 2022 in the Nasiriyah Cardiac heart center will be included in this study. Half of the participants (n=107) received sublingual midazolam, and others (n=107) received intranasal midazolam. This study's outcome is the anxiety score in children (quantitative and qualitative). The exposure of the study is the consumption of midazolam before general anesthesia. The measurement for all participants was in the same method. Result: Totally, of 214 patients were included in this study. Among them, 50.9% (n=109) were male, and 49.1% (n=105) were female. The mean age was 10.15 ± 1.87 years (95% Confidence Interval 9.90 - 10.40 years).  Our result showed that the anxiety of patients who received intranasal midazolam was significantly lower than patients who received sublingual midazolam at 10 (P=0.006) and 20 (P=0.020) minutes. However, this difference was not statistically significant in min 30 (P=0.644) and 60 (P=0.655). In addition, the pain of participants who received intranasal midazolam was significantly lower than patients who received sublingual. While this difference was not statistically significant, it was borderline significant (p=0.078). In addition, our results showed that the mean time for sedation of participants in the nasal midazolam intervention group was 9.47±2.01years. In the sublingual midazolam intervention group, it was 16.38±2.99 years. The difference was statistically significant (p<0.001), which means the mean sedation time in patients who received sublingual midazolam was significantly higher than in those who received intranasal midazolam. Discussion: We concluded from our study that intranasal midazolam has superiority compared with sublingual midazolam in premedication in children for sedation and anxiety score and some other factors, including pulse rate and o2 saturation before anesthesia. The anxiety scores after premedication are significantly lower in the intranasal compared are sublingual. In addition, the onset time for sedation was significantly lower in intranasal inter, which nation group means this method may have a faster effect. The adverse effect was similar in both groups. Thus, intranasal midazolam is a fallow-danger, low-danger method for children undergoing anesthesia.