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Sedation with intranasal midazolam of Angolan children undergoing invasive procedures

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Aim:  Ambulatory surgery is a daily requirement in poor countries, and limited means and insufficient trained staff lead to the lack of attention to the patient’s pain. Midazolam is a rapid‐onset, short‐acting benzodiazepine which is used safely to reduce pain in children. We evaluated the practicability of intranasal midazolam sedation in a suburban hospital in Luanda (Angola), during the surgical procedures.

Methods:  Intranasal midazolam solution was administered at a dose of 0.5 mg/kg. Using the Ramsay’s reactivity score, we gave a score to four different types of children’s behaviour: moaning, shouting, crying and struggling, and the surgeon evaluated the ease of completing the surgical procedure using scores from 0 (very easy) to 3 (managing with difficulty).

Results:  Eighty children (median age, 3 years) were recruited, and 140 surgical procedures were performed. Fifty‐two children were treated with midazolam during 85 procedures, and 28 children were not treated during 55 procedures. We found a significant difference between the two groups on the shouting, crying and struggling parameters (p < 0.001). The mean score of the ease of completing the procedures was significantly different among the two groups (p < 0.0001).

Conclusion:  These results provide a model of procedural sedation in ambulatory surgical procedures in poor countries, thus abolishing pain and making the surgeon’s job easier.

Document Type: Research Article


Affiliations: 1: Divina Providéncia Hospital, Luanda, Angola 2: Institute for Maternal and Child Health – IRCCS-Bo Garofolo – Trieste, University of Trieste, Italy

Publication date: July 1, 2012

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