Affiliations: [a] Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA | [b] Department of Rehabilitation and Physiotherapy, American Hospital Dubai, Dubai, United Arab Emirates | [c] Department of Orthopedic Medicine, Tufts Medical Center, Boston, MA, USA
Correspondence:
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Corresponding author: Nadia Alwasiah, Department of Rehabilitation and Physiotherapy, American Hospital Dubai, Oud Metha Road, Dubai, United Arab Emirates. Tel.: +971 563177956; E-mail: [email protected].
Abstract: PURPOSE: Pediatric outpatient procedures can be traumatic experiences for patients. This retrospective study, evaluates intramuscular midazolam as a safe option for anxiolysis during spasticity management injections. METHODS: We performed a retrospective chart review of 72 patients from a Tertiary Pediatric Hospital Outpatient Clinic. One hundred and twenty injections were administered over two years by a single practitioner. Comorbidities included asthma, sleep apnea, chronic obstructive disease, and epilepsy. Duration of sedation, safety of midazolam as determined through the use of the REACT (Respiration, Energy, Alertness, Circulation, Temperature) score, and frequency of side effects (prolonged sedation, breakthrough crying, medication reversal, and emergent evaluation) were recorded. A student’s t test evaluated the relationship between the above comorbidities and duration of sedation. RESULTS: The average duration of sedation was 29 minutes (95% CI 26.51–31.35) with an average dose of midazolam of 0.20 mg/kg (95% CI 0.9–0.21). None of the subjects required medication reversal or emergent evaluation. 39% of the patients had prolonged sedation (> 30 minutes after medication administration), 22% had breakthrough crying, and 0% had respiratory events requiring oxygen, intubation or an emergency evaluation. No statistical significance found between the comorbidities and duration of sedation. CONCLUSION: Intramuscular midazolam is a possible effective anxiolytic medication strategy for outpatient pediatric injections. Additional studies are needed to ensure its safety and efficacy.
