Comparison of Discharge Readiness in Pediatric Patients: Oral Versus Intranasal Preoperative Midazolam Administration.

IF 1.6 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2026-10-01 Epub Date: 2026-07-15 DOI:10.1002/pan.70267

Mohammad Naem, Jobayer Hossain, Janna Hamideh, Judit Szolnoki

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引用次数: 0

Abstract

Background: Midazolam is commonly administered orally or intranasally to reduce preoperative anxiety in children undergoing tympanostomy. Prior studies suggest differences in recovery exist between the two routes, but their impact on post-anesthesia care unit (PACU) length of stay remains unclear.

Methods: We conducted a retrospective chart review of pediatric patients aged 6 months to 10 years undergoing tympanostomy at Nemours Children's Hospital, Central Florida, between November 2023 and November 2024. Patients were grouped by midazolam route (intranasal 0.2 mg/kg IV formulation vs. oral 0.5 mg/kg syrup). The primary outcome was PACU length of stay, defined as time from PACU arrival to discharge based on standard hospital criteria. Predictors of administration route were evaluated using univariate logistic regression, and PACU length of stay was analyzed using age-adjusted ANCOVA with backward stepwise variable selection.

Results: A total of 463 patients were included: 322 received oral midazolam and 141 received intranasal midazolam. In unadjusted analysis, intranasal midazolam was associated with a shorter PACU stay (mean 39.7 vs. 42.9 min, p = 0.02). However, patients receiving intranasal midazolam were significantly younger (31.5 vs. 37.8 months, p < 0.001). After adjustment for age, age emerged as the only independent predictor of PACU length of stay, and the association between administration route and PACU duration was attenuated and no longer significant (p = 0.15).

Conclusions: Age, rather than route of midazolam administration, primarily explained differences in PACU discharge readiness among children undergoing tympanostomy. Previously reported differences in recovery time between oral and intranasal midazolam may reflect age-related confounding rather than a true effect of route. Future prospective, age-stratified studies are needed to clarify this relationship and refine pediatric sedation practices.

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儿科患者出院准备的比较：口服与鼻内咪达唑仑术前给药。

背景：咪达唑仑通常是口服或鼻内给药，以减少术前焦虑的儿童鼓室造口术。先前的研究表明，两种途径在恢复方面存在差异，但它们对麻醉后护理单位（PACU）住院时间的影响尚不清楚。方法：我们对2023年11月至2024年11月期间在佛罗里达州中部Nemours儿童医院接受鼓膜造口术的6个月至10岁儿童患者进行了回顾性图表回顾。患者按咪达唑仑组分组（鼻内0.2 mg/kg静脉制剂vs口服0.5 mg/kg糖浆）。主要观察指标为PACU住院时间，定义为PACU到达医院至出院的时间。采用单因素logistic回归评估给药途径的预测因素，采用年龄调整ANCOVA分析PACU住院时间，并采用反向逐步变量选择。结果：共纳入463例患者，其中口服咪达唑仑322例，鼻用咪达唑仑141例。在未经调整的分析中，鼻内咪达唑仑与PACU停留时间较短相关（平均39.7分钟对42.9分钟，p = 0.02）。然而，接受鼻内咪达唑仑的患者明显更年轻（31.5个月vs 37.8个月）。结论：年龄，而不是咪达唑仑给药途径，主要解释了接受鼓膜造口术的儿童PACU出院准备程度的差异。先前报道的口服和鼻内咪达唑仑恢复时间的差异可能反映了与年龄相关的混淆，而不是途径的真正效果。未来的前瞻性，年龄分层的研究需要澄清这种关系和完善儿科镇静的做法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.