Midazolam premedication facilitates mask ventilation in children during propofol induction of anesthesia: a randomized clinical trial.

Purpose: Mask ventilation is the most widely used method to provide ventilation during anesthesia induction. Appropriate head and neck positions, exaggerated jaw lifts, two-hand and two-person ventilation, and the use of oral or nasal airways can facilitate mask ventilation. Neuromuscular blockers and premedication drugs such as midazolam and dexmedetomidine have also been proposed to facilitate mask ventilation. The hypothesis of this study was that midazolam premedication would facilitate mask ventilation in children.

Methods: Children aged 2-10 years were randomized into two groups. The midazolam group (Group M) received an intravenous dose of midazolam premedication (0.1 mg/kg, maximum dose 3 mg), and the control group received an intravenous dose of saline of the same volume (Group C). The primary outcome of the study was to examine the effect of midazolam premedication on mask ventilation in children, using the Han mask grading scale.

Results: The data of 120 children were analyzed (n = 60 in Group M, n = 60 in Group C). According to the Han mask grading scale, the scores of the patients in the midazolam group were significantly lower than those of the control group. The distribution of Han scores was significantly different between the groups (p < 0.001). In the midazolam group, 93.3% of the children had a Han score of 1 and 6.7% had 2, and in the control group, 60% had a score of 1, and 40% had 2. In the subgroup analysis of overweight children, a Han score of 1 was determined in 91.7% of the midazolam group and 61.1% of the control group (p = 0.03).

Conclusion: In conclusion, the results of this clinical research demonstrated that midazolam premedication improves mask ventilation in children during general anesthesia induction. The findings also showed that the effect of midazolam in facilitating mask ventilation was similar in overweight children.

Clinical trial registration: The study was registered in clinicaltrials.gov (trial ID: NCT05368441 on 10/05/2022).