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Premedication for little invasive procedures performed in paediatric practice

Bartosz Rustecki1, Agnieszka Rustecka2

Affiliation and address for correspondence
Pediatr Med rodz Vol 7 Numer 3, p. 223-228
Abstract

Assessing of possible profits and endangers of premedication performed for little invasive procedures in paediatrics are goal of this work. Lack of researches in that direction, made to base on researches concerning premedication of children for general anaesthesia and surgical procedures, there are various methods of sedation of children with applied with various drug used traditionally in anaesthesiological practice. Midazolam is best researched drug. On that issue it can be administrated trough IV, orally, rectal or with usage of transmucosal routes, nasal, sublingual or with usage of application on anterosuperior aspect of the child’s tongue route. All these methods gave similar sedation effect vs. placebo, but were variously tolerated by children depending on route of administration. Oral and rectal administration demands higher doses, which gave prolonged sedation effect and requires more time to achieve proper sedation. Transmucosal application methods allowed reduction of total dose, similar to intravenous route, and allowed early sedation onset. Lack of children cooperation makes sublingual route difficult to perform. Nasal route gave better effects, but in was poorly tolerated by children. It seemed technically more difficult to administrate drug through aliquots doses on anterosuperior aspect of the child’s tongue, but it appeared to connect advantages and eliminate disadvantages of previous forms of drug administration. Usage of opioids adapted in children premedication don’t seem to find usage in sedation of children in paediatric ward due to post operational tendency to cause nausea and vomiting, and appearance of respiratory disorders connected with these drugs usage. Usage of proper monitoring and preservation of safety precautions should be obligatory, due to adverse event including death of patient connected with irresponsible usage of sedation drugs by unprepared medical personnel and lack of preservation of safety precautions while dealing with children. Further research are necessary to set proper guidelines for premedication for little invasive procedures in paediatric practice.

Keywords
premedication, sedation, anaesthesiology, paediatrics, midazolam, opioids

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