Midazolam syrup

As a group, paediatric patients generally require higher doses of midazolam than do adults and younger children may require higher doses than older children. In obese individuals, the midazolam syrup dose should be calculated based on ideal body weight.

Oral premedication: Oral midazolam syrup is effective for sedation and anxiolysis at the doses of 0.25—1 mg/kg without producing any significant effect on ventilation.

Midazolam is water soluble and therefore not generally painful on intravenous administration .

It should be noted that because of its water solubility, it takes three times as long to reach a peak EEG effect as the more fat-soluble diazepam.

The clinical importance of this is that one should wait at least 3 minutes between intravenous doses to avoid “stacking” of effect. The shorter elimination half-life (∼2 hours) of midazolam than diazepam (∼18 hours) offers an advantage for use as a premedicant in children as midazolam syrup.

Some children cannot be consoled and it is not possible to find the source of their concern. It is these children who will benefit from heavy premedication, such as the combined oral midazolam, ketamine, and atropine or plain midazolam syrup.

Premedication is not normally necessary for the usual 6-month-old infant but is warranted for a 10- to 12-month-old who is afraid to be separated from parents.

Oral midazolam is the most commonly administered premedication in the United States. An oral dose of 0.25 to 0.33 mg/kg (maximum, 20 mg) generally results in a very compliant child who will separate from parents without crying especially a midazolam syrup.

A review of previous anesthetic records is particularly helpful in ascertaining how the child has responded in the past.

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