The perfect preanesthetic medication and its ideal route of administration are still debated. Transmucosal administration of midazolam has been of interest because of the rapid, reliable onset of action, predictable effects and avoidance of injections. Because many medications are well absorbed from the mucosa, we conducted a randomized, prospective, blinded study to compare acceptance and efficacy of intranasal and sublingual administration of midazolam as a preanesthetic medication in children.

One hundred twenty eight patients aged 0.5-12year were stratified by age: 38 infants and toddlers, 0.5-3yr; 48 preschoolers, 3.1-7yr; and 42 school age, 7.1-12yr. They were randomized to received 0.2 mg/kg of midazolam in the nose or under the tongue. Hemoglobin oxygen saturation by pulse oximetry and sedation score were recorded before drug administration, at 2.5min intervals for 15min, at separation from parents and during induction with enflurane in O2. Retention time of sublingual drug and duration of crying were recorded.

The incidence of crying at the time of administration of midazolam was greater following intranasal compared with sublingual administration(60% vs 17%, p<0.05). Within age groups, only infants and toddlers showed a significant difference in the incidence of crying between treatment groups. Significant changes in sedation occured in both groups from 2.5min after administration.

Sublingual midazolam is better accepted than intranasal midazolam as a preanesthetic sedative in children.