Paediatric Premedication: A Comparison of Sublingual Buprenorphine and Midazolam in Children (4-10 Years) Scheduled for Adenotonsillectomy

Introduction and Objectives. Preanesthetic medication may reduce the risks of adverse psychological and physiological sequela of induction of anesthesia in children. Administration of premedication by sublingual route may provide the best compromise, that is, relatively rapid absorption without causing pain. In this study, we compared sedative and anxiolytic effects of midazolam and buprenorphine in children.
Methods. In this randomized, placebo-controlled, double-blinded study, one hundred and fifty normal healthy children, aged between four and ten years scheduled for adenotonsillectomy were randomized to receive sublingual buprenorphine 3 μg/kg, midazolam 0.2 mg/kg or placebo. Heart rate, respiratory rate, and SpO₂ were also recorded from the time of premedication to awakening from anesthesia. Anxiety and sedation scores and patients acceptance of mask at induction, were all recorded using a four-point rating scale. Times to spontaneous eye opening and incidence of postoperative emesis were also recorded.
Results. Children receiving sublingual midazolam or buprenorphine had similar sedation, anxiety and mask acceptance scores, but higher than no premedication group (P < 0.0001). None of the children experienced respiratory depression or oxygen desaturation after drug administration and during the postoperative period. Time to spontaneous eye opening was longer in the midazolam group (P < 0.0001). Incidence of vomiting was similar in all groups.
Discussion & Conclusion. Midazolam has been extensively studied and it has been demonstrated that the drug is highly effective in alleviating anxiety and increasing cooperation. Karl et al. found a 10% incidence of crying at separation from parents after sublingual administration of midazolam. In our study, 6% of midazolam and 8% of buprenorphine group were tearful at separation from parents, but children in Karl’s study were younger (0.5-10 years) than children in our study. We concluded that sublingual buprenorphine is as effective as sublingual midazolam in providing sedation and anxiolysis for pediatric premedication.

Keywords
anesthesia, sublingual premedication, benzodiazepine, opioid, adenotonsillectomy