a comparative study on the sedative effect of oral midazolam and oral promethazine medication in lumbar puncture

how to cite this article: derakhshanfar h, modanlookordi m, amini a, shahrami a. a comparative study of the sedative effect of oral midazolam and oral promethazine medication in lumbar puncture. iran j child neurol. 2013 spring;7(2):11-16.   objective lumbar puncture (lp) essentially is a painful and stressful procedure that indicated for diagnosis and therapeutic purposes. one way to reduce the anxiety is to administer an oral premedication. the aim of this study is to compare clinical effects of oral midazolam and oral promethazine in lp. materials & methods this prospective randomized controlled clinical trial study was performed on 80 children aged 2-7 years that were candidate for lp. they were divided into two randomized equal groups. first group received oral midazolam syrup 0.5 mg/kg and the other group received oral promethazine syrup 1mg/kg. level of sedation, hemodynamic changes and any other complications were monitored every 5 minutes from 30 minutes before the start of the procedure. results midazolam group and promethazine group were similar in age, gender and weight. midazolam had significantly shorter onset of sedation and also shorter duration to maximal sedation. the two groups were similar with respect to sedative effect at all time. the only complication that was significantly more in midazolam group was nausea and vomiting. conclusion midazolam syrup and promethazine syrup have same sedative effect in children. both of these medications are easy to use in preschool children and none of them appeared to be superior to another.   references 1. ellenby ms, tegtmeyer k, lai s, braner da. lumbar puncture. n engl j med 2006;28;355(13):e12. 2. crock c, olsson c, phillips r, chalkiadis g, sawyer s, ashley d, et al. general anesthesia or conscious sedation for painful procedures in childhood cancer: the family’s perspective. arch dis child 2003;88(3):253−7. 3. holdsworth mt, raisch dw, winter ss, frost jd, moro ma, doran nh, et al. pain and distress from bone marrow aspirations and lumbar punctures. ann pharmacother 2003;37(1):17-22. 4. ellis ja, villeneuve k, newhook k, ulrichsen j. pain management practices for lumbar punctures: are we consistent? j pediatr nurs 2007 dec;22(6):479-87. 5. mathai a, nazareth m, raju rs. preanesthetic sedation of preschool children: comparison of intranasal midazolam versus oral promethazin. anesth essays res 2011;5(1):67-71. 6. mccann me, kain zn. the management of preoperative anxiety in children: an update. anesth analg 2001; 93(1): 98–105. 7. kain zn, caldwell-andrews aa. psychological preparation of children undergoing surgery. anesth clinic na 2005;23:597–614. 8. wolf ar, rosenbarum a, kain zn, larsson p, lönnqvist pa. the place of premedication in pediatric practice. paediatr anaesth 2009;19(9):817-28. 9. yuen vm, hui tw, irwin mg, yuen mk. a comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia: a double-blinded randomized controlled trial. anesth analg 2008;106(6):1715–21. 10. funk w, jakob w, riedl t, taeger k. oral preanaesthetic medication for children: double blind randomized study of a combination of midazplam and ketamine vs midazolam or ketamine alone. br janaesth 2000;84(3):355-40 11. mazurek ms. sedation and analgesia for procedures outside the operating room. semin in pediatr surg 2004;13(3):166-173. 12. jo sh, hong hk, chong sh, lee hs, choe h. h1 antihistamine drug promethazine directly blocks herg k+ channel. pharmacol res 2009;60(5):429-37. 13. gutstein hb, johnson kl, heard mb, gregory ga. oral ketamine preanesthetic medication in children, anesthesiology 1992;76(1):28-33. 14. almenrader n, passariello m, coccetti b, haiber r, pietropaoli p. premedication in children: a comparison of oral midazolam and oral clonidine. pediatr anesth 2007;17(12):1143–9. 15. singh n, pandey rk, saksena ak, jaiswal jn. a comparative evaluation of oral midazolam with oral sedatives as  premedication in pediatric dentistry. j clin pediatr dent 2002;26(2):161-4. 16. naziri f, alijanpour e, rabei sm, seifi s, mir m, hosseinpour m, et al. comparison of oral midazolam with oral promethazine on decreasing anxiety of children when separated from their parents before anesthesia. j babol univ medl sci  2007;9(4):29-32. 17. parkinson l, hughes j, gill a, billingham i, ratcliffe j, choonara i. a randomized controlled trial of sedation in the critically ill. paediatr anaesth 1997;7(5): 405-10. 18. crean p. sedation and neuromuscular blockade in paediatric intensive care;practice in the united kingdom and north america. paediatr anaesth 2004;14(6):439-42. 19. schmidt ap, valinetti ea, bandeira d, bertacchi mf, simões cm, auler jo jr. effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. paediatr anaesth 2007;17(7):667-74. 20. pfeil n, uhlig u, kostev k, carius r, schröder h, kiess w, et al. antiemetic edications in children with presumed infectious gastroenteritis--harmacoepidemiology in europe and northern america. j pediatr 2008;153(5):659-62.