Efficacy and Safety of Nebulized Midazolam versus Oral Midazolam as Sedative Premedication in Pediatric Surgeries

Purpose: To compare the effectiveness of midazolam premedication administered through nebulization and orally as premedication in pediatric anesthesia in ophthalmic surgeries. Methods: In this randomized controlled double-blind trial, 70 patients scheduled for strabismus surgery were enrolled and divided into two groups. Group O (oral, n = 32) received 0.5 mg/kg oral midazolam and Group N (nebulized, n = 33) received 0.5 mg/kg midazolam through nebulization. Our outcomes included satisfactory sedation of patients, parental separation anxiety, mask acceptance scores, and perioperative hemodynamics up to 30 min postpremedication. Results: A significant difference in oxygen saturation (SpO 2 ) at the 30 th min emerged between nebulized and oral midazolam ( P = 0.006). Ramsay Sedation scores within 30 min demonstrated comparable sedation levels between Groups N and O. Face mask acceptance scores were excellent in both groups, with no significant differences. Parental separation anxiety scores and the mask acceptance score at the 30 th min revealed no statistically significant differences at various time points ( P > 0.05). Conclusions: In pediatric patients undergoing ophthalmic surgeries, nebulized midazolam is as effective as oral midazolam for sedation. The nebulized form is better tolerated and results in significantly improved SpO 2 levels 30 min after administration. These findings indicate that nebulized midazolam is a safe and effective alternative to oral midazolam for sedative premedication in young children.