A comparative study between midazolam, promethazine, and chloral hydrate as oral premedication in pediatric patients

Background Ensuring adequate preoperative sedation and anxiolysis is essential, especially in pediatric surgery. Various drugs and routes of administration have been evaluated to determine the optimal method of sedation. Aim The aim of the study was to compare the clinical effects of orally administered midazolam, promethazine, and chloral hydrate as premedication in pediatric patients. Patients and methods Ninety children of both sexes, of ASA grade I–II, aged 3–6 years, scheduled to undergo pediatric surgery were allocated randomly into three groups of 30 patients each. Group M (midazolam) patients were premedicated with a dose of 0.5 mg/kg of injectable midazolam mixed in sugarfree apple juice. Group P (promethazine) patients were premedicated with 1 mg/kg of the commercially available syrup. Group CH (chloral hydrate) patients were premedicated with 50 mg/kg of the commercially available syrup. In the presence of their parents, oral sedative premedication in the form of syrup was given 45 min before induction of general anesthesia. On arrival at the operating room, the sedation score, the easy separation score, and behavior at the time of venipuncture were assessed. At the end of the operation, recovery was assessed using the ‘Vancouver sedative recovery scale for children’. The incidence of adverse effects was recorded and amnesia was assessed after 24 h. Results Sedation and ease of separation scores were higher in the M group than in the P and CH groups. As regards behavior at the time of venipuncture the proportion of children with no reaction was higher in the M group than in the P group; no cases were recorded in the CH group. The recovery time from anesthesia was shorter in group M (15.3 ± 5.2 min), longer in group CH (24.2 ± 3.7 min), and midway in group P (20.8 ± 3.5 min) (P 0.001). Anterograde amnesia was more pronounced in group M in comparison with groups P and CH (P 0.001). Conclusion Oral midazolam at a dose of 0.5 mg/kg of body weight is a suitable premedication for children. It may be preferred over promethazine and chloral hydrate because of its better sedative effect, good easy separation score, good behavior scores of children at the time of venipuncture, and better recovery from anesthesia with postoperative amnesia.