Midazolam

It has been discussed in several references that the use of benzodiazepine drugs will be effective in reducing psychological impacts of invasive diagnostic procedures, which are especially important in children.[19] Midazolam belongs to the family of benzodiazepine with antianxiety and sedative effects. It has a rapid onset and short duration of action so that it is commonly used in children and adults to perform diagnostic and therapeutic procedures. It creates anterograde amnesia, so it can prevent undesirable remembrance when a process is painful for the patient.[20,21]

This drug is used for premedication in different forms, such as intravenous, intramuscular, sublingual, oral, and intranasal. The half-life of midazolam is about 2 h. A half-life of more than 7 h has also been reported due to genetic dissimilarities of different persons. The action mechanism of midazolam is similar to diazepam (resonance opening chloride channels in gamma-aminobutyric acid neurotransmitters, hyperpolarization of the membrane cells, and neuronal stimulates resistance).

Midazolam is metabolized in the liver. Several metabolites are produced during the hydroxylation, and its major metabolite (1-hydroxymethyl midazolam) that is a less active metabolite than midazolam is excreted in urine mainly as conjugated with glucuronide.[22]

Several studies have examined the effect of midazolam. Two studies applied oral midazolam with the dose of 0.5 mg/kg and 0.6 mg/kg. The maximum dose given was 15 mg, 15–30 min before the procedure.[23,24] In another study, the dose of intranasal (0.2 mg/kg) was used 5 min before the procedure.[25] All studies above showed a significant distress reduction with midazolam in the group under study, although in one study, complications such as paradoxical agitation were reported in <5% of children for whom flumazenil was used as antidote of midazolam.[26] One of the benefits of midazolam investigated by who Bozkurt compared the effects of high-dose intranasal midazolam (0.5 mg/kg) with placebo group in VCUG and shows there are no differences between the two groups in terms of the degree of reflux.[27]