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 Vol. 14 No. 4, October 2005
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AAP Grand Rounds 14:41-42 (2005)
© 2005 American Academy of Pediatrics

EMERGENCY MEDICINE

Midazolam in the Bum or Between Cheek and Gum?

Source: McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomized controlled trial. Lancet. 2005;366:205–210.[Medline]

The first 20% of the full text of this article appears below.

To compare the safety and efficacy of rectal diazepam and buccal midazolam for the treatment of acute tonic-clonic seizures in children, researchers in the United Kingdom conducted a multicenter, nonblinded, randomized controlled trial. The study group included 177 patients, ages 6 months and older, representing 219 separate emergency department visits to 1 of 4 participating hospitals. Participants’ median age was 3 years (range: age 7 months to 15 years) and 98 of the 177 (55%) were male. All had visible seizure activity upon arrival in the ED, and none had established intravenous access. The dose of midazolam or diazepam was approximately 0.5 mg/kg based on estimated weight. The intravenous preparation of midazolam was dripped into the buccal cavity between the gum and cheeks using a needle or straw. Of the 219 episodes, 109 . . . [Full Text of this Article]

Mike Dubik, MD, FAAP
Pediatrics, Naval Medical Center, San Diego, CA