Use of Low Dose Oral Midazolam During Invasive Procedures in Pediatric Hematology Patients

  • Fatma Burcu Belen İzmir Katip Celebi University Tepecik Training and Research Hospital Department of Pediatric Hematology and Oncology
  • Ulker Kocak Gazi University Medical Faculty Department of Pediatric Hematology
  • Hulya Kayilioglu Gazi University Medical Faculty Department of Pediatrics
  • Melek Isik Gazi University Medical Faculty Department of Pediatric Hematology
  • Ebru Yilmaz Keskin Gazi University Medical Faculty Department of Pediatric Hematology
  • Nergiz Oner Gazi University Medical Faculty Department of Pediatric Hematology
  • Zuhre Kaya Gazi University Medical Faculty Department of Pediatric Hematology
  • Idil Yenicesu Gazi University Medical Faculty Department of Pediatric Hematology
  • Turkiz Gursel Gazi University Medical Faculty Department of Pediatric Hematology
Keywords: Midazolam, invasive procedures, pediatric hematology

Abstract

 Objective: Children with hematological diseases (especiallly with leukemias) often undergo painfull procedures that adds more stress to their underlying illness. The aim of this study was to investigate whether oral midazolam can decrease fear and distress when given together with usual intravenous sedoanalgesia.Methods: A total of 47 patients with 1- 18 years of age who were followed at hematology inpatient setting were included in the study. The study group consisted of patients undergoing bone marrow aspiration or lumbar puncture for  acute lymphoblastic leukemia (ALL) , acute myeloblastic leukemia (AML) ,immune thrombocytopenic purpura ( ITP) , thrombocytosis, chronic myeloid leukemia (CML) and aplastic anemia. Patients were divided into placebo (n=23) and oral midazolam (n=24) groups in this double-blind randomized study. Midazolam group received 0.1 mg/kg(maximum 10 mg) orally 30 minutes before the procedure. Both groups were administered 0.5mg/kg ketamine intravenously before the procedure. Parents and children>7 years reported their fear and distress with visual analogous scale(VAS) and Wong-Baker Fascies Scale. CHEOPS score was filled by the blinded pediatric hematologist performing the procedures.Results: There was no difference of fear and distress levels of placebo and midazolam groups according to VAS ,Wong Baker Fascies and CHEOPS scores(p>0.05). We found no additional effect in decreasing pain and stress of oral midazolam versus placebo when administered together with intravenous ketamineanalgesia. Nausea according to analgesia was found to be more reduced  in the midazolam group (p< 0.05).Conclusion: Low dose oral midazolam does not have an additional effect in decreasing fear and distress in pediatric hematology patients when administered together with intravenous ketamineanalgesia. More studies to evaluate its effect when used without intravenous analgesia is warranted.

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Published
2015-10-01
Section
Original Research