Plasma concentrations and sedation scores after nebulized and intranasal midazolam in healthy volunteers.

BACKGROUND: An efficacious, reliable, and non-invasive route of administration for midazolam, a drug used for sedation and pre-anaesthetic medication, would have obvious advantages. This study compares two potential methods of administering midazolam by the nasal and nebulized routes. METHODS: Midazolam (0.2 mg kg(-1)) was given by both nebulizer and nasally by liquid instillation to 10 healthy volunteers in a randomized, double-blind crossover study. Plasma concentrations of midazolam, Ramsay sedation scores, visual analogue scores, critical flicker fusion frequency, and parameters of cardiovascular and respiratory function were measured over 60 min and summarized using 'area under the curve'. RESULTS: Nasal instillation caused more sedation than nebulized administration. This was demonstrated by higher Ramsay sedation scores (P=0.005), lower visual analogue scores (P<0.001), and lower critical flicker fusion frequency (P<0.02). Nasal instillation was associated with higher plasma concentrations of midazolam (P<0.001). Unpleasant symptoms were recorded by six volunteers in the intranasal and one in the nebulized group (P=0.06). CONCLUSIONS: There was some evidence that midazolam caused less discomfort when given by nebulizer compared with intranasally. Comparative bioavailability of midazolam, estimated by the ratio (nebulized:nasal) of area under the 60 min plasma concentration curve, was 1:2.9. A higher dose may need to be administered for adequate pre-anaesthetic medication when midazolam is given by nebulizer.

Spinal anaesthesia for insertion of a peritoneal dialysis catheter in a neonate.

A 5-day-old neonate born at term presented in renal failure for insertion of a peritoneal dialysis catheter. This was successfully achieved with spinal anaesthesia, with no intra- or postoperative complications. Regional techniques are considered suitable for an increasing variety of procedures in patients in whom the risks of general anaesthesia are significant.

Visual disturbances and seizures associated with pregnancy: a diagnostic dilemma and the role of radiological techniques as an aid to diagnosis.

We present two cases of visual disturbances associated with tonic-clonic seizures during pregnancy and the associated radiological findings. We review the use of neuroimaging techniques as an aid to diagnosis and their role in elucidating the pathophysiology of cortical blindness.

Oxygen saturation of patients recovering from electroconvulsive therapy.

Oxygen saturation was measured by pulse oximetry in 33 psychiatric patients breathing air during recovery from 60 episodes of electroconvulsive therapy. Desaturation to less than 90% occurred in 17% of patients. Oxygen saturation values in recovery were significantly lower than pre-operative saturations (p = 0.0014 using ANOVA), with a significant difference (p = 0.001) for up to 5 min in recovery.

Parents in the anaesthetic room: a questionnaire survey of departments of anaesthesia.

Thirty departments of paediatric anaesthesia in the United Kingdom were sent a questionnaire about their policies and practices regarding parental presence in the anaesthetic room. Of 22 respondents, 100% left the decision about whether a parent should be present for induction of anaesthesia to the individual anaesthetist and only 14% had written policy guidelines. All departments permitted parental presence at induction for elective surgery, compared with 77% for emergency surgery and 55% for a rapid sequence induction. The minimum age of child below which parents were not allowed at induction varied between no age limit and one year.