Oral midazolam premedication in paediatric oncology patients undergoing day care procedures- Does it improve mask acceptance?

Pre medication is given routinely as a part of standard anaesthesia care in paediatric patients undergoing major surgical procedures.This practice is not followed in paediatric patients undergoing short duration procedures as the parents are allowed to accompany the child into the operation theatre (OT). Even with the parents around, children fear and resist the process of mask induction. Often these children are posted for minor procedures multiple times and repeated exposure to this fear of mask can remain in the memory of the children leading to long term complications like enuresis, night terrors and other psychological disorders.Therefore, premedication of children is important for smooth induction of anaesthesia and recovery.

Oralmidazolam is the most widely used and accepted method of premedicating children. For ease of parental separation, we routinely giveoral midazolam premedication to all children undergoing major surgical procedures. Unlike procedures in major operation theatres where parents are not allowed to accompany the child into the operation theatre, parents are allowed inside the procedure rooms for day care procedures.Hence, premedication was avoided in children coming for day care procedures. Also, in high volume centres there is insufficient time between two procedures to give premedication to the children. However, despite the presence of parents children cry excessively and do not easily accept the mask for induction of anaesthesia.

The purpose of this study is to see if giving oral midazolam, helps to improve the mask acceptance during anaesthesia for short procedures (bone marrow biopsy/aspiration, csf analysis, intrathecal methotrexate injection) without causing any delay in between two procedures or any delay in discharge from the recovery.