A randomized infant CT-sedation study found more initial success with its higher-dose midazolam regimen. Even so, many children required additional treatment.
Population and result
Barzegari and colleagues studied 110 hemodynamically stable infants younger than two years who needed head CT after trauma. They compared two intravenous midazolam regimens. Initial success was 38.2% in the lower-dose group and 60% in the higher-dose group.
Overall, 56 infants did not reach adequate sedation after the initial treatment and received additional midazolam or ketamine. The higher-dose group also had a longer duration of action; onset and reported physiologic measures did not show the same difference.
Several limits affect interpretation
The groups differed in mean age despite random assignment. This matters because age can affect response and recovery. Recruitment was also constrained by parental willingness to participate.
Failure to detect a difference in adverse effects within 110 selected infants cannot establish equal safety for all patients or rule out uncommon respiratory events. The need for rescue treatment further separates the effect of the initial regimen from the final procedural outcome.
How to describe the evidence
Distinguish successful completion after all treatment from success after the first dose. This study does not provide an individualized dosing instruction or establish that greater sedation is always the safer clinical choice. Its result is specific to the studied trauma-imaging population and regimens.
Source
Original analysis of the supplied paper: Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia. Paper identifier: PMC5007910.
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