Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability

Midazolam is often used for paediatric premedication. We have compared two methods of administering midazolam intranasally in 44 surgical day-case children allocated randomly to receive midazolam 0.2 mg kg(-1) as drops or midazolam 0.1 mg kg(-1) from an intranasal spray device. Behaviour was recorded on a four-point scale by the parent, nurse and anaesthetist. Coefficients were obtained representing the change in behaviour score. There was no significant difference in method of administration (coefficient 0.13, P=0.39). Children were significantly more distressed at the time of premedication and at the time of venous cannulation (coefficients 1.31 and 0.70) than at baseline. There was no significant difference in the assessments between observers. Midazolam by either method was equally effective but acceptability of the premedication was poor in both groups. Intranasal midazolam cannot be recommended as a method for routine premedication of young children.