Intranasal midazolam (0.2 mg/kg of 5 mg / ml) is an alternative that I have
found useful clinically and the advantage of midazolam is that it can be
used i.m. We used 0.5 mg/kg intranasally in a study comparing the drug with
im Ketamine prior to suturing and had no problem with hypoxia. Ketamine was
superior so we have stopped using intranasal midazolam prior to suturing
children.

The patent on midazolam is expiring soon so Roche are not interested in
getting a product licence for midazolam in epilepsy.

Regards,

Ray McGlone
A&E Consultant
Lancaster

Intranasal midazolam for childhood seizures  E Lahat et al.  The Lancet Vol
352 August 22 p620 1998

 McGlone R, Ranasinghe S, Durham S. An alternative to "Brutacaine": a
comparison of low dose intramuscular ketamine with intranasal midazolam in
children before suturing. J Accid Emerg Med 1998;15:231-236

Payne J G, Mattheyse F J. The pharmacokinetics of midazolam in paediatric
patients  Eur J Clin Pharmacol 1989 37:267-72

Nishiyama T, Matsukawa T, Hanaoka K. The effects of age and gender on the
optimal premedication dose of intramuscular midazolam. Anesthesia &
Analgesia. 86(5):1103-8, 1998 May

Rey E, Delaunay L. Pharmacokinetics of midazolam in children : comparative
study of intranasal and intravenous administration. Eur J Clin Pharmacol
1991 41: 355-57


Taylor MB, Vine PR. Intramuscular midazolam premedication in young children.
Anaesthesia 1986 41:21-26



----- Original Message -----
From: Mark Parsons <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, July 02, 2000 10:36 AM
Subject: Buccal midazolam (previously Fitting one year old)


> Buccal midazolam sounds like a Paramedics dream, no more rectal diazepam
> to give, great, it is something we all dread.
> But surely it must be very difficult to administer, generally a fitting
> patient has thier mouth clamped shut. It is nearly always impossible to
> administer an airway, does the report go on to say how this was
> overcome?
>
> Mark Parsons - Paramedic, Sussex.
>
> ----- Original Message ----- Lancet 1999 Feb 20;353(9153):623-6 Related
> Articles, Books, LinkOut
>
>
> Buccal midazolam and rectal diazepam for treatment of prolonged seizures
> in childhood and
> adolescence: a randomised trial.
>
> Scott RC, Besag FM, Neville BG
>
> Wolfson Centre, Institute of Child Health, Great Ormond Street Hospital
> for Children NHS
> Trust, London, UK. [log in to unmask]
>
> BACKGROUND: Convulsive status epilepticus is the most common
> neurological medical
> emergency and has high morbidity and mortality. Early treatment before
> admission to hospital
> is best with an effective medication that can be administered safely. We
> aimed to find out
> whether there are differences in efficacy and adverse events between
> buccal administration of
> liquid midazolam and rectal administration of liquid diazepam in the
> acute treatment of
> seizures. METHODS: At a residential school with on-site medical
> facilities 42 young people
> with severe epilepsy were enrolled. Continuous seizures of more than 5
> min duration were
> randomly treated with buccal midazolam or rectal diazepam. If the
> seizure did not stop within
> 10 min additional medication chosen by the attending physician was
> administered. We
> monitored oxygen saturation and blood pressure for 30 min after
> treatment. The main outcome
> measures were efficacy, time from arrival of the nurse to drug
> administration, time from drug
> administration to end of seizure, and incidence of adverse
> cardiorespiratory events.
> FINDINGS: Buccal midazolam was used to treat 40 seizures in 14 students,
> and rectal diazepam
> 39 seizures in 14 students. Midazolam stopped 30 (75%) of 40 seizures
> and diazepam 23 (59%)
> of 39 (p=0.16). The median time from arrival of the nurse to
> administration of medication was 2
> min. Time from administration to end of seizure did not differ
> significantly between the two
> treatments. No clinically important adverse cardiorespiratory events
> were identified in the two
> groups. Buccal midazolam was universally acceptable to the nursing and
> care staff.
> INTERPRETATION: Buccal midazolam is at least as effective as rectal
> diazepam in the acute
> treatment of seizures. Administration via the mouth is more socially
> acceptable and
> convenient and may become the preferred treatment for long seizures that
> occur outside
> hospital.
>
> And the original paper:
>
> : Am J Emerg Med 1989 Mar;7(2):168-72 Related Articles, Books, LinkOut
>
>
> Rectal diazepam in pediatric status epilepticus.
>
> Albano A, Reisdorff EJ, Wiegenstein JG
>
> Emergency Medicine Residency, Michigan State University, Lansing.
>
> Status epilepticus is a neurologic emergency with an 8% to 12%
> mortality. Rapid ablation of
> seizure activity is imperative. Although intravenous administration of
> diazepam is the
> preferred immediate treatment, vascular access is often difficult to
> achieve. Rectal
> administration of diazepam is easily accomplished during status
> epilepticus. Five cases in
> which diazepam administered in the rectal lumen stopped seizure activity
> are reported. Rectal
> diazepam appears to be safe and efficacious. It should be considered as
> an alternate to
> intravenous therapy when immediate vascular access is delayed. Rectal
> diazepam may have
> great benefit in the prehospital setting.
>
>
>
>
>
>
>
>



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