Intranasal Midazolam for Distress or Pain Provoking Procedures in Children: A Systematic Review and Meta-Analysis
Abstract
Medical procedures (e.g., intravenous insertion, laceration repair, diagnostic imaging, lumbar puncture) are often a source of distress in children. Intranasal midazolam (INM) is a commonly used anxiolytic, but there is no comprehensive summary of evidence to inform clinicians of its benefit across indications in children. Our objective was to evaluate the effectiveness of INM relative to any comparator for minimizing distress in children undergoing distressful or painful medical procedures through systematic review and meta-analysis. During intravenous insertions, laceration repairs, and diagnostic imaging, INM was more effective compared to placebo for reducing procedural distress and allowed adequate procedural completion with rare serious adverse events. There was insufficient evidence that INM was more effective relative to any comparator for reducing distress during intravenous insertion, laceration repair, diagnostic imaging, lumbar puncture, or bone marrow aspiration. More rigorously designed trials following official reporting guidelines and using validated measures of distress are needed.