Sedation with intranasal midazolam of Angolan children undergoing invasive procedures.

Background. Ambulatory surgery is a daily requirement in poor countries and limited means and insufficient trained staff lead to lack of attention to the patient’s pain. Midazolam is a rapid-onset, benzodiazepine which used safely to reduce pain in children. Aim. We evaluated the practicability of intranasal-midazolam-sedation in a suburban hospital in Luanda (Angola) during surgical procedures. Methods. Intranasal-midazolam-solution was administered at a dose of 0.5 mg/kg. Using the Ramsay’s reactivity score we gave a score to four different types of children’s behaviour: moaning, shouting, crying, and struggling and the surgeon evaluated the ease of completing the surgical procedure using scores from 0 (very easy) to 3 (managing with difficulty). Results. Eighty children (median age 3 years) were recruited and 140 surgical procedures were performed. Fifty-two children were treated with midazolam during 85 procedures and 28 children were not treated during 55 procedures. We found a significant difference between the two groups on the shouting, crying, and struggling parameters (p <0.001). The mean score of the ease of completing the procedures was significantly different among the two groups (p <0.0001). Conclusion. These results provide a model of procedural sedation in ambulatory surgical procedures in poor countries, thus abolishing pain and making the surgeon’s job easier.