Sedation with intranasal midazolam of Angolan children undergoing invasive procedures

Lumana Kawanda, Ivan Capobianco, Meta Starc, Daniel Felipe, Davide Zanon, Egidio Barbi, Nadine Munkela, Verónica Rodrigues, Lúis Malundo, Tarcisio Not

Research output: Contribution to journalArticlepeer-review


Aim: Ambulatory surgery is a daily requirement in poor countries, and limited means and insufficient trained staff lead to the lack of attention to the patient's pain. Midazolam is a rapid-onset, short-acting benzodiazepine which is used safely to reduce pain in children. We evaluated the practicability of intranasal midazolam sedation in a suburban hospital in Luanda (Angola), during the 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.

Original languageEnglish
JournalActa Paediatrica, International Journal of Paediatrics
Issue number7
Publication statusPublished - Jul 2012


  • Developing country
  • Paediatricians
  • Pain management
  • Pain reduction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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