Obviously, other administration methods such as rectal or intramuscular have to be used with specific patient populations. Unlike other sedative premedicants, both oral midazolam and transmucosal fentanyl have been approved by the Food and Drug Administration for use as sedatives for children. Midazolam can be given by any route as dictated by the clinical setting. Oral midazolam has rapid onset and predictable effects, and while the peak anxiolytic effect is 20-30 minutes, the onset of the anxiolytic effects is about 10 minutes. A recent investigation also reported significant amnestic effects at 10 minutes after administration of oral midazolam.
Side effects related to oral midazolam administrated to healthy children are minimal.
Of importance is that midazolam can be reversed with flumazenil. Finally, when midazolam is directly compared to PPIA, children receiving oral midazolam are significantly less anxious than those accompanied into the operating room by a parent. This premedication has been reported to produce effective preoperative sedation and facilitation of induction of anesthesia in children. While an excellent analgesic, transmucosal fentanyl may causes pruritus and postoperative nausea and vomiting. Because of the excellent analgesic properties of this drug, it may be that its best use is in burn units and emergency departments rather than in the preoperative settings.