Acceptability of Various Available Midazolam Formulations (Syrup, Rectal Suppository, Oro-dispersible Minitablet) in Clinical Practice

Study Overview
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Brief Summary
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This observational study aims to gain knowledge on how the different midazolam formulations (oral syrup, rectal suppository, ODMT) are accepted by 2- to 10-year-old pediatric inpatients and outpatients at the University Children's Hospital Basel (UKBB) in Switzerland. The present study will use non-invasive scoring to assess acceptability of the different midazolam formulations.

Detailed Description
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At the University Children's Hospital Basel (UKBB) in Switzerland,   2500 children are referred to the Pediatric Anesthesiology Unit per year receiving midazolam sedation before surgery. Further,  2000 children are admitted to the Pediatric Emergency Unit for procedures requiring midazolam sedation per year. Medication palatability is a key element of treatment adherence and successful therapy outcome. In a previous cross-sectional acceptability study in 2- to 10-year-old pediatric patients at UKBB, it was demonstrated that an inorganic calcium carbonate/calcium phosphate carrier material as the main excipient in an oro- dispersible mini-tablet (ODMT) formulation is safe, palatable, and highly acceptable in children. To date, no data for acceptability in terms of palatability and anxiolysis in daily preoperative practice for midazolam oral syrup, rectal suppository or ODMT formulation is available. As such the goal of this observational study is to better understand acceptability of various midazolam formulations (oral syrup, rectal suppository, ODMT) in clinical practice in 2- to 10-year-old pediatric patients at UKBB. .

Official Title
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Observational Study to Understand Acceptability of Various Available Midazolam Formulations (Syrup, Rectal Suppository, Oro-dispersible Tablet) in Clinical Practice

Conditions
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Medication Palatability

Intervention / Treatment
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* Other: Data collection on acceptability of midazolam administration by 2- to 10-year-old pediatric patients at UKBB


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children from 2 years (meaning 2 years 0/12 months) to younger than 10 years (meaning 9 years 12/12 months) of age at the time of surgery Children scheduled for ambulatory or elective surgery or for procedures requiring anxiolysis at the UKBB Children qualifying as American Society of Anesthesiologists (ASA) 1 or ASA 2 patients Clinically indicated administration of midazolam oral syrup, rectal suppository or ODMT Parent or legal guardian has been informed about the study and has signed the Informed Consent Form Exclusion Criteria: Children qualifying as ASA 3 and above patients Children arriving at the emergency ward in a critically ill condition which needs immediate intervention (i.e. American Thoracic Society (ATS) Score 1 and 2) and no tolerance for time delay due to informed consent. Difficulty in assessing palatability due to neurological impairments Hypersensitivity to midazolam, other benzodiazepines, or any formulation excipients Hypersensitivity to cherries (syrup)

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 1 (reference: midazolam oral syrup or rectal suppository formulations)<br>Oral syrup or rectal suppository formulation of midazolam prescribed in the Anesthesiology Unit or Emergency Unit of UKBB as current reference formulations in clinical routine. | Other: Data collection on acceptability of midazolam administration by 2- to 10-year-old pediatric patients at UKBB<br>* On the day of entry to the Anesthesiology Unit for an elective surgery, or before an intervention at the Emergency Unit, all children, irrespective of their participation to the present study, will receive standard midazolam dose of 0.3-0.5 mg/kg as prescribed by the treating clinician at UKBB in line with clinical practice (as oral syrup, rectal suppository or ODMT). The children's spontaneous reactions after intake of midazolam (e.g., positive comments, spitting out of medication, crying) will be observed and recorded by the research staff. Children who are able to understand the Hedonic Scale (FHS) will be questioned on how they liked the medication by pointing to the appropriate face of a Facial Hedonic Scale (FHS) at the time of midazolam intake.<br>|
| Group 2 (alternative: midazolam oro- dispersible mini-tablet (OMDT) formulation)<br>ODMT formulation of midazolam prescribed in the Anesthesiology or Emergency Unit at UKBB as a recently introduced alternative formulation in clinical routine. | Other: Data collection on acceptability of midazolam administration by 2- to 10-year-old pediatric patients at UKBB<br>* On the day of entry to the Anesthesiology Unit for an elective surgery, or before an intervention at the Emergency Unit, all children, irrespective of their participation to the present study, will receive standard midazolam dose of 0.3-0.5 mg/kg as prescribed by the treating clinician at UKBB in line with clinical practice (as oral syrup, rectal suppository or ODMT). The children's spontaneous reactions after intake of midazolam (e.g., positive comments, spitting out of medication, crying) will be observed and recorded by the research staff. Children who are able to understand the Hedonic Scale (FHS) will be questioned on how they liked the medication by pointing to the appropriate face of a Facial Hedonic Scale (FHS) at the time of midazolam intake.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Children's acceptance after intake of midazolam rated by research staff | 4-point acceptability scale (from child liked the medication to child did not like the medication) rated by research staff | one time assessment at baseline | 
| Children's acceptance after intake of midazolam rated by the pediatric patients | Children who are able to understand the Facial Hedonic Scale (FHS) will be questioned on how they liked the medication by pointing to the appropriate face of a Facial Hedonic Scale (FHS) at the time of midazolam intake. Each face will be associated to a number from a scale to 1 (very bad) to 6 (very good). The spontaneous reactions of the patient will be recorded to identify acceptability. | one time assessment at baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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midazolam, midazolam oral syrup, midazolam rectal suppository, midazolam oro- dispersible mini-tablet, drug-adherence in pediatrics, pediatric sedation management, anxiolysis