Preschool age children often experience marked anxiety and physical
pain during
laceration repair. Locally infiltrated
anesthetics or topical
tetracaine,
adrenaline, and
cocaine (TAC) usually control the physical
pain but have little or no effect on anxiety.
Midazolam is a short-acting
benzodiazepine with
anxiolytic,
hypnotic, and antegrade amnestic effects. In a double-blind, randomized clinical trial, we evaluated the efficacy of
midazolam in alleviating anxiety during
laceration repair in children less than 6 years old. On admission to the emergency department, anxiety level was determined on a scale of 1 to 4 based on a predetermined behavior criteria. Patients with high anxiety level (3 or 4) received a single oral dose of either
midazolam (0.2 mg/kg) or placebo. The
anxiolytic effect of
midazolam was considered adequate if the anxiety level decreased two or more points (from 4 to less than or equal to 2 or from 3 to 1) during
laceration repair. In the
midazolam group (30), 70% of the children had a two-point or more decrease in anxiety level compared with 12% in the placebo group (25) (P less than .0001). No
respiratory depression or other complications were noted in the
midazolam group. We conclude that a single oral dose of
midazolam (0.2 mg/kg) is a safe and effective treatment for alleviating anxiety in children less than 6 years old during
laceration repair in the ED.