• Logo
  • SBMUJournals

Intravenous versus Subcutaneous Midazolam Using Jet-injector in Pediatric Sedation; a Randomized Clinical Trial

Majid Hajimaghsoudi, Mehdi Bagherabadi, Ehsan Zarepur, Vahid Ahmadi Hanzaei




Introduction: The quality of interventions in children is largely dependent on their control. Hence, this study compared the sedative effects of subcutaneous (SC) and intravenous (IV) Midazolam in pediatric sedation induction.

Methods: This randomized clinical trial was conducted on children aged 1-6 years presenting to emergency departments of Shahid Sadoughi and Shahid Rahnemoon Hospitals, Yazd, Iran. Participants were randomly assigned to IV or SC midazolam using a jet injector and success rate, degree of sedation, and satisfaction of parents and physician were compared between groups.

Results: 60 cases with the mean age of 3.15±1.43 (1-6) years were randomly assigned to the SC (30 cases) or IV (30 cases) groups (56.7% female). SC and IV groups were similar regarding the mean age (p = 0.165) and sex (p = 0.121).

Depth of sedation (p=0.900), control of child (p=0.711), in-charge physician’s satisfaction (p=0.467), successful sedation and need for rescue dose (p=0.519) were not different between groups. IV midazolam group had a significantly shorter recovery time (about 10 minutes; p=0.040) and SC midazolam group had a significantly higher level of parent satisfaction (p=0.001).

Conclusion: The findings indicate no significant difference in depth of sedation, control of child, in-charge physician’s satisfaction, successful sedation (reaching stage 1 of sedation or higher), and need for rescue dose of SC and IV midazolam. Parents’ satisfaction was significantly greater with SC administration and IV injection had shorter recovery time.


Midazolam; sedation; jet injector; Injections, Subcutaneous; Personal satisfaction; children.


Hijazi OM, Ahmed AE, Anazi JA, Al-Hashemi HE, Al-Jeraisy MI. Chloral hydrate versus midazolam as sedative agents for diagnostic procedures in children. Saudi Med J. 2014;35(2):123-31.

Coté C, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118(6):2587-602.

Imanian M, Ghasemzadeh MJ, Zarepur E, Zarepur A, Farahani RS, Farahani RS. The Relationship between Pneumonia with Parental Smoking in Children under 10 Year Old: A Case- Control Study. Int J Pediatr-Masshad. 2018;6(6):7791-6.

Sasannejad P, Rezaei F, Bidaki R, Zarepur E. Rare Presentation of Moyamoya Disease with Sub acute Presentation in Iran. Iran J Child Neurol. 2018;12(1):89-93.

Jafari M, Biuki AA, Hajimaghsoudi M, Bagherabadi M, Zarepur E. Intravenous Haloperidol versus Midazolam in Management of Conversion Disorder; a Randomized Clinical Trial. Emergency.6(1):43.

Khurmi N, Patel P, Kraus M, Trentman T. Pharmacologic Considerations for Pediatric Sedation and Anesthesia Outside the Operating Room: A Review for Anesthesia and Non-Anesthesia Providers. Paediatr Drugs. 2017;19(5):435-46.

Martinez JL, Sutters KA, Waite S, Davis J, Medina E, Montano N, et al. A comparison of oral diazepam versus midazolam, administered with intravenous meperidine, as premedication to sedation for pediatric endoscopy. J Pediatr Gastroenterol Nutr. 2002;35(1):51-8.

Fallah R, Fadavi N, Behdad S, Fallah Tafti M. Efficacy of chloral hydrate-hydroxyzine and chloral hydrate-midazolam in pediatric magnetic resonance imaging sedation. Iran J Child Neurol. 2014;8(2):11-7.

Playfor S, Jenkins I, Boyles C, Choonara I, Davies G, Haywood T, et al. Consensus guidelines on sedation and analgesia in critically ill children. Intensive Care Med. 2006;32(8):1125-36.

Hajimaghsoudi M, Vahidi E, Momeni M, Arabinejhad A, Saeedi M. Comparison of local anesthetic effect of lidocaine by jet injection vs needle infiltration in lumbar puncture. Am J Emerg Med. 2016;34(7):1225-9.

Luhmann JD, Kennedy RM, Porter FL, Miller JP, Jaffe DM. A randomized clinical trial of continuous-flow nitrous oxide and midazolam for sedation of young children during laceration repair. Ann Emerg Med. 2001;37(1):20-7.

Bennett J, Nichols F, Rosenblum M, Condry J. Subcutaneous administration of midazolam: a comparison of the Bioject jet injector with the conventional syringe and needle. J Oral Maxillofac Surg. 1998;56(11):1249-54.

Pecking M, Montestruc F, Marquet P, Wodey E, Homery MC, Dostert P. Absolute bioavailability of midazolam after subcutaneous administration to healthy volunteers. Br J Clin Pharmacol. 2002;54(4):357-62.

Greenberg RS, Maxwell LG, Zahurak M, Yaster M. Preanesthetic medication of children with midazolam using the Biojector jet injector. Anesthesiology. 1995;83(2):264-9.

Fine B, Castillo R, McDonald T, Paisansathan C, Zsigmond E, Hoffman WE. Jet injector compared with oral midazolam for preoperative sedation in children. Paediatr Anaesth. 2004;14(9):739-43.

Domino EF, Zsigmoid EK, Kovacs V, Olajos B, Fekete G. A new route, jet injection for anesthetic induction in children. IV. Midazolam plasma levels. Int J Clin Pharmacol Ther. 1998;36(8):458-62.

DOI: https://doi.org/10.22037/emergency.v6i1.21211


  • There are currently no refbacks.