From the Guidelines
The recommended dosing for anxiolysis in children is not explicitly stated, but options include inhalation of nitrous oxide, hydroxyzine, and benzodiazepines like midazolam, with administration routes and personnel authorization being crucial.
Anxiolysis Options
- Inhalation of nitrous oxide: a practical option with negligible side effects, but with a failure rate of 20 to 30% and less effective in children under 3 years 1.
- Hydroxyzine: a sedative antihistamine approved for anxiolytic use, available in tablets and syrup, with few contraindications in children 1.
- Benzodiazepines (e.g., midazolam): require rectal or nasal administration, offering effective relief, but not recommended in children under 16 years of age and in children where nitrous oxide is preferable 1.
Administration and Personnel
- Drug administration should only be performed by authorized, qualified personnel according to hospital and national regulations (anesthetist or equally trained physician) 1.
- Combinations with other anxiolytics are contraindicated, and other drugs like intrarectal nalbuphine, fentanyl, and ketamine are less frequently used 1.
From the Research
Recommended Dosing for Anxiolysis in Children
The recommended dosing for anxiolysis in children varies depending on the medication used.
- For intranasal ketamine, a dosage of 5 mg/kg is considered a reasonable starting point, as 80% of patients had appropriate anxiolysis 2.
- For intranasal dexmedetomidine, the median dose used was 3.05 μg/kg/dose, with a range of 2.04-4.00 μg/kg/dose 3.
- Another study found that doses of intranasal ketamine between 3 and 5 mg/kg maximized patient comfort 4.
Medications Used for Anxiolysis in Children
Several medications can be used for anxiolysis in children, including:
- Intranasal midazolam, which has sedative, anxiolytic, and amnesic effects, but no analgesic properties 5.
- Intranasal fentanyl and ketamine, which are mainly used for pain control 5.
- Intranasal dexmedetomidine, which has anxiolytic and analgesic properties 5.
Administration Routes and Methods
The intranasal route is a non-invasive procedure that is generally well-tolerated by children and has become increasingly widespread 5.