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research

Comparison of buccal midazolam and rectal diazepam for seizures in children

02 March 2023
Features
02 March 2023
Volume 15 · Issue 3

Abstract

Background:

buccal midazolam and rectal diazepam are used as first-line drugs to control seizures in children. Immediate treatment and management of a continuing seizure is vital to ensure its safe, effective and prompt termination.

Aim:

To allow practitioners to evaluate the safety and efficacy of buccal midazolam versus rectal diazepam when treating seizures in children.

Methods:

A systematic review process was used to identify sources from CINAHL, MEDLINE, Embase, Google Scholar and the Cochrane Library, published in English between February 1999 and June 2010

Findings:

five studies, totalling 676 patients, received buccal midazolam or rectal diazepam for seizures were identified. Treatment response occurred within 293 (76%) of 386 episodes treated with buccal midazolam and 248 (65%) of 383 episodes where rectal diazepam was used. There was no significant difference between groups regarding incidence of respiratory depression.

Conclusion:

the reviewed articles suggest that buccal midazolam is as effective as rectal diazepam for the termination of seizures.

In the UK, an estimated 211 000 suspected calls are made to ambulance services about seizures each year. Of these, 60 000 result in transportation the emergency department (ED), of which two-thirds (40 000) result in hospital admission (Dickson et al, 2017).

Convulsive status epilepticus (CSE) is a life-threatening condition affecting between 17 and 23 per 100 000 children each year (Chin et al, 2008). It is identified when the duration of a seizure is in excess of 30 minutes or when two or more seizures occur without a return to consciousness (Scott et al, 1998).

Convulsions in children lasting longer than 5 minutes constitute a life-threatening condition; it is therefore vital to patient outcomes that appropriate interventions are administered without undue delay (McCartney and Finnikin, 2019).

Prompt anticonvulsant treatment leads to the rapid termination of convulsions, thus helping to decrease morbidity and mortality in children (Smith et al, 2016).

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