Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2006 Massachusetts Medical Society. All rights reserved.

Buccal midazolam is effective for acute seizures ▸

Rapid cessation of acute tonic-clonic seizures is a basic principle of emergency care. In a multicenter, randomized study, investigators in the U.K. compared the efficacy and safety of buccal midazolam and rectal diazepam (both about 0.5 mg/kg) for 219 acute seizures in 177 children (median age, 3 years) who presented to the emergency department without established intravenous access. In 35% of episodes, the child was febrile; 28% of episodes were the patients’ first seizure. Treatment success was defined as cessation of the seizure within 10 minutes, lack of respiratory depression, and no seizure recurrence within 1 hour.

Overall, treatment success was significantly better with buccal midazolam than with rectal diazepam (56% vs. 27%). Buccal midazolam also was significantly better than diazepam among patients with an initial seizure episode. Median time for seizure cessation was significantly shorter for midazolam (8 vs. 15 minutes). Seizure recurrence was less common with midazolam. Rates of respiratory depression were similar in the two groups (5%–6%).

Comment ▸

Buccal midazolam appears to be an effective emergency treatment for tonic-clonic seizures in children and should be considered when IV access is not immediately available. Training professionals to administer buccal midazolam during an active seizure will be necessary if it becomes the standard of care.

F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 29, 2005

Which trauma patients require the presence of a surgeon? ▸

Level I trauma centers require that a trauma surgeon be present within 15 minutes of a major resuscitation (as defined by criteria developed by the American College of Surgeons Committee on Trauma). These …