Premedication with midazolam is more effective by the sublingual than oral route

Abstract

Purpose: This study compared the sedative effects of sublingual tablet midazolam (Roche Dormicum 7.5 mg) with the oral route as premedication. Methods: One hundred ASA physical status I and II gynaecological patients were randomly selected to receive a 7.5 mg tablet of midazolam either sublingually or orally as premedication about one hour before elective surgery. There were 50 patients in each group. The degree of sedation was assessed according to the Ramsay scale initially and then at 20, 30, 45 and 60 min intervals by a second observer blinded to the route of administration. The time for complete drug dissolution was studied in the sublingual group by the inspection of tablet residue under the tongue every five minutes for 20 min, then the patients were interviewed regarding their acceptance of the taste. Results: The sedation scores in the sublingual group were higher than in the oral group at 30 and 60 min after drug administration, (P=0.0054 and P=0.008). Seventy-two percent of the sublingual group had complete drug dissolution within 10 min and 64% of the patients in the sublingual group found the tablet acceptable with regard to its taste. Conclusion: Midazolam 7.5 mg sublingual is a more effective pre-anaesthetic sedative than by the oral route.