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Midazolam premedication in ileocolic intussusception: a retrospective multicenter study

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Abstract

Ileocolic intussusception is a common cause of bowel obstruction. When spontaneous reduction does not occur, non-operative management through enema reduction is necessary. Despite the evidence indicating that sedatives favor success in the reduction, their use is still not a common practice. To determine if midazolam (MDZ) before enema improves the rate of procedure success, we retrospectively reviewed charts of patients admitted to two Italian pediatric emergency departments. Outcome measures were the success rate of the enema, recurrence, and need for surgery. Patients were grouped according to the use of MDZ or not, before hydrostatic reduction attempt. We included 69 and 37 patients in the MDZ and non-MDZ groups, respectively. The two groups did not differ in demographics, clinical characteristics, and ultrasound findings. Intussusception reduction after the first enema attempt occurred in 75% (MDZ group) and 32.4% (non-MDZ group) of patients (P < .001); 27.9% (MDZ group) and 77.8% (non-MDZ group) of patients underwent surgery (P < .001). Among them, spontaneous reduction of intussusception during the induction of general anesthesia occurred in 31.6% and 42.9% of patients, respectively (P .43). Multivariate logistic regression analysis showed that only MDZ had a positive effect on the result of the enema (OR 7.602, 95%CI 2.669–21.652, P < .001).

Conclusion: Procedural sedation with MDZ for enema reduction of intussusception can increase the success rate and lead to a better management of patients.

What is Known:

• Despite the evidence of the usefulness of sedatives in the reduction of intussusception, their use is still not a common practice.

What is New:

• Midazolam during enema reduction of intussusception can increase the success rate and consequently lead to better management of patients.

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Fig. 1

Availability of data and material

The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Code availability

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Abbreviations

CI:

Confidence interval

ED:

Emergency department

IN:

Intranasal

IV:

Intravenous

MDZ:

Midazolam

OR:

Odds ratio

PO:

Oral

PSA:

Procedural sedation and analgesia

SD:

Standard deviation

US:

Ultrasound

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Authors and Affiliations

  1. Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy

    Martina Giacalone & Niccolò Parri

  2. Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy

    Luca Pierantoni, Marcello Lanari & Irene Bettini

  3. Department of Experimental and Clinical Biomedical Sciences Radiodiagnostic Unit 2, University of Florence, Careggi University Hospital, Florence, Italy

    Valeria Selvi

  4. Radiology Department, Meyer University Children’s Hospital, Florence, Italy

    Valeria Selvi, Francesca Fierro & Massimo Basile

  5. Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children’s Hospital, University of Florence, Florence, Italy

    Antonino Morabito, Filippo Incerti & Roberto Lo Piccolo

  6. Pediatric Radiology, S. Orsola University Hospital, Bologna, Italy

    Michelangelo Baldazzi

  7. Pediatric Surgery, S. Orsola University Hospital, Bologna, Italy

    Mario Lima & Vincenzo Davide Catania

  8. Department of Emergency Medicine, Meyer University Children’s Hospital, Florence, Italy

    Stefano Masi

Authors
  1. Martina Giacalone
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  2. Luca Pierantoni
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  3. Valeria Selvi
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  4. Antonino Morabito
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  7. Marcello Lanari
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  11. Massimo Basile
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  13. Vincenzo Davide Catania
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  14. Irene Bettini
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  15. Niccolò Parri
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Contributions

Conceptualization: Martina Giacalone, Niccolò Parri, Methodology: Martina Giacalone, Niccolò Parri, Luca Pierantoni, Formal analysis and investigation: Martina Giacalone, Luca Pierantoni, Valeria Selvi, Michelangelo Baldazzi, Irene Bettini, Vincenzo Davide Catania, Writing—original draft preparation: Martina Giacalone, Niccolò Parri, Luca Pierantoni, Valeria Selvi, Michelangelo Baldazzi, Writing—review and editing: Antonino Morabito, Marcello Lanari, Mario Lima, Stefano Masi, Irene Bettini, Vincenzo Davide Catania. , Supervision: Antonino Morabito, Marcello Lanari, Stefano Masi, All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Martina Giacalone.

Ethics declarations

Ethics approval

The study was approved by the Ethical Committee at both institutions.

Consent to participate

Informed consent to participate in the study was obtained from parents.

Consent for publication

Parents of retrospectively enrolled patients consented both to participate in the study and to have their data (reported as aggregated data) published in a journal article.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Piet Leroy

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Cite this article

Giacalone, M., Pierantoni, L., Selvi, V. et al. Midazolam premedication in ileocolic intussusception: a retrospective multicenter study. Eur J Pediatr 181, 3531–3536 (2022). https://doi.org/10.1007/s00431-022-04524-6

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  • DOI: https://doi.org/10.1007/s00431-022-04524-6

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