***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objectives . To assess the efficacy and safety of injectable midazolam administered orally in 3 different doses in children undergoing complete dental rehabilitation under GA . Subjects and Methods . 60 children aged 2–6 years were enrolled in the study . The children were r and omly assigned to one of 3 groups and received orally 0.5 , 0.75 , or 1.0 mg/kg of injectable midazolam mixed with apple juice 30 minutes before separation from parents . The following measurements were assessed : patient 's acceptance of the medication , reaction to separation from parents , sedation scores , and recovery conditions . Results . More children were comfortable with parent separation in the group that received the 1.0 mg/kg dose ( 90 % ) compared to the group that received the 0.75 mg/kg dose ( 75 % ) and the group that received the 0.5 mg/kg dose ( 55 % ) . The number of children who had desirable sedation was similar in the 0.75 mg/kg and 1.0 mg/kg dose groups . Twenty five percent of the children in the group that received the 0.5 mg/kg dose did not allow venepuncture before induction of GA , and induction of GA was poor for 20 % of the children in this group . An increasing number of children scored excellent in terms of ease of venepuncture in 0.75 mg/kg dose group ( 10 % ) and in the 1.0 mg/kg dose group ( 20 % ) and in terms of induction of GA , 25 % and 35 % , respectively . Recovery of spontaneous ventilation and extubation was delayed by over 15 minutes in 2 children in the 1.0 mg/kg dose group . Conclusion . The dose of 0.75 mg/kg of injectable midazolam given orally as premedication is acceptable , effective , and safe PURPOSE The purpose of this study was to compare the effectiveness of midazolam ( MDZ ) alone to a combination of MDZ and hydroxyzine ( MDZH ) when sedating young children for dental treatment . METHODS This was a prospect i ve , double-blinded , crossover clinical study of young uncooperative children in need of at least 2 restorative visits . Twenty-eight children , ages 21 to 56 months , with a mean age of 36.6 months , participated in this study . The subjects were assigned r and omly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment . The alternative drug regimen was administered at the second appointment . All subjects also received 50 % nitrous oxide and were restrained with a papoose board . The child 's behavior ( quiet or crying , relaxed or moving ) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child . At the conclusion of treatment , each session was evaluated for overall effectiveness . RESULTS Regardless of the type of premedication , more patients exhibited quiet behavior at the beginning of treatment , with an increase in crying and movement toward the end of treatment . Regarding movement , a significant difference was observed during the first 20 minutes between the 2 regimens . MDZ showed more children exhibiting movement . During the first 30 minutes of treatment , more children cried in the MDZ group , while MDZH presented more children asleep or quiet . No significant differences were found in behavior as a function of the order the sedative regimens were given . No significant differences between the 2 regimens regarding overall behavior and success ( t=0.655 at 27 degrees of freedom ; P=.518 ) were found . CONCLUSIONS The combination of hydroxyzine ( 3.7 mg/kg ) with MDZ ( 0.3 mg/kg ) administered 30 minutes before treatment result ed in safe and effective sedation for the dental treatment of young children . This combination 's use might be more advantageous when compared to MDZ alone , result ing in less crying and movement during the first 30 and 20 minutes , respectively Anxiolysis and sedation with oral midazolam are common practice in paediatric anaesthesia . However , good or excellent results are seen in only 50 - 80 % of cases . For this reason , we investigated if addition of a low dose of oral ketamine ( MIKE : ketamine 3 mg kg-1 , midazolam 0.5 mg kg-1 ) result ed in better premedication compared with oral midazolam 0.5 mg kg-1 or ketamine 6 mg kg-1 alone , in a prospect i ve , r and omized , double-blind study . We studied 120 children ( mean age 5.7 ( range 2 - 10 ) yr ) undergoing surgery of more than 30 min duration . After oral premedication in the ward and transfer , the child 's condition in the induction room was evaluated by assigning 1 - 4 points to the quality of  anxiolysis , sedation , behaviour at separation from parent and during venepuncture ( transfer score ) . On days 1 and 7 after operation , parents were interviewed for changes in behaviour ( eating , sleep , dreams , toilet training ) , re collection and satisfaction , using a st and ardized question naire . The groups were similar in age , sex , weight , intervention and duration of anaesthesia . The transfer score was significantly better in the MIKE group ( 12.5 ( 95 % confidence interval ( CI ) 11.9 - 13.1 ) ) than in the ketamine or midazolam groups ( 10.6 ( 9.8 - 11.4 ) and 11.5 ( 10.7 - 12.3 ) , respectively ) . Success rates for anxiolysis and behaviour at separation were greater than 90 % with the combination , approximately 70 % with midazolam and only 51 % with ketamine alone . The incidence of salivation , excitation and psychotic symptoms was low in all groups . Vertigo and emesis before induction were significantly more frequent after ketamine premedication . During recovery , there were no differences in sedation or time of possible discharge . After 1 week , parents reported nightmares  ( ketamine five , midazolam three , MIKE one ) , restless sleep ( five/four/four ) or negative memories ( three/four/one ) . There were no major or continuing disturbances in behaviour or development . In summary , significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam , even in awake children ( sedation was not successful according to the preset criteria ) , than with midazolam or ketamine alone . Duration of action and side effects of the combination were similar to those of midazolam . The combination of both drugs in strawberry flavoured glucose syrup ( pH 4.5 approximately ) is chemically stable for 8 weeks BACKGROUND This study was performed to evaluate the effect of midazolam , as premedication before intravenous conscious sedation , on preprocedural , procedural , and post-procedural patient comfort and anxiety in children undergoing endoscopy . METHODS A placebo-controlled , double-blind , r and omized study was conducted in 123 children ( age 7.75 + /- 4.46 years , 56 % male ) using oral midazolam ( 0.5 mg/kg , maximum 20 mg ) as a premedication before insertion of an intravenous access device ( i.v . ) and upper endoscopy .  Patients were evaluated with regard to changes in vital signs , level of sedation during i.v . placement , level of pre- and post-procedure conscious sedation , ease of separation from parents , ease and duration of procedure , recovery time , and amnesia to objects shown before i.v . placement and immediately before the start of the procedure . RESULTS A significant difference was noted in the study group for the following parameters : level of sedation for i.v . placement ( p < 0.0001 ) , pre-procedural sedation ( p < 0.001 ) , ease of i.v . insertion ( p < 0.003 ) , ease of separation from parents ( p = 0.022 ) , and ease of the nursing personnel 's ability to monitor the patient during the procedure ( p = 0.0012 ) . The patient 's amnesia to an object shown immediately before beginning the endoscopy was increased ( p < 0.001 ) . Patients and parents were also more satisfied with the procedure process ( p < 0.05 ) . No significant difference was noted with regard to the length or performance of the procedure or recovery time or in the dose of i.v . medication required for successful completion of the endoscopy . CONCLUSION Oral midazolam is an effective and safe premedication for children undergoing upper endoscopy and should be used in all anxious children and in patients previously judged to be difficult to se date Preoperative anxiety and emergence delirium  in children continue to be common even with midazolam premedication . Midazolam is unpleasant tasting even with a flavored vehicle and as a result , patient acceptance is sometimes poor . As an alternative , we evaluated dexmedetomidine administered intranasally . Dexmedetomidine an alpha-2 adrenergic agonist is tasteless , odorless , and painless when administered by this route . Alpha-2 adrenergic agonists produce sedation , facilitate parental separation , and improve conditions for induction of general anesthesia , while preserving airway reflexes . Institutional review board approval was obtained to study 100 pediatric patients r and omized to intranasal dexmedetomidine ( 2 μg/kg ) or oral midazolam ( 0.5 mg/kg ) administered 30 to 45 minutes before the surgery . Subjects received general anesthesia with oxygen , nitrous oxide , isoflurane , and analgesics ( 0.05–0.1 mg/kg morphine or 0.1 mg/kg methadone ) . Nurses and anesthetists were blinded to the drug administered and evaluated patients for preoperative sedation , conditions for induction of general anesthesia , emergence from anesthesia , and postoperative pain . Responses of 100 patients ( 50 dexmedetomidine and 50 midazolam ) were analyzed . Dexmedetomidine ( P = .003 ) was more effective than midazolam at inducing sleep preoperatively . Dexmedetomidine and midazolam were comparable for conditions at induction ( P > 0.05 ) , emergence from anesthesia ( P > 0.05 ) , or postoperative pain ( P > 0.05 ) . Both drugs were equieffective in these regards . In pediatric patients , dexmedetomidine 2 μg/kg administered intranasally and midazolam 0.5 mg/kg administered orally produced similar conditions during induction and emergence of anesthesia . Intranasal administration of dexmedetomidine is more effective at inducing sleep and in some circumstances offers a useful alternative to oral midazolam in children INTRODUCTION Midazolam and ketamine are useful for oral premedication in children to allay anxiety . We compared the effects of midazolam with a combination of high- and low-dose ketaminemidazolam as an oral premedication . METHODS This is a r and omised , controlled prospect i ve study conducted in 87 children who were scheduled for ophthalmologic surgeries . Group M received oral midazolam 0.5 mg/kg , Group MKL received oral midazolam 0.25 mg/kg and ketamine 3 mg/kg , and Group MKH received midazolam 0.5 mg/kg and ketamine 6 mg/kg . St and ard general anaesthesia technique was used . Sedation levels and ease of parental separation were noted . RESULTS A linear increasing trend in sedation was seen in the preoperative sedation scores of all the three groups . At 30 minutes , 23 children in Group MKH had good sedation scores as opposed to 20 in Group MKL and 12 in Group M. The best parental separation time was much shorter in the combination groups . There were no statistically significant differences in the parental separation scores , mean response to induction and mask acceptance . The time to reach Aldrete score of 10 was shorter in Group MKL ( 22 + /- 5 min ) and Group M ( 36 + /- 1 min ) compared to Group MKH ( 52 + /- 2 min ) . Group MKH had a higher incidence of excessive salivation compared to the other groups . CONCLUSION A combination of low-dose midazolam and ketamine is as effective as high-dose midazolam and ketamine for achieving optimum anxiolysis and a faster recovery , with a lower incidence of excessive salivation in children undergoing ophthalmic surgery BACKGROUND The purpose of this study was to determine whether oral midazolam 1.5 mg x kg(-1 ) is a safe and effective alternative to st and ard-dose midazolam ( 0.5 - 1.0 mg x kg(-1 ) ) premedication for infants and children with congenital heart disease . METHODS A total of 193 infants and children ( 4 months to 2 years ) undergoing cardiovascular surgery were studied . Each patient received 0.5 , 1.0 , or 1.5 mg x kg(-1 ) of oral midazolam . The level of sedation was assessed with a 5-point scale and vital signs were measured including blood pressure ( BP ) , heart rate ( HR ) and oxyhaemoglobin saturation ( Sp 
    Output:
    
The efficacy of midazolam for pediatric minimal/moderate sedation from a dose of 0.25 mg/kg and above was demonstrated .
The probability of occurrence of adverse events and over-sedation increases with increasing doses