Research Article

Comparative Study of the Effect of Midazolam Administration before and after Seizures on the Prevention of Complications in Children Undergoing Electroconvulsive Therapy Compared with a Control Group


Background: One of the complications of ECT treatment is headache. There is a need to use sedation during ECT. As a result, midazolam has been used to address a safe and effective strategy in this regard.
Methods: This study is a double-blind clinical trial that has been performed in three groups: group A, which receives midazolam based on the usual regimen, group B, which receives midazolam after shock, and group C, which is the control group. Patients were asked about headache, nausea, and muscle aches during the recovery time, seizure duration and after becoming fully conscious. Data were analyzed in the PASW version18 software using analysis of variance and repeated measurement tests, ANOVA, independed t and χ2 tests.
Results: Analysis showed that the frequency of muscle pain after full consciousness in group C was significantly higher than group B, with group B being higher than group A. χ2 test showed that the frequency of headache, cough and nausea in group C was significantly higher than the two groups A and B.
Conclusion: The result of this research showed that midazolam prodrug plays an effective role in preventing post-ECT complications in children. The effect of midazolam before and after ECT on headache, muscle pain and nausea was investigated and compared with the control group. Also, due to its anterograde amnesia, midazolam can reduce the patient's stress in the next visits, and this issue is even more important when the patient is a child.

[1] Padhi PP, Bhardwaj N, Yaddanapudi S. Effect of premedication with oral midazolam on preoperative anxiety in children with history of previous surgery- A prospective study. Indian J Anaesth. 2018; 62(12):958-962.
[2] Altintas O, Karabas VL, Demirci G, Onur I, Caglar Y. Evaluation of intranasal midazolam in refraction and fundus examination of young children with strabismus. J Pediatr Ophthalmol Strabismus. 2005; 42(6):355-9.
[3] Bahramsari S, Modir H, Moshiri E, Jamilian H, Mohammadbeigi A. Comparing the premedication effects of dexmedetomidine, remifentanil and labetalol before electroconvulsive therapy on haemodynamic responses and seizure duration in psychotic patients: A double-blinded clinical trial. Advances in Human Biology. 2020; 10(2): 65.
[4] Leroy A, Naudet F, Vaiva G, Francis A, Thomas P, Amad A. Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2018; 268(7):675-687.
[5] Rosenquist PB, Miller B, Pillai A. The antipsychotic effects of ECT: a review of possible mechanisms. J ECT. 2014; 30(2):125-31.
[6] Stevens A, Fischer A, Bartels M, Buchkremer G. Electroconvulsive therapy: a review on indications, methods, risks and medication. Eur Psychiatry. 1996;11(4):165-74.
[7] Griesemer DA, Kellner CH, Beale MD, Smith GM. Electroconvulsive therapy for treatment of intractable seizures. Initial findings in two children. Neurology. 1997; 49(5):1389-92.
[8] Kadiyala PK, Kadiyala LD. Anaesthesia for electroconvulsive therapy: An overview with an update on its role in potentiating electroconvulsive therapy. Indian J Anaesth. 2017; 61(5):373-380.
[9] Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT). Acta Psychiatr Scand. 2020; 141(4):304-315.
[10] White PF, Purdue L, Downing M, Thornton L. Intranasal sumatriptan for prevention of post-ECT headaches. Headache. 2006; 46(4):692.
[11] Gazdag G, Dragasek J, Takács R, Lõokene M, Sobow T, Olekseev A, et al. Use of Electroconvulsive Therapy in Central-Eastern European Countries: an Overview. Psychiatr Danub. 2017; 29(2):136-140.
[12] Millar K, Asbury AJ, Bowman AW, Hosey MT, Martin K, Musiello T, et al. A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition. Anaesthesia. 2007. 62(9): 923-930.
[13] Loimer N, Hofmann P, Chaudhry HR. Midazolam shortens seizure duration following electroconvulsive therapy. J Psychiatr Res. 1992; 26(2):97-101.
[14] Shah PJ, Dubey KP, Watti C, Lalwani J. Effectiveness of thiopentone, propofol and midazolam as an ideal intravenous anaesthetic agent for modified electroconvulsive therapy: A comparative study. Indian J Anaesth. 2010; 54(4):296-301.
[15] Isuru A, Rodrigo A, Wijesinghe Ch, Ediriweera D, Premadasa Sh, Wijesekara C, et al. A randomized, double-blind, placebo-controlled trial on the role of preemptive analgesia with acetaminophen [paracetamol] in reducing headache following electroconvulsive therapy [ECT]. BMC Psychiatry. 2017; 17(1): 275.
[16] Weiner SJ, Ward TN, Ravaris CL. Headache and electroconvulsive therapy. Headache. 1994; 34(3):155-9.
[17] Hawken ER, Delva NJ, Lawson JS. Successful use of propranolol in migraine associated with electroconvulsive therapy. Headache. 2001; 41(1):92-6.
[18] Ye L, Karlapati SK, Lippmann S. Topiramate for post-electroconvulsive therapy headaches. J ECT. 2013; 29(3):e49.
[19] Stein ALS, Sacks SM, Roth JR, Habis M, Saltz SB, Chen C. Anesthetic Management During Electroconvulsive Therapy in Children: A Systematic Review of the Available Literature. Anesth Analg. 2020; 130(1):126-140.
[20] Pastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, et al. Safety and Efficacy of Remimazolam Compared With Placebo and Midazolam for Moderate Sedation During Bronchoscopy. Chest. 2019; 155(1):137-146.
[21] Palmio J, Huuhka M, Saransaari P, Oja SS, Peltola J, Leinonen E, et al. Changes in plasma amino acids after electroconvulsive therapy of depressed patients. Psychiatry Res, 2005. 137(3): 183-90.
[22] Lim SW, So E, Yun HJ, Karm MH, Chang J, Lee H, et al. Analysis of the effect of oral midazolam and triazolam premedication before general anesthesia in patients with disabilities with difficulty in cooperation. J Dent Anesth Pain Med. 2018;18(4):245-254.
[23] Wahidi MM, Jain P, Jantz M, Lee P, Mackensen GB, Barbour SY, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011; 140(5): 1342-1350.
[24] Franklin AD, Sobey JH, Stickles ET. Anesthetic considerations for pediatric electroconvulsive therapy. Paediatr Anaesth. 2017 May;27(5):471-479.
IssueVol 8 No 1 (2022): Winter QRcode
SectionResearch Article(s)
Midazolam Electroconvulsive therapy Headache Nausea and vomiting Myalgia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Masoudifar M, Nazemroaya B, Raisi M. Comparative Study of the Effect of Midazolam Administration before and after Seizures on the Prevention of Complications in Children Undergoing Electroconvulsive Therapy Compared with a Control Group. Arch Anesth & Crit Care. 2022;8(1):53-59.