What is the role of diazepam in pediatric sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Answer

Diazepam

Diazepam modulates the postsynaptic effects of GABA-A transmission, resulting in an increase in presynaptic inhibition. It appears to act on part of the limbic system, the thalamus, and the hypothalamus to induce a calming effect. The peak effect for rectal administration occurs at 1.5 hours. The negative attributes of diazepam for pediatric sedation are that it has a long half-life, active metabolites, and erratic absorption. Additionally, it causes pain with injection.

IV and IM dosing depend on age. Dosing is not established in neonates younger than 30 days. In children aged 30 days or older, IV or IM dosing is 0.25 mg/kg/dose; the agent should be administered over 3 minutes to avoid respiratory depression. The dose may be repeated after 15-30 minutes, with care taken not to exceed 10 mg/dose.

Rectal gel dosing also depends on age. Dosing is not established in children younger than 2 years. In children aged 2-5 years, the rectal dose is 0.5 mg/kg/dose. In children aged 6-11 years, rectal dosing is 0.3 mg/kg. In children aged 12 years and older, rectal dosing is 0.2 mg/kg.


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