Cristiano,

Although I have not performed this technique (sublingual administration), I have performed intranasal administration. In the 1990's, it was very common to administer midazolam orally or nasally. Both routes work well. In the sublingual administration in children, the was a high likelihood of swallowing the medication prior to sublingual effect. The intranasal was more reliable but the children didn't tolerate administration without crying prior to sedative effect. 

As for the quality of conscious sedation for bronchoscopy: flexible with local anesthetic should be sufficient. Ridgid bronchoscopy is very stimulating and sufficient sedation and localization would prove difficult. 

Regards,

Christopher

Karl, H. W., Rosenberger, J. L., Larach, M. G., & Ruffle, J. M. (1993). Transmucosal administration of midazolam for premedication of pediatric patients. Comparison of the nasal and sublingual routes. Anesthesiology, 78(5), 885-891

Kogan, A., Katz, J., Efrat, R., & Eidelman, L. A. (2002). Premedication with midazolam in young children: a comparison of four routes of administration. Pediatric Anesthesia, 12(8), 685-689.

http://www.kalbemed.com/Portals/6/KOMELIB/ANAESTHETICS-LOCAL%20and%20GENERAL/Anestesi/Midazolam/the%20comparative%20dose%20response%20effects%20of%20melatonin.pdf

thanks for yours feedback

Hello All,

I may be old fashioned or extraprudent but I would consider a seemingly safer approach.

First, I didn't understand from the body of the question it was about children only. Well, let's say it"s logical otherwise an adult would allow for an i.v. line to be inserted. 

In children, performing bronchoscopy only with sedation (conscious?) without an i.v. line (at least this is what I understood from the answer above) seems risky.

I agree that oral administration is unpredictable and the nasasl route is unpleasant. In my opinion, and that's only a personal point of vue, whenever a child need such a preocedure, bronnchospcopy, I would kindly suggest to bring the child into an appropriate area, and here I strongly preffer the OR, make a volatile induction, insert an i.v. line and then do whatever examination is needed. All the trained personnel is there, the needed help (just in case) is there. Better safe than sorry.

Let me agree with Paul. Oral or nasal administration is unpredictable. An i.v. line is a need because it is about safety.Then we start to talk about what  the best sedation is and the minimal monitoring. 

I agree with Paul and Martinos, We used intra nasal and sublingual administration followed by placing a IV line and further IV titration of Midazolam. We found no advantages for the technique. The intra nasal administration as very unpleasant and resulted in extra stress. The sublingual route is untasteful and unpredictable. For children we prefer rectal premedication, iv line placement and IV titration to the desired level of sedation while monitoring BP, capno and pulsoxymetry.