Midazolam (M) has been successfully used in oral and rectal premedication of children of one to six years of age. The following study was designed to investigate the efficacy of both methods when used as premedication "on demand". 60 children (1-6 years) were randomly assigned to 0.3 mg/kg bw M orally and 0.5 mg/kg bw M rectally. Psychological, behavioural and physiological parameters were measured at special time intervals and special stressful events (separation from the mother or father, induction of anaesthesia). Rectally premedicated children were found to be better prepared concerning psychological and behavioural parameters. This can be due to the dosage as well as the faster absorption of M. In the postoperative period orally premedicated children experienced significantly more nausea and vomiting. This might be due to the preparation with saccharin, peppermint oil and ethanol. - In "premedication on demand" rectal Midazolam must be preferred to orally administered Midazolam in the preparation mentioned above.
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