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Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children.
- Source :
-
Paediatric anaesthesia [Paediatr Anaesth] 2007 Apr; Vol. 17 (4), pp. 347-52. - Publication Year :
- 2007
-
Abstract
- Background: Behavioral disturbance in children following sevoflurane anesthesia is a relatively frequent event. The aim of this study was to evaluate whether a higher dose of preoperatively administered rectal midazolam compared with a lower would alleviate this phenomenon. Furthermore the impact of these two doses of midazolam on sedation at induction of anesthesia was compared.<br />Methods: A total of 115 children presenting for minor surgery under anesthesia were included in the study. The children were randomized to receive rectally either 1 mg.kg(-1) midazolam (group H) or 0.5 mg.kg(-1) midazolam (group L). General anesthesia was induced with propofol or sevoflurane and maintained with 1.5% sevoflurane in the inspiratory limb. Prior to the start of surgery a regional block was performed to ensure adequate pain relief. Behavior on emergence was assessed using a three point scale. In case of severe agitation propofol was administered IV.<br />Results: The children in group H were significantly better sedated preoperatively (P < 0.01). There was no significant difference in emergence behavior: 42.1% of children in group H compared with 36.2% of children in group L exhibited severe agitation requiring sedation with propofol (P = 0.37). However, regardless of the preoperative dose of midazolam more children under the age of 36 months (61.4%) were severely distressed at emergence compared with older children (16.7%) (P < 0.01).<br />Conclusions: A higher dose of 1 mg.kg(-1) rectal midazolam results in much better sedated children on induction of anesthesia than 0.5 mg.kg(-1). This, however, does not result in a reduced incidence of emergence delirium after sevoflurane anesthesia. Regardless of the premedication negative behavioral changes occur more frequently in children younger than 3 years of age.
- Subjects :
- Administration, Rectal
Age Factors
Akathisia, Drug-Induced drug therapy
Anesthesia, General methods
Anesthetics, Intravenous administration & dosage
Child, Preschool
Delirium drug therapy
Dose-Response Relationship, Drug
Female
Humans
Infant
Male
Midazolam administration & dosage
Minor Surgical Procedures methods
Nerve Block methods
Postoperative Complications chemically induced
Postoperative Complications drug therapy
Postoperative Complications prevention & control
Propofol administration & dosage
Prospective Studies
Sevoflurane
Stress, Psychological chemically induced
Stress, Psychological drug therapy
Time Factors
Treatment Failure
Anesthetics, Inhalation adverse effects
Anesthetics, Intravenous therapeutic use
Delirium chemically induced
Delirium prevention & control
Methyl Ethers adverse effects
Midazolam therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1155-5645
- Volume :
- 17
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Paediatric anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 17359403
- Full Text :
- https://doi.org/10.1111/j.1460-9592.2006.02101.x