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Postoperative behavioral outcomes in children: effects of sedative premedication
Z N Kain1, L C Mayes, S M Wang
1Department of Anesthesiology and Pediatrics, Children's Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA. kain@biomed.med.yale.edu
Insights
Midazolam premedication in children undergoing surgery significantly reduced preoperative anxiety and improved postoperative behavioral outcomes during the first week. However, these benefits diminished by the second postoperative week.
Area of Science:
- Pediatric Anesthesiology
- Behavioral Psychology
- Pharmacology
Background:
- Preoperative anxiety in children is well-documented.
- Limited data exists on the impact of sedative premedication on postoperative behavioral outcomes in pediatric patients.
Purpose of the Study:
- To investigate the effect of midazolam premedication on preoperative anxiety and postoperative behavioral recovery in children undergoing surgery.
- To assess the duration of midazolam's impact on behavioral outcomes.
Main Methods:
- Randomized controlled trial involving 86 children undergoing anesthesia and surgery.
- Intervention group received oral midazolam (0.5 mg/kg) with acetaminophen; control group received acetaminophen alone.
- Anxiety assessed pre-intervention, post-intervention, and during anesthesia induction.
- Postoperative behavioral recovery evaluated on days 1, 2, 3, 7, and 14 using the Post Hospitalization Behavior Questionnaire.
Main Results:
- Midazolam group showed significantly lower anxiety during separation and anesthesia induction (P=0.041).
- Postoperative behavioral changes were significantly dependent on group assignment and days after operation (P=0.0001).
- Fewer negative behavioral changes observed in the midazolam group during postoperative days 1-7.
- No significant differences in behavioral outcomes between groups by postoperative week 2.
Conclusions:
- Midazolam premedication effectively reduces preoperative anxiety in children.
- Children receiving midazolam exhibit fewer negative behavioral changes in the first postoperative week.
- The positive behavioral effects of midazolam are transient, with benefits not sustained by the second postoperative week.
Background:
Although multiple studies document the effect of sedative premedication on preoperative anxiety in children, there is a paucity of data regarding its effect on postoperative behavioral outcomes.
Methods:
After screening for recent stressful life events, children undergoing anesthesia and surgery were assigned randomly to receive either 0.5 mg/kg midazolam in 15 mg/kg acetaminophen orally (n = 43) or 15 mg/kg acetaminophen orally (n = 43). Using validated measures of anxiety, children were evaluated before and after administration of the intervention and during induction of anesthesia. On postoperative days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed using the Post Hospitalization Behavior Questionnaire.
Results:
The intervention group demonstrated significantly lower anxiety levels compared with the placebo group on separation to the operating room and during induction of anesthesia (F[1,77] = 3.95, P = 0.041). Using a multivariate logistic regression model, the authors found that the presence or absence of postoperative behavioral changes was dependent on the group assignment (R = 0.18, P = 0.0001) and days after operation (R = -0.20, P = 0.0001). Post hoc analysis demonstrated that during postoperative days 1-7, a significantly smaller number of children in the midazolam group manifested negative behavioral changes. At week 2 postoperatively, however, there were no significant differences between the midazolam and placebo groups.
Conclusions:
Children who are premedicated with midazolam before surgery have fewer negative behavioral changes during the first postoperative week.