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[Oral dormicum premedication of children in day surgery]
Insights
Oral dormicum premedication impacts pediatric cardiovascular and respiratory function differently by age. Younger children experienced decreased peripheral resistance and increased respiratory rate, while older children showed facilitated heart work and increased respiratory volume.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Physiology
- Respiratory Medicine
Background:
- Premedication is crucial for managing pediatric anxiety and ensuring procedural success.
- Dormicum (midazolam) is commonly used for oral premedication in children.
- Understanding age-specific effects of premedication is essential for optimizing patient care.
Purpose of the Study:
- To evaluate the efficacy and physiological effects of oral dormicum premedication in children aged 5-14 years.
- To compare the cardiovascular and respiratory responses to dormicum between younger (5-8 years) and older (8-14 years) pediatric patients.
- To assess the clinical effectiveness and side effects of oral dormicum in different age groups.
Main Methods:
- A study involving 34 pediatric patients (5-14 years) divided into two age groups.
- Evaluation of central hemodynamic parameters and cardiointervalography to assess cardiovascular function.
- Monitoring of external respiration parameters and clinical signs to determine efficacy and side effects.
- Four examination stages: pre-medication, and at 10, 20, and 30 minutes post-administration.
Main Results:
- Oral dormicum (0.5 mg/kg) did not significantly alter heart rate or arterial pressure in either age group.
- In younger children, dormicum decreased total peripheral resistance, respiratory volume, and sympathetic tone, while increasing respiration rate by 20 minutes.
- In older children, dormicum facilitated heart work, increased respiratory volume, and decreased respiration rate, with minimal impact on peripheral resistance and autonomic balance.
- Positive clinical effects were observed in 71.1% of older children, while younger children experienced fewer adverse psychomotor reactions (35.2%).
- Hallucinations (visual disturbances) were reported in the older group starting at 17 minutes.
Conclusions:
- Oral dormicum at 0.5 mg/kg demonstrates age-dependent effects on pediatric cardiovascular and respiratory systems.
- The premedication is effective in facilitating sleep and reducing anxiety in children, with a higher success rate in older children.
- While generally safe, potential side effects like psychomotor reactions in younger children and visual disturbances in older children warrant consideration.
Abstract:
Thirty-four patients aged 5-14 years were observed, divided into age groups OF 5-8 and 8-14 years. Cardiovascular function was evaluated by central hemodynamic parameters and cardiointervalography. Changes in external respiration parameters were studied. The efficacy of premedication was assessed by objective parameters and by clinical signs. Each patient was examined 4 times at the following stages: 1) before premedication; 2) at the 10th min; 3) at the 20th min; and 4) at the 30th min. Oral premedication with dormicum in a dose of 0.5 mg/kg did not affect heart rate or arterial pressure. By the 20th min it notably decreased total peripheral resistance, significantly decreased the respiratory volume, increased respiration rate, and decreased sympathetic tone in younger children. In older children the premedication virtually did not affect total peripheral resistance and facilitated heart work, increased the respiratory volume, rarefied the respiratory rate, and did not affect the autonomic regulation balance. Younger children fell asleep without excitation or negativism; 35.2% developed psychomotor reactions. In older group the effect was good in 71.1% children, the rest had "apparitions" starting from the 17th min: doubling of the staff's faces, white spiders, or white moths.