[Prevention of "post-sevoflurane delirium" with midazolam]

Area of Science:

• Anesthesiology
• Pediatric Anesthesia
• Pharmacology

Background:

• Post-anesthetic agitation is a common complication in pediatric patients.
• Sevoflurane administration is frequently associated with emergence agitation.
• Effective prophylactic strategies are needed to manage post-anesthetic delirium.

Purpose of the Study:

• To evaluate the efficacy of a single prophylactic midazolam bolus in reducing post-anesthetic agitation.
• To assess the impact of midazolam on the incidence and severity of agitation after sevoflurane anesthesia in children aged 2-7 years.

Main Methods:

• Randomized, double-blind, placebo-controlled trial.
• Inclusion of children aged 2-7 years undergoing anesthesia.
• Administration of a single prophylactic midazolam bolus (0.1 mg/kg) before anesthesia termination.

Main Results:

• Midazolam prophylaxis significantly decreased the overall incidence of post-anesthetic delirium compared to placebo.
• The incidence of severe agitation requiring treatment did not differ significantly between groups.
• Mean severity of agitation was significantly lower in the midazolam group.
• Midazolam treatment for severe agitation reduced severity but did not eliminate it.

Conclusions:

• A prophylactic midazolam bolus can reduce the incidence and severity of post-sevoflurane agitation in some pediatric patients.
• Midazolam is insufficient for managing severe agitation.
• Prophylactic midazolam can attenuate, but not completely resolve, post-sevoflurane agitation.