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Behavioural changes in children following minor surgery--is premedication beneficial?
K A Payne1, A R Coetzee, F J Mattheyse
1Department of Anesthesiology, Medical School, University of Stellenbosch, Tygerberg, South Africa.
Insights
Premedication for pediatric hernia repair showed minimal behavioral benefits. However, midazolam reduced night crying and awakenings in young surgical patients.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Surgical Patient Care
Background:
- Hospitalization and surgery can induce behavioral changes in children.
- Premedication is often used to mitigate perioperative anxiety and behavioral disturbances in pediatric patients.
Purpose of the Study:
- To investigate the impact of different premedication regimens on behavioral changes in male children undergoing inguinal hernia repair.
- To assess the efficacy of various pharmacological agents in reducing post-hospitalization behavioral disturbances.
Main Methods:
- A study involving 123 male children (aged 1-10 years) undergoing inguinal hernia repair.
- Four groups received different premedications: no premedication (control), oral trimeprazine/methadone/droperidol, oral midazolam, or intramuscular midazolam.
- Behavioral changes were assessed via parental questionnaires two weeks post-discharge; anesthesia and analgesia methods were standardized.
Main Results:
- Overall, premedication demonstrated limited benefit in preventing behavioral changes, reported in 78% of children.
- Midazolam premedication (both oral and intramuscular) was associated with significantly less night-time crying and fewer awakenings compared to the control group.
- Younger age (under five years) was a significant factor for increased night-time crying and disrupted day-time toilet training.
Conclusions:
- While general premedication offers little advantage for behavioral changes post-hernia repair, midazolam shows promise in reducing sleep disturbances.
- Age is a critical factor influencing behavioral outcomes, with younger children experiencing more significant disruptions.
- Further research into targeted premedication strategies for specific behavioral issues in pediatric surgical patients is warranted.
Abstract:
One hundred and twenty-three male children, aged one to ten years, were studied to determine the influence of premedication on changes in patterns of behaviour following hospitalization for repair of inguinal hernias. Four comparable groups were selected for premedication regimen: (1) A control group without premedication; (2) oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg and droperidol 0.15 mg/kg; (3) oral midazolam 0.45 mg/kg; (4) intramuscular midazolam 0.15 mg/kg. Standard inhalational anesthesia was used and caudal blocks employed for analgesia. The parents returned a questionnaire at two weeks. Changes in behaviour were reported in 78% of the children and overall, premedication showed little benefit. However, midazolam premedication was associated with a significantly lower incidence of night-time crying and awakening, compared with no premedication. Only for night-time crying and day-time toilet training did age below five years prove to be a significant contributing factor.