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Oral midazolam is an effective premedication for children having day-stay anaesthesia
S J Parnis1, J A Foate, J H van der Walt
1Department of Anaesthesia, Adelaide Children's Hospital, South Australia.
Insights
Oral midazolam effectively calms children before day-stay anesthesia. This study found midazolam 0.5 mg/kg improved patient state at anesthesia induction and prolonged recovery sleep.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Premedication is often used to reduce anxiety in children undergoing anesthesia.
- Oral administration offers a non-invasive route for pediatric premedication.
Purpose of the Study:
- To evaluate the efficacy of oral midazolam and diazepam as premedication for day-stay anesthesia in children.
- To compare the effects of different doses of midazolam and diazepam against a placebo.
Main Methods:
- A double-blind, randomized trial involving 200 children undergoing day-stay anesthesia.
- Administration of oral midazolam (0.25 mg/kg or 0.5 mg/kg), diazepam (0.5 mg/kg), or placebo one hour prior to anesthesia.
- Behavioral assessment using a four-point scale at multiple stages, including induction and postoperative recovery.
Main Results:
- 82% of children were calm or asleep at anesthesia induction, regardless of premedication.
- Midazolam 0.5 mg/kg significantly increased the likelihood of children being calm or asleep at induction (P=0.05).
- Midazolam 0.5 mg/kg and diazepam 0.5 mg/kg groups experienced longer sleep times and stays in the post-anesthetic recovery room (P<0.005).
Conclusions:
- Oral midazolam is an effective premedication for day-stay pediatric anesthesia.
- A significant proportion of children remain calm during anesthesia induction even without sedation.
- Midazolam 0.5 mg/kg offers benefits in terms of patient state at induction and recovery sleep duration.
Abstract:
The effect of oral premedication was studied in a double-blind, randomised trial of 200 children undergoing day-stay anaesthesia. Midazolam 0.25 mg/kg, midazolam 0.5 mg/kg, diazepam 0.5 mg/kg or a placebo was given orally one hour prior to anaesthesia. Patient state was assessed at nine stages, from administration of the premedication up to and including induction of anaesthesia, using a four-point behavioural scale. Patient state was also assessed postoperatively in the recovery area and the day-stay ward. There was no difference between the four groups until induction of anaesthesia. At this stage 82% of children were either asleep or awake and calm. Patients who received midazolam 0.5 mg/kg were more likely to be asleep or awake and calm at induction rather than other groups (P = 0.05). Children receiving midazolam 0.5 mg/kg or diazepam 0.5 mg/kg slept longest in the post anaesthetic recovery room (P less than 0.005), and spent most time there (P less than .005). There was no difference between groups in the length of time spent in the day-stay ward or in the number of overnight admissions. The study shows that a high proportion of unsedated children are calm at induction of anaesthesia and that oral midazolam is an effective premedication in children for day-stay anaesthesia.