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Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in

Robin G Cox1, Ulyana Nemish, Alastair Ewen

  • 1Division of Pediatric Anesthesia, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada. robin.cox@calgaryhealthregion.ca

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|December 5, 2006
PubMed

Insights

Oral midazolam effectively reduces pre-anesthesia anxiety in children but doesn't consistently improve home behavior. This evidence-based review confirms its benefits for separation and induction anxiety.

Area of Science:

  • Pediatric Anesthesiology
  • Evidence-Based Medicine
  • Clinical Pharmacology

Background:

  • Preoperative anxiety in children is a common challenge.
  • Oral midazolam is frequently used for pediatric premedication.
  • Assessing its impact on behavioral outcomes is crucial for clinical practice.

Purpose of the Study:

  • To evaluate the evidence for improved behavioral outcomes in children receiving oral midazolam before anesthesia.
  • To synthesize findings from randomized controlled trials (RCTs) on oral midazolam's efficacy.

Main Methods:

  • Conducted a systematic literature search on PubMed and OVID for RCTs (1990-2006) involving oral midazolam in children (0-18 years).
  • Included studies with placebo or control arms, focusing on premedication for general anesthesia.
  • Assigned levels of evidence and grades of recommendation using the Centre for Evidence-Based Medicine criteria.

Main Results:

  • Oral midazolam significantly reduces anxiety related to parental separation and anesthesia induction.
  • No significant delays in recovery times were observed.
  • Evidence for reducing emergence agitation and improving postoperative behavior at home is inconsistent.

Conclusions:

  • A Grade A recommendation supports oral midazolam (0.5 mg/kg) 20-30 minutes preoperatively for reducing separation and induction anxiety in children.
  • Minimal impact on recovery times is noted.
  • Consistent improvement in postoperative behavioral outcomes, either in the postanesthesia care unit or at home, cannot be reliably predicted.
Abstract

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