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A randomised placebo-controlled trial of the effects of midazolam premedication on children's postoperative cognition

K Millar1, A J Asbury, A W Bowman

  • 1University of Glasgow, Section of Psychological Medicine, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. k.millar@clinmed.gla.ac.uk

Anaesthesia
|August 19, 2007
PubMed

Insights

Low-dose midazolam premedication significantly impairs children's postoperative cognitive function, including reaction time and memory. These cognitive deficits, particularly amnesia, persist for up to 48 hours after dental surgery.

Area of Science:

  • Pediatric Anesthesiology
  • Cognitive Neuroscience
  • Pharmacology

Background:

  • Midazolam is commonly used for premedication in pediatric anesthesia.
  • Its effects on postoperative cognitive function in children require thorough investigation.
  • Understanding these effects is crucial for optimizing perioperative care.

Purpose of the Study:

  • To evaluate the impact of midazolam premedication on children's cognitive function post-surgery.
  • To assess the duration of any observed cognitive impairments and amnesia.

Main Methods:

  • A randomized, placebo-controlled trial involving 179 children aged 5-10 years.
  • Participants received either buccal midazolam (0.2 mg/kg) or placebo before sevoflurane-nitrous oxide anesthesia for dental extractions.
  • Cognitive tests (reaction time, attention, psychomotor coordination, memory) were administered pre-operatively, before discharge, and at 48 hours post-surgery.

Main Results:

  • Midazolam group showed significantly slower reaction times and impaired psychomotor coordination compared to placebo postoperatively.
  • Significant anterograde amnesia was observed in the midazolam group, persisting for 48 hours.
  • Cognitive function and reaction time returned to baseline levels by 48 hours post-surgery for both groups.

Conclusions:

  • Low-dose midazolam premedication leads to short-term cognitive impairment in children.
  • Anterograde amnesia following midazolam can endure for at least 48 hours.
  • These findings highlight potential risks associated with midazolam use in pediatric surgical settings.

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