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Midazolam and amnesia in pediatric premedication
K A Payne1, A R Coetzee, F J Mattheyse
1Department of Anesthesiology, Medical School, University of Stellenbosch, South Africa.
Insights
Midazolam and T.M.D. premedication significantly improved amnesia in children aged 3-10 years for preanesthetic periods. Oral or intramuscular midazolam demonstrated superior amnesia compared to placebo, with T.M.D. also showing benefits.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Cognitive Neuroscience
Background:
- Preanesthetic medication in children aims to reduce anxiety and improve cooperation.
- Amnesia for the peri-anesthetic period is a desirable outcome, potentially reducing psychological distress.
- Evaluating the efficacy of different premedication regimens on memory is crucial for pediatric anesthesia.
Purpose of the Study:
- To assess the impact of various premedication strategies on the incidence of amnesia in pediatric patients.
- To compare the amnesic effects of oral and intramuscular midazolam, T.M.D. (trimeprazine, methadone, droperidol), and a control group.
Main Methods:
- A study involving 128 children aged 3-10 years, divided into four groups: control, oral trimeprazine tartrate, methadone plus droperidol (T.M.D.), oral midazolam, and intramuscular midazolam.
- Amnesia was evaluated by testing recall of four pictorial facts and memory of anesthesia induction.
- Statistical analysis was performed to compare amnesia incidence between groups.
Main Results:
- Both oral and intramuscular midazolam resulted in a 60% incidence of amnesia for pictorial facts, significantly higher than the 16% in the control group (p < 0.001).
- The T.M.D. group showed a 43% incidence of amnesia for pictorial facts, also significantly better than the control group (p < 0.05).
- Memory of anesthesia induction was lower in the midazolam groups (50%) compared to T.M.D. (66%) and control (81%), though not all differences were statistically significant.
Conclusions:
- Midazolam, administered orally or intramuscularly, is effective in inducing amnesia for preanesthetic events in children.
- The T.M.D. combination also provides significant amnesic benefits compared to no premedication.
- The findings highlight the potential advantages of specific premedications for enhancing amnesia in pediatric anesthesia, with implications for patient well-being.
Abstract:
One hundred and twenty-eight children aged three to ten years, were studied to determine the effect of premedication on amnesia for the preanesthetic period. Four comparable groups were used: A control group, no premedication; oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg plus droperidol 0.15 mg/kg (T.M.D.); oral midazolam 0.45 mg/kg; intramuscular midazolam 0.15 mg/kg. Amnesia was tested for four pictorial facts, and for induction of anesthesia. For pictorial facts, both routes of midazolam administration gave a sixty percent incidence of amnesia compared with sixteen percent in the control group (p less than 0.001). The T.M.D. premedication provided a forty-three percent incidence, also better than the control group (p less than 0.05). Induction was remembered by fifty percent of the midazolam children compared with sixty-six percent of the T.M.D. group (p greater than 0.05) and eight-one percent of the control group (p less than 0.05). The potential advantages of amnesia in pediatric premedication are discussed.