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Preoperative melatonin and its effects on induction and emergence in children undergoing anesthesia and surgery
Zeev N Kain1, Jill E MacLaren, Leslie Herrmann
1Department of Anesthesiology, University of California, Irvine School of Medicine, Irvine, California, USA. zkain@uci.edu
Insights
Midazolam effectively reduced preoperative anxiety in children undergoing surgery, unlike melatonin. However, melatonin demonstrated a dose-dependent reduction in emergence delirium, suggesting potential benefits for postoperative behavior.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Clinical Trials
Background:
- Oral melatonin's preoperative benefits are documented in adults but understudied in pediatric surgical patients.
- Limited data exists on melatonin's efficacy for anxiety and emergence behavior in children undergoing anesthesia.
Purpose of the Study:
- To compare the efficacy of oral melatonin versus midazolam in reducing preoperative anxiety in children.
- To evaluate the impact of melatonin on induction compliance, emergence behavior, and parental anxiety.
Main Methods:
- Children were randomized to receive midazolam (0.5 mg/kg) or melatonin (0.05, 0.2, or 0.4 mg/kg) preoperatively.
- Preoperative anxiety, induction compliance, emergence behavior, and parental anxiety were assessed using validated scales.
Main Results:
- Melatonin, at all tested doses, was less effective than midazolam in reducing preoperative anxiety (P < 0.001).
- Parental anxiety levels did not significantly differ across treatment groups.
- Melatonin exhibited a dose-dependent reduction in emergence delirium, with lower incidence at higher doses (0.4 mg/kg: 5.4%; 0.2 mg/kg: 8.3%; 0.05 mg/kg: 25.0%) compared to midazolam (P < 0.05).
Conclusions:
- Midazolam is superior to melatonin for managing preoperative anxiety in pediatric surgical patients.
- Melatonin demonstrates a dose-dependent efficacy in mitigating emergence delirium in children post-anesthesia.
Background:
Studies conducted in adults undergoing surgery reported a beneficial effect of oral melatonin administered before surgery. There is a paucity of such data in children undergoing anesthesia and surgery.
Methods:
Children undergoing surgery were randomly assigned to receive preoperatively oral midazolam 0.5 mg/kg or oral melatonin 0.05 mg/kg, 0.2 mg/kg, or 0.4 mg/kg. The primary outcome of the study was preoperative anxiety (Yale Preoperative Anxiety Scale). The secondary outcomes were the children's compliance with induction (Induction Compliance Checklist), emergence behavior (Keegan scale), and parental anxiety (State-Trait Anxiety Inventory).
Results:
Repeated measures ANOVA showed that children who received melatonin at any of the three doses were more anxious compared with children who received midazolam (P < 0.001). Parental anxiety did not differ on the basis of the experimental condition (P = ns). The melatonin groups showed a dose-response effect on emergence behavior. Children who received melatonin developed less emergence delirium compared with those who received midazolam (P < 0.05), and the effect was dose related; the incidence after 0.05 mg/kg melatonin was 25.0%, incidence after 0.2 mg/kg melatonin was 8.3%, and incidence after 0.4 mg/kg melatonin was 5.4%.
Conclusions:
Midazolam is more effective than melatonin in reducing children's anxiety at induction of anesthesia. Melatonin showed a direct dose-dependent effect on emergence delirium.
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