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The perioperative effects of oral premedication in children
J H van der Walt1, R Jacob, D Murrell
1Department of Anaesthesia, Adelaide Children's Hospital, South Australia.
Insights
Preoperative trimeprazine in children undergoing adenotonsillectomy prolonged waking times but reduced recovery distress and vomiting. Other sedatives showed no significant sedation differences compared to placebo.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Preoperative sedation is crucial for pediatric surgical procedures.
- Evaluating the efficacy and safety of different sedatives is essential for optimizing patient care.
Purpose of the Study:
- To compare the pre- and postoperative effects of oral diazepam, trimeprazine, pentobarbitone, and placebo in children undergoing adenotonsillectomy.
Main Methods:
- A randomized, double-blind clinical trial involving 149 children (aged 1-10 years).
- Standardized anesthesia with intraoperative papaveretum.
- Assessment of preoperative sedation at multiple time points and postoperative outcomes including waking times, recovery distress, and vomiting.
Main Results:
- No significant sedation differences were found between diazepam, trimeprazine, pentobarbitone, and placebo, except for a higher unsatisfactory sedation rating in the placebo group during anesthesia induction.
- Trimeprazine significantly prolonged waking times compared to other groups.
- The trimeprazine group showed significantly less distress in the recovery unit and a lower incidence of vomiting.
Conclusions:
- While trimeprazine prolonged recovery, it offered significant benefits in reducing postoperative distress and vomiting in pediatric adenotonsillectomy patients.
- Diazepam and pentobarbitone did not show significant advantages over placebo in terms of sedation efficacy.
Abstract:
The pre- and postoperative effects of oral diazepam (0.5 mg/kg), trimeprazine (4 mg/kg), pentobarbitone (3 mg/kg) and a placebo were compared in a randomized double-blind clinical trial in 149 children, aged one to ten years, undergoing adenotonsillectomy. The anaesthetic was standardised and each patient received intraoperative intramuscular papaveretum (0.3 mg/kg). Preoperative sedation was assessed in the ward before transfer onto the theatre trolley, on leaving the ward, on arrival on the theatre floor, on arrival in the induction room and on induction of anaesthesia. There was no significant difference in sedation between the four drug groups except for the placebo group which had a significantly greater unsatisfactory rating at the stage of induction of anaesthesia (P = 0.001). There were no differences in waking times between the diazepam, pentobarbitone and placebo groups, but the trimeprazine group's waking times were significantly prolonged (P less than 0.001). However, the trimeprazine group exhibited significantly less distress in the recovery unit (P = 0.02) and had half the incidence of vomiting (P less than 0.001) than did the other premedication groups.