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Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy
Andrew Garcia1, Elizabeth A Clark1, Sohel Rana2
1Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Insights
Preoperative midazolam did not prolong anesthesia emergence or discharge times in pediatric patients undergoing tonsillectomy and adenoidectomy (T&A). This study found no increased side effects or complications in patients receiving midazolam.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Sleep Medicine
Background:
- Midazolam is a common preoperative medication for anxiety in pediatric patients.
- Limited data exists on midazolam's adverse effects in pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy (T&A).
- Understanding these effects is crucial for optimizing perioperative care in this vulnerable population.
Purpose of the Study:
- To determine if preoperative midazolam administration impacts anesthesia emergence and postoperative discharge times in pediatric T&A patients with OSA.
- To assess if midazolam increases the risk of side effects or complications in this patient group.
- To analyze these effects across different severities of OSA.
Main Methods:
- Retrospective chart review of pediatric patients undergoing T&A between July 2014 and December 2015.
- Comparison of patients receiving midazolam (midazolam group, MG) versus those not receiving it (non-midazolam group, NMG).
- Multivariable analyses adjusted for potential confounding variables, including OSA severity.
Main Results:
- Midazolam group showed slightly longer emergence (5.2 min) and discharge times (10.1 min), but these differences were not statistically significant.
- No significant differences in emergence or discharge times were observed between MG and NMG within mild, moderate, or severe OSA categories.
- The incidence of postoperative complications was comparable between the midazolam and non-midazolam groups.
Conclusions:
- Premedication with midazolam is not associated with prolonged emergence or discharge times following anesthesia for T&A in pediatric patients with OSA.
- Midazolam does not appear to increase the incidence of postoperative complications in this population.
- These findings support the continued use of midazolam for preoperative anxiety management in pediatric T&A patients with OSA.
Abstract:
Background Midazolam is commonly used preoperatively for anxiety. Adverse effects data in pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy (T&A) is limited. Aims We hypothesized that preoperative midazolam increases the time to emergence from anesthesia and postoperative discharge. Secondary objectives assessed if patients receiving midazolam experienced increased side effects or complications from treatment. Methods This study was a retrospective chart review of patients undergoing T&A from July 2014 to December 2015. Midazolam receiving patients (midazolam group: MG) were compared to patients who did not (non-midazolam group: NMG). Multivariable analyses were performed and adjusted for predefined potential cofounder variables. Results Emergence and discharge times were 5.2 minutes (95% CI [-7.1, 17.4]; p=0.41) and 10.1 minutes (95% CI [-6.7, 26.8]; p=0.24) longer in MG. These results were not statistically significant. Comparing by OSA status, there was no statistical difference in emergence and discharge times between mild, moderate and severe OSA groups or between MG and NMG within each OSA group. Emergence and discharge times in moderate OSA was 6.1 minutes (95% CI [-17.6, 29.8]; p=0.61) and 18.8 minutes (95% CI [-16.4, 53.9]; p=0.29) longer than mild OSA, and in the severe OSA group, 2.6 minutes (95% CI [-19.9, 25.1]; p=0.82) shorter and 2.8 minutes (95% CI [-30.3, 35.9]; p=0.87) longer. The incidence of postoperative complications was comparable between MG and NMG groups. Conclusions Premedication with midazolam was not associated with prolonged emergence or discharge time or higher incidence of complications after anesthesia for T&A in patients with OSA.
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