Related Experiment Videos

Association between midazolam premedication and deep sedation following general anesthesia in pediatric patients: a

Aurelia Zodl1, Toby N Weingarten1, Darrell R Schroeder1

  • 1Department of Anesthesiology and Perioperative Medicine and Division of Clinical Trials and Biostatistics (Schroeder), Mayo Clinic, 200 First St SW, Rochester, 55905, MN, US.

Journal of Anesthesia
|May 14, 2026
PubMed

Insights

Oral midazolam increases the risk of deep sedation in pediatric patients aged 2-11 years, particularly after shorter procedures. This deep sedation did not lead to adverse outcomes.

Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Pediatric Sedation Management
  • Pharmacology of Sedative Agents

Background:

  • Midazolam is commonly used for premedication in pediatric patients.
  • The route of midazolam administration (oral vs. intravenous) may influence postoperative sedation levels.
  • Understanding sedation risks is crucial for patient safety in the postanesthesia care unit.

Purpose of the Study:

  • To investigate whether oral (PO) versus intravenous (IV) midazolam premedication is associated with an increased risk of deep sedation in pediatric patients.
  • To identify patient and procedural factors associated with deep sedation after midazolam premedication.

Main Methods:

  • Retrospective review of medical records for pediatric patients (2-17 years) who received midazolam premedication from May 2018 to December 2023.
  • Stratification of patients based on midazolam administration route (PO vs. IV).
  • Assessment of sedation levels using the Richmond Agitation-Sedation Scale, with deep sedation defined as ≤ -4.
  • Application of Inverse Probability of Treatment Weighting (IPTW) to adjust for confounding variables and assess the association between administration route and deep sedation.

Main Results:

  • Out of 5245 pediatric patients, 11.6% experienced deep sedation.
  • Deep sedation was significantly more frequent with oral midazolam compared to intravenous midazolam (13.7% vs. 5.3% unadjusted; 13.3% vs. 6.6% adjusted; OR 2.17).
  • The risk of deep sedation was higher in younger children (2-11 years) and after shorter surgical procedures (≤ 1 hour), with no significant difference observed in adolescents or after longer procedures.
  • No sedation-related adverse events were reported.

Conclusions:

  • Oral midazolam is a significant factor contributing to postoperative deep sedation in pediatric patients aged 2-11 years, especially following brief surgical interventions.
  • The increased risk is potentially linked to insufficient drug elimination time during shorter procedures.
  • Despite the increased incidence, deep sedation following midazolam premedication was not associated with adverse outcomes.
Abstract

Keywords:
Deep sedationGeneral anesthesiaMidazolamPediatric patientPost anesthesia care unitPremedication

Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...