Evaluating the Impact of Clonidine and Midazolam Premedication on Emergence Delirium in Pediatric Patients

Preoperative anxiety is common in children and is associated with emergence delirium-a distressing postoperative complication characterized by agitation and disorientation. Midazolam has long been the drug of choice for preoperative anxiolysis. More recently, α₂ adrenoceptor agonists, such as clonidine, have gained popularity for their sedative and analgesic properties. The effect of these agents on the incidence of emergence delirium remains uncertain. This study evaluated whether premedication with clonidine or midazolam is associated with emergence delirium in children undergoing general anesthesia.

We performed a post hoc analysis of prospectively collected data pooled from 10 clinical studies, comprising data from 4796 general anesthetics in children (0-16 years). The studies were carried out at a tertiary pediatric hospital in Perth, Australia. We assessed the impact of premedication with clonidine or midazolam on the incidence of emergence delirium using validated scales.

In this cohort, with a mean age of 6.8 (range: 0.03-16.97), 331 children received clonidine and 731 received midazolam. Overall, the incidence of emergence delirium was 6%. Primary propensity score-matched analyses found no significant association between clonidine (OR 1.19, 95% CI 0.65-2.16) or midazolam (OR 1.23, 95% CI 0.79-1.92) and emergence delirium. In our secondary adjusted logistic regression models, midazolam was associated with increased odds of emergence delirium, whereas clonidine showed no statistically significant association overall.

The overall incidence of emergence delirium was low. While clonidine showed no statistically significant association with emergence delirium, our secondary multivariate analysis suggests midazolam might be associated with an increased risk of emergence delirium.