Pre-anaesthetic medication in paediatric day-care surgery

Pre-anaesthetic medication has the primary aim of making the whole process of anaesthesia smooth and agreeable. This prospective blind study was planned to compare the efficacy of three active drugs and a placebo as premedication in a paediatric population undergoing operation on a day care basis. One hundred and fifty-nine patients between one and 12 years of age were assigned randomly to one of four groups who received either hydroxyzine 0.5 mg . kg-1 (n - 43) promethazine 0.5 mg . kg-1 (n 40) diazepam 0.1 mg . kg (n - 378) or placebo (n - 36) by mouth, 60 minutes before operation. Observations in the operating room included the emotional state of the patient on arrival, quality of induction and complications. In the recovery room time for emergence from anaesthesia, complications and requirements for analgesia were recorded. The parents were asked for return a questionnaire detailing psychological and physical complications during three postoperative days. There was no difference between the groups in any of the factors examined. From this study we conclude that children undergoing surgical operations and anaesthesia on a day care basis should not receive pharmacological premedication, not because of overwhelming risk from its use, but because of the absence of any benefit.