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Oral midazolam premedication for paediatric day case patients
Insights
Oral midazolam did not consistently calm children undergoing day-stay surgery. However, it effectively reduced anxiety in children with high observer anxiety scores, though it delayed hospital discharge.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Care
Background:
- Premedication is often used to manage anxiety in pediatric surgical patients.
- The efficacy and impact of sedative premedication on anxiety and recovery in day-stay surgery require further investigation.
Purpose of the Study:
- To evaluate the effectiveness of oral midazolam as a sedative premedication for children undergoing day-stay surgical procedures.
- To assess the impact of midazolam on child and observer anxiety levels and subsequent recovery.
Main Methods:
- A double-blind, randomized controlled trial involving 49 children undergoing day-stay surgery.
- Children received either oral midazolam (0.75 mg.kg-1) or placebo.
- Anxiety was assessed using parental, child, and observer scales before and during anesthesia induction.
Main Results:
- Most children were calm regardless of midazolam administration; parents often overestimated anxiety.
- Observer anxiety scores predicted behavior during induction.
- Midazolam significantly reduced observer anxiety scores, particularly in children under six (P < 0.02).
- Hospital discharge was delayed by a median of 30 minutes in the midazolam group (P < 0.01).
Conclusions:
- Routine sedative premedication is not necessary for all children undergoing day-stay procedures.
- Oral midazolam is beneficial for managing anxiety in children with high observer-rated anxiety.
- The potential delay in discharge should be considered when using midazolam.
Abstract:
Forty-nine children having day-stay surgical procedures were randomly assigned to receive oral midazolam 0.75 mg.kg-1 or placebo in a double blind fashion. The child's level of anxiety was assessed before premedication using parental, child and observer scales. The child and observer anxiety scores were repeated in the anaesthetic room. Most children presented for anaesthesia in a calm state, irrespective of whether they had received midazolam. Parents tended to overestimate their child's level of anxiety. Observer anxiety scores reliably predicted behaviour during induction of anaesthesia in the absence of a sedative. Observer scores decreased in the midazolam group (P < 0.02), but not in the placebo group, children below six years having the greatest decrease with midazolam. The median time to discharge from hospital was delayed by 30 min in the midazolam group (P < 0.01). Children do not require routine sedative premedication for day case procedures, but oral midazolam is useful in producing calm behaviour in those children with high observer anxiety scores.