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Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children
R G Gillerman1, A J Hinkle, H M Green
1Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Insights
Oral midazolam combined with parental presence significantly reduced the need for 5% halothane induction and decreased behavioral distress in children undergoing anesthesia. This approach offers a less stressful induction experience for pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Behavioral Science
Background:
- Inhalation induction with halothane can cause significant behavioral distress in children.
- Parental presence during anesthesia induction is a common strategy to reduce anxiety.
- Premedication with midazolam is often used to manage preoperative anxiety in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of oral midazolam combined with parental presence versus parental presence alone.
- To determine the impact on the frequency of 5% halothane induction.
- To assess the level of behavioral distress during inhalation induction.
Main Methods:
- Randomized, controlled, double-blind study involving 72 children (3-10 years old) undergoing first-time anesthesia.
- Children received either oral midazolam (0.5 mg/kg) or placebo, with a parent present during induction.
- Behavioral distress was quantified using the revised Observational Scale of Behavioral Distress via videotaping.
Main Results:
- Significantly fewer children in the midazolam group required a 5% halothane induction compared to the placebo group (p < 0.02).
- Children receiving midazolam and parental presence exhibited less behavioral distress (p < 0.01).
- The combination of oral midazolam and parental presence proved more effective than parental presence alone.
Conclusions:
- Oral midazolam premedication, in conjunction with parental presence, effectively reduces the need for rapid 5% halothane induction.
- This combined approach significantly mitigates behavioral distress during inhalation anesthesia induction in pediatric patients.
- The findings support the use of midazolam and parental presence as a beneficial strategy for pediatric anesthesia induction.
Study Objective:
To determine the frequency of 5% halothane induction and behavioral distress during inhalation induction with both oral midazolam and parental presence compared with parental presence alone.
Design:
Randomized, controlled, double blind study.
Setting:
Same day anesthesia at a university department of anesthesiology.
Patients:
72 ASA status I and II children, 3 to 10 years of age, scheduled for first time anesthesia.
Interventions:
Children were assigned to one of two groups to receive midazolam 0.5 mg/kg orally or placebo. A parent was present during induction. Children were videotaped at baseline, after treatment, and during induction. Tapes were scored for behavioral distress using the revised Observational Scale of Behavioral Distress.
Measurements And Main Results:
Children who received midazolam in the setting of parental presence had significantly fewer 5% halothane inductions than those who received placebo (p < 0.02). They also had less behavioral distress (p < 0.01).
Conclusions:
The combination of parental presence plus oral midazolam reduces the likelihood of needing a 5% rapid halothane induction when compared with parental presence without premedication.