Oral premedications in paediatric day surgery

Area of Science:

• Pediatric Anesthesiology
• Pharmacology
• Sedation Management

Background:

• Oral premedication is frequently used to manage anxiety and facilitate sedation in pediatric patients undergoing ambulatory surgery.
• The choice of premedicant can significantly impact patient comfort, cooperation, and recovery.
• Optimizing sedation strategies is crucial for successful day-stay procedures in children.

Purpose of the Study:

• To compare the efficacy of various oral premedicants in achieving adequate sedation and anxiolysis in day-stay pediatric patients.
• To evaluate the duration of sedative effects and potential adverse events associated with different agents.
• To determine the most suitable premedication strategy based on age groups.

Main Methods:

• A randomized controlled trial involving 191 day-stay children, divided into two age groups (1-5 years and 5-12 years).
• Administration of oral premedications including chloral, midazolam, promethazine, trimeprazine, or placebo.
• Assessment of sedation levels using a four-category scale at multiple time points, including separation, induction, and post-operative recovery.

Main Results:

• In younger children (1-5 years), chloral and trimeprazine demonstrated superior sedative effects.
• Trimeprazine's sedative effect persisted longer into the postoperative period compared to other agents in Group 1.
• For older children (5-12 years), midazolam provided adequate anxiolysis without the need for deep sedation.

Conclusions:

• Chloral and trimeprazine are effective for achieving sedation in younger pediatric patients undergoing day-stay procedures.
• Midazolam is a suitable option for anxiolysis in older children, offering adequate sedation without over-sedation.
• Age-specific premedication choices can optimize sedation and recovery outcomes in pediatric day-stay surgery.