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Published on: October 19, 2011
[Modulation of the stress response in children in the preoperative preparation]
U Burkhardt1, L Wild, B Vetter
1Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Leipzig.
Insights
Midazolam effectively reduces preoperative stress in children. Oral midazolam (0.2 mg/kg) significantly lowered heart rate, blood pressure, and stress hormones compared to psychological preparation alone.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Psychoneuroendocrinology
Background:
- Preoperative anxiety in children is a significant concern.
- Anxiolytic drugs and psychological preparation are used for preoperative management.
- Quantifying the effectiveness of anxiolytics can be challenging.
Purpose of the Study:
- To compare the efficacy of oral midazolam versus psychological preparation in reducing preoperative stress in children.
- To assess the impact of midazolam on physiological and hormonal stress markers.
Main Methods:
- A comparative study involving two groups of children aged 5-10 years.
- Group I received psychological preparation; Group II received oral midazolam (0.2 mg/kg).
- Measurements included heart rate, blood pressure, norepinephrine, epinephrine, and cortisol levels at baseline, 30 minutes post-medication, and at anesthesia induction.
Main Results:
- Children receiving midazolam (Group II) showed significantly lower heart rate and blood pressure 30 minutes post-medication compared to the psychological preparation group (Group I).
- Epinephrine levels decreased in the midazolam group from pre-medication to anesthesia induction, unlike the psychological group.
- Cortisol levels decreased only in children who received midazolam.
Conclusions:
- Oral midazolam at a dose of 0.2 mg/kg is effective in reducing preoperative stress in children.
- Midazolam demonstrates superior anxiolytic effects compared to psychological preparation alone, as evidenced by physiological and hormonal stress markers.
Abstract:
Anxiolysis with drugs and psychoprophylaxis are both recognised methods of preoperative preparation. The beneficial effects of anxiolytics, however, appear to be difficult to prove. In this study a comparison was made of heart rate (HR), blood pressure (BP), and norepinephrine, epinephrine, and cortisol levels. In group I 19 children received only psychological treatment, while in group II 21 children received 0.2 mg/kg midazolam orally. Measuring points were directly before medication, 30 min afterward, and at induction of anaesthesia. During the observation period the patients (5-10 years old) remained calm. At the beginning of the study the parameters of all patients were within a normal range; 30 min after premedication the HR and BP were significantly higher in group I than in group II. In contrast to group I, epinephrine levels in group II were lower at the beginning of anaesthesia than before premedication. In both groups, norepinephrine levels were the same at induction of anaesthesia as before premedication. Cortisol decreased only in patients who received midazolam. HR, BP, as well as humoral stress parameters indicate that midazolam in a dose of 0.2 mg/kg orally is sufficient to reduce preoperative stress in children.
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