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Oral midazolam premedication and postoperative behaviour in children

T McGraw1, A Kendrick

  • 1Oregon Health Sciences University, Portland 97201, USA.

Paediatric Anaesthesia
|April 29, 1998
PubMed

Insights

Oral midazolam premedication in children reduced crying during anesthesia induction. However, it was associated with a higher incidence of adverse postoperative behavioral changes, such as nightmares and anxiety, one week later.

Area of Science:

  • Pediatric Anesthesiology
  • Behavioral Pediatrics

Background:

  • Preoperative anxiety and behavioral distress are common in children undergoing anesthesia.
  • Sedative premedication aims to alleviate these issues, but its long-term effects require careful evaluation.

Purpose of the Study:

  • To investigate the impact of oral midazolam premedication on children's behavior during anesthesia induction and in the postoperative period.
  • To assess the incidence of adverse behavioral changes following midazolam administration.

Main Methods:

  • A prospective, randomized, blinded study involving 70 children (ASA Physical Status 1 and 2; aged 1-10 years).
  • Participants received either oral midazolam (0.5 mg/kg, max 10 mg) or placebo.
  • Behavioral assessments were conducted before medication, during induction, and 15 minutes post-recovery.

Main Results:

  • Children receiving midazolam exhibited significantly less crying during anesthesia induction (P < 0.02).
  • One week post-procedure, 19 of 35 children in the midazolam group reported adverse behavioral changes (e.g., nightmares, anxiety), compared to 8 of 35 in the placebo group (P < 0.02).
  • Most behavioral changes resolved by four weeks post-procedure.

Conclusions:

  • Oral midazolam effectively reduces crying and distress during anesthesia induction in pediatric patients.
  • Preoperative midazolam is associated with an increased incidence of adverse postoperative behavioral changes, necessitating careful consideration of risks and benefits.

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