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Morphine-midazolam combination doses for presurgical analgesia in children
M M Atallah1, G E Hammouda, M M Saied
1Dept. of Anesthesia, Faculty of Medicine, University of Mansoura, Egypt.
Insights
Pre-surgical morphine and midazolam effectively managed pain in pediatric hypospadias repair. Doses of 50 mcg/kg of each drug provided effective pain relief and sedation.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Hypospadias repair in children requires effective pre-surgical sedation and analgesia.
- Optimizing pre-anesthetic medication can improve patient outcomes and reduce perioperative stress.
Purpose of the Study:
- To evaluate the efficacy of different pre-surgical morphine-midazolam combination doses in pediatric patients undergoing hypospadias repair.
- To determine optimal dosing for sedation and analgesia in this patient population.
Main Methods:
- A double-blind, randomized study involving 80 children aged 2-10 years undergoing hypospadias repair.
- Four different morphine-midazolam dosage combinations were administered post-induction and pre-surgery.
- Children were assessed using an observational scoring system for pain, crying, movement, agitation, and posture in the recovery room.
Main Results:
- Pre-surgical administration of morphine-midazolam resulted in stable hemodynamic variables.
- Satisfactory postoperative analgesia and sedation were achieved across the tested dose ranges.
- The combination of 75 mcg/kg morphine and 75 mcg/kg midazolam was identified as the upper permissible dose, while 50 mcg/kg of each was the lower effective dose.
Conclusions:
- Pre-surgical morphine-midazolam is a safe and effective combination for pediatric hypospadias repair.
- Dosing of 50 mcg/kg for both morphine and midazolam provides effective pre-anesthetic sedation and analgesia.
- Further research could explore long-term effects and patient satisfaction with these regimens.
Abstract:
We have examined the use of presurgical morphine-midazolam combination in 80 children aged 2-10 y undergoing repair of hypospadias. They were allocated randomly, in a double-blind study, to receive one of four morphine-midazolam combination doses (n = 20 each); (group I: 75 microg/kg each) [corrected] (group II: 75 microg/kg [corrected] morphine, 50 microg/kg [corrected] midazolam); (group III: 50 microg/kg [corrected] morphine, 75 microg/kg [corrected] midazolam); (group IV: 50 microg/kg [corrected] each). Drugs were given after induction of anesthesia and before the start of surgery. Observational scoring system, using crying, movement, agitation, posture and localization of pain as scoring criteria, was used to assess the children during their stay in the recovery room together with their sedative and/or analgesic requirement. Pre-surgical morphine-midazolam administration produced stable hemodynamic variables with satisfactory postoperative analgesia suggesting 75 microg/kg [corrected] dose of both morphine and midazolam as upper permissible dose, and 50 microg/kg [corrected] each as lower effective dose.