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Canadian Journal of Anesthesia

, Volume 53, Issue 12, pp 1213–1219 | Cite as

Evidence-based clinical update: Does premedication with oral midazolam lead to improved behavioural outcomes in children?

  • Robin G. Cox
  • Ulyana Nemish
  • Alastair Ewen
  • Marie-Josée Crowe
Obstetrical and Pediatric Anesthesia

Abstract

Purpose

The purpose of this evidence-based clinical update was to identify the best evidence to determine if behavioural outcomes are improved in children after oral midazolam premedication.

Methods

A literature search was conducted using both PubMed and OVID programs, utilizing the terms ‘midazolam’, and either ‘premedication’ or ‘preoperative treatment’. Search limits that were employed included randomized controlled trials (RCTs), English language, human studies, children aged 0–18 yr, and publication dates 1990 — present (January 2006). A review of the 171 abstracts obtained was undertaken and, of these, 30 papers were identified that concerned oral midazolam in children prior to general anesthesia, and that involved a RCT with a placebo or control arm. These studies were assigned levels of evidence, and grades of recommendation were made according to Centre for Evidence-Based Medicine criteria.

Results

Oral midazolam premedication in children was found to reduce the anxiety associated with separation from parents/ guardians, and with induction of anesthesia. Recovery times are not significantly delayed. There is no consistent evidence to suggest a reduction in the phenomenon of emergence agitation. Evidence suggesting an improvement in behavioural outcomes at home is also inconsistent.

Conclusion

Premedication with midazolam 0.5 mg·kg−1 po administered 20–30 min preoperatively, is effective in reducing both separation and induction anxiety in children (grade A recommendation), with minimal effect on recovery times. However improved postoperative behavioural outcomes in the postanesthesia care unit, or at home cannot be predicted on a consistent basis.

Keywords

Midazolam Sevoflurane Separation Anxiety Preoperative Treatment Music Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Mise à jour basée sur des données probantes: Améliore-t-on le comportement des enfants par une prémédication au midazolam par la bouche?

Résumé

Objectif

L’objectif de cette mise à jour basée sur des données probantes est d’évaluer les meilleures données sur l’amélioration du comportement des enfants après une prémédication au midazolam.

Méthodes

Une recherche d’articles a été effectuée avec les programmes PubMed et OVID, en utilisant les termes « midazolam », ainsi que « premedication » ou « preoperative treatment ». On a limité la recherche aux études contrôlées randomisées, en langue anglaise, sur des êtres humains, sur des sujets de 0 à 18 ans, publiées de 1990 à maintenant (janvier 2006). Après examen des 171 résumés obtenus, on a retenu 30 articles qui portaient sur le midazolam par voie orale chez les enfants avant une anesthésie générale et qui comportaient une randomisation avec un groupe placebo ou témoin. Les études ont été évaluées selon le niveau de preuve et on leur a donné une cote selon le barème du « Centre for Evidence-Based Medicine ».

Résultats

On a trouvé que midazolam par voie orale diminuait l’anxiété survenant à la séparation des parents ou tuteurs et à l’induction de l’anesthésie. Les temps de récupération n’étaient pas prolongés significativement. Il n’y a pas de données solides qui suggéreraient une diminution du phénomène d’agitation à l’émergence. De même, les données sur l’amélioration du comportement au retour à la maison sont contradictoires.

Conclusion

Une prémédication avec du midazolam 0,5 mg·kg−1 administré par voie orale 20–30 min avant la chirurgie est efficace pour diminuer l’anxiété liée à la séparation et à l’induction (recommandation de niveau A) avec peu d’effets sur le temps de récupération. Toutefois, on ne peut pas prédire avec certitude les comportements à la salle de réveil ou au retour à la maison.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Robin G. Cox
    • 1
  • Ulyana Nemish
    • 1
  • Alastair Ewen
    • 1
  • Marie-Josée Crowe
    • 2
  1. 1.Division of Pediatric AnesthesiaAlberta Children’s Hospital, University of CalgaryCalgary
  2. 2.Department of AnesthesiologyUniversity of MontréalMontréalCanada

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