Abstract
Purpose
To study the effect of midazolam premedication on the recovery characteristics of sevoflurane anesthesia induced with propofol in pediatric outpatients.
Methods
Sixty children, one to three years, presenting for ambulatory adenoidectomy were randomly assigned in a double-blind fashion, to receive either 0.5 mg·kg−1 midazolam (Group M) or placebo (Group P)po 30 min before anesthesia. Anesthesia was induced with 10 μg·kg−1 atropine, 10 μg·kg−1 alfentanil, and 3–4 mg·kg−1 propofoliv. Tracheal intubation was facilitated with 0.2 mg·kg−1 mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane with controlled ventilation. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery end-points (emergence, full Aldrete score, discharge). A postoperative questionnaire was used to evaluate the children’s wellbeing at home until 24 hr after discharge.
Results
Emergence from anesthesia (22 ± 9 vs 16 ± 6 min (mean ± SD),P = 0.005) and achieving full Aldrete scores (30 ± 11 vs 24 ± 16 min,P = 0.006) were delayed in patients receiving midazolam. Children in the placebo group were given postoperative analgesia sooner than those in the midazolam group (18 ± 11 vs 23 ± 8 min,P = 0.009). More children premedicated with midazolam suffered from arousal distress (20%vs 3%,P = 0.04) and scored higher on the Pain/Discomfort scale (P = 0.004) at 20 min after arrival in the recovery room. Discharge was not affected by premedication and well-being at home was similar in the groups.
Conclusions
Oral premedication with midazolam delays early recovery but not discharge after ambulatory sevoflurane anesthesia induced with propofol in children one to three years. Midazolam did not improve the quality of recovery.
Résumé
Objectif
Étudier, chez des enfants, l’effet de la prémédication de midazolam sur la récupération de l’anesthésie ambulatoire au sévoflurane, induite au propofol.
Méthode
Soixante enfants, de 1–3 ans, admis pour une adénoïdectomie ambulatoire, ont participé à une étude randomisée à double insu et ont reçu soit 0,5 mg·kg−1 de midazolam (Groupe M), soit un placebo (Groupe P)po 30 min avant l’anesthésie. L’induction comprenait 10μg·kg−1 d’atropine, 10μg·kg−1 d’alfentanil, et 3–4 mg·kg−1 de propofoliv. L’intubation endotrachéale a été facilitée par 0,2 mg·kg−1 de mivacurium et l’anesthésie maintenue sous ventilation contrôlée avec un mélange de protoxyde d’azote et d’oxygène (FiO2 0,3) et du sévoflurane. On a comparé les caractéristiques de la récupération en utilisant le système de cotation modifié d’Aldrete, l’échelle douleur/inconfort et des mesures de seuils spécifiques de la récupération (réveil, cotation d’Aldrete complète, congé). Un questionnaire postopératoire a servi à évaluer l’état des enfants 24 h après le congé.
Résultats
Le réveil (22 ± 9vs 16 ± 6 min (moyenne ± écart type),P = 0,005) et l’obtention de tous les scores d’Aldrete (30 ± 11 vs 24 ± 16 min,P = 0,006) ont été retardés chez les enfants du groupe midazolam. La demande d’analgésie postopératoire a été plus précoce chez les enfants du groupe placebo (18 ± 11vs 23 ± 8 min,P = 0,009). Un plus grand nombre d’enfants du groupe midazolam a souffert d’anxiété du réveil 20% vs 3%,P = 0,04) et a présenté des scores plus élevés à l’échelle douleur/inconfort (P = 0,004), 20 min après l’arrivée en salle de réveil. La prémédication n’a pas influencé le moment du congé et le bien-être des enfants à la maison a été similaire dans les deux groupes.
Conclusion
La prémédication orale de midazolam a retardé la récupération, mais non pas le congé à la suite de l’anesthésie ambulatoire au sévoflurane, induite avec du propofol chez des enfants de un à trois ans. Le midazolam n’a pas amélioré la qualité de la récupération.
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Supported by a grant from the Medical Research Fund of Tampere University Hospital.
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Viitanen, H., Annila, P., Viitanen, M. et al. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1–3 yr. Can J Anesth 46, 766–771 (1999). https://doi.org/10.1007/BF03013912
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DOI: https://doi.org/10.1007/BF03013912