title: Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children.
abstract: We studied the effect of oral premedication with midazolam on the recovery characteristics of sevoflurane anesthesia in small children. In a randomized, double-blinded study, 60 children (1-3 yr, ASA physical status I or II) undergoing ambulatory adenoidectomy received either midazolam 0.5 mg/kg (Group M) or placebo (Group P) PO approximately 30 min before the induction of anesthesia. All children received atropine 0.01 mg/kg IV and alfentanil 10 microg/kg IV before the induction of anesthesia with sevoflurane up to 8 vol% inspired concentration in N2O 67% in O2. Tracheal intubation was facilitated with mivacurium 0.2 mg/kg. Anesthesia was continued with sevoflurane adjusted to maintain hemodynamic stability. In the postanesthesia care unit, predetermined recovery end points (emergence, recovery, discharge) were recorded. A pain/ discomfort scale was used to determine the quality of recovery. A postoperative questionnaire was used to evaluate the well-being of the patient at home 24 h after surgery. Emergence (spontaneous eye opening), recovery (full points on the modified Aldrete scale), and discharge were achieved later in Group M than in Group P (15+/-6 vs. 11+/-3 min [P = 0.002], 25+/-17 vs. 16+/-6 min [P = 0.01], and 80+/-23 vs. 70+/-23 min [P = 0.03]). Side effects, postanesthetic excitement, and analgesic treatment did not differ significantly between groups. At home, more children in Group P (30%) experienced disturbed sleep during the night compared with those in Group M (4%) (P = 0.007).
  
  
  CONCLUSIONS
  In this randomized, double-blinded, placebo-controlled study, premedication with midazolam 0.5 mg/kg PO delayed recovery in children 1-3 yr of age after brief (<30 min) sevoflurane anesthesia. Except for more peaceful sleep at home, premedication did not affect the quality of recovery.
authors.affiliation: Department of Surgery and Anaesthesia, Central Hospital of Seinäjoki, Finland. msv@sci.fi
authors.forename: H
authors.initials: H
authors.lastname: Viitanen
authors.forename: P
authors.initials: P
authors.lastname: Annila
authors.forename: M
authors.initials: M
authors.lastname: Viitanen
authors.forename: P
authors.initials: P
authors.lastname: Tarkkila
mesh_terms: D000233:Adenoidectomy; D000556:Ambulatory Surgical Procedures; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D014151:Anti-Anxiety Agents / Q000494:pharmacology*; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007223:Infant; D008738:Methyl Ethers / Q000494:pharmacology*; D008874:Midazolam / Q000494:pharmacology*; D010149:Postoperative Pain / Q000503:physiopathology; D011229:Preanesthetic Medication; D000077149:Sevoflurane; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D014151:Anti-Anxiety Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D008874:Midazolam