Midazolam: effects on amnesia and anxiety in children.
BACKGROUND
The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administration may not be tolerated.


METHODS
Children (n = 113) undergoing general anesthesia and surgery completed preoperative baseline memory testing using a validated series of picture cards and were randomly assigned to one of three midazolam groups or a control group. Exactly, 5, 10, or 20 min after receiving oral midazolam (0.5 mg/kg) or 15 min after receiving placebo, children were administered a second memory test that used pictures. Anxiety of children was assessed during induction of anesthesia with use of a validated anxiety measurement tool. Postoperatively, recall and recognition for picture cards seen during baseline testing and postintervention testing were assessed.


RESULTS
Postoperatively, recall and recognition of pictures presented to patients after drug administration (anterograde amnesia) showed significant group differences (P = 0.0001), with recall impaired in the 10- (P = 0.004) and 20-min groups (P = 0.0001). Similarly, recognition memory was impaired in the 5- (P = 0.0008), 10- (P = 0.0001) and 20-min (P = 0.0001) groups. Significant anxiolytic effects of midazolam were observed as early as 15 +/- 4 min after midazolam administration (P = 0.02).


CONCLUSIONS
Midazolam administered orally produces significant anterograde amnesia when given as early as 10 min before a surgical procedure.
Kain
Z N
ZN
Departments of Anesthesiology, Pediatrics, Child Psychiatry, Psychology, and the Children's Clinical Research Center, Yale University, New Haven, Connecticut, USA. zeev.kain@yale.edu
Hofstadter
M B
MB
Mayes
L C
LC
Krivutza
D M
DM
Alexander
G
G
Wang
S M
SM
Reznick
J S
JS
D000647:Amnesia / Q000139:chemically induced*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000187:drug effects; D011939:Mental Recall / Q000187:drug effects; D008874:Midazolam / Q000627:therapeutic use*; D013997:Time Factors
D014151:Anti-Anxiety Agents; D008874:Midazolam