[Prevention of "post-sevoflurane delirium" with midazolam].
In a randomized double-blind placebo-controlled trial in children 2-7 years of age, we investigated the effect of a single prophylactic midazolam bolus (0.1 mg/kg b.w.) prior to the termination of anaesthesia, on the incidence and severity of agitation occurring after sevoflurane administration. Compared to the placebo group, midazolam prophylaxis significantly decreased the incidence of postanaesthetic delirium. However, the incidence of severe agitation requiring treatment was not different between the groups (placebo: n = 6; midazolam: n = 4). The mean severity of agitation was significantly lower in patients with midazolam prophylaxis. When midazolam was administered for the treatment of severe agitation it reduced the severity but did not abolish agitation. All patients were discharged from the recovery room after the 2 h observation period. From our study we conclude that a small prophylactic midazolam bolus is able to reduce the incidence and severity of agitation after sevoflurane anesthesia in some patients but is insufficiently effective in patients with severe agitation. Thus, the prophylactic administration of midazolam extenuates but does not solve the problem of post-sevoflurane agitation.
Kulka
P J
PJ
Abteilung für Anästhesiologie und Intensivmedizin, Evangelisches Krankenhaus Oberhausen, EKO, Virchowstrasse 20, 46047 Oberhausen. Peter.Kulka@ruhr-uni-bochum.de
Bressem
M
M
Wiebalck
A
A
Tryba
M
M
D000759:Adjuvants, Anesthesia / Q000627:therapeutic use*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003693:Delirium / Q000139:chemically induced* / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008874:Midazolam / Q000627:therapeutic use*; D011595:Psychomotor Agitation; D000077149:Sevoflurane
D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D008874:Midazolam