Premedication in children: hypnosis versus midazolam.
BACKGROUND
The main objectives of premedication in children are to facilitate the separation from the parents, to reduce preoperative anxiety, to smooth the induction of anesthesia and to lower the risk of postoperative behavioral disorders. The most common technique is sedative premedication with midazolam. Hypnosis enables a state of relaxation to be achieved and has never been evaluated as a premedication technique. The aim of the present study was to evaluate the efficacy of hypnosis on anxiety and perioperative behavioral disorders versus midazolam.


METHODS
Fifty children from 2 to 11 years of age were randomized into two groups: group H received hypnosis as premedication; group M were given 0.5 mg x kg(-1) midazolam orally, 30 min before surgery. Preoperative anxiety was evaluated using the Modified Yale Preoperative Anxiety Scale (mYPAS) score when arriving in the department (T1), when entering the operating room (T2), and when fitting the facemask (T3). Postoperative behavioral disorders were evaluated using the Posthospitalization Behavioral Questionnaire (PHBQ) at days 1, 7 and 14.


RESULTS
The two groups showed no significant difference preoperatively with the PHBQ: (M) 21 (17-25) vs (H) 20 (8-25) and mYPAS score: (M) 28 (23-75) vs (H) 23 (23-78). The number of anxious children was less during induction of anesthesia in the hypnosis group (T3: 39% vs 68%) (P < 0.05). Postoperatively, hypnosis reduced the frequency of behavior disorders approximately by half on day 1 (30% vs 62%) and day 7 (26% vs 59%).


CONCLUSIONS
Hypnosis seems effective as premedication in children scheduled for surgery. It alleviates preoperative anxiety, especially during induction of anesthesia and reduces behavioral disorders during the first postoperative week.
Calipel
Séverine
S
Department of Anesthesiology and Surgical Intensive Care 2, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
Lucas-Polomeni
Marie-Madeleine
MM
Wodey
Eric
E
Ecoffey
Claude
C
D000005:Abdomen / Q000601:surgery; D001007:Anxiety / Q000523:psychology; D001519:Behavior / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006990:Hypnosis; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D011229:Preanesthetic Medication; D011569:Psychiatric Status Rating Scales
D006993:Hypnotics and Sedatives; D008874:Midazolam