title: Effect of flumazenil on recovery from sevoflurane anesthesia in children premedicated with oral midazolam before undergoing herniorrhaphy with or without caudal analgesia.
abstract: OBJECTIVE
  Oral midazolam is frequently used to treat children, but its effect on recovery from anesthesia is controversial. This study was designed to evaluate the effect of flumazenil on reversal of midazolam during recovery from sevoflurane-induced anesthesia in children who underwent caudal analgesia compared to those who did not.
  
  
  METHODS
  A series of 60 children 1-8 years of age, with an American Society of Anesthesiologists (ASA) physical status of 1 or 2, who were scheduled to undergo herniorrhaphy were randomly assigned to one of four groups: group 1, control/placebo; group 2, control/flumazenil; group 3, caudal/placebo; group 4, caudal/flumazenil. After oral administration of midazolam 0.5 mg x kg(-1), anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen via a face mask with spontaneous ventilation. The time from the discontinuation of anesthetics to emergence was recorded, and at the time of discharge from the operating room each patient's recovery characteristics were assessed using a three-point scale.
  
  
  RESULTS
  Emergence from anesthesia was significantly less agitated in the group of children who underwent caudal analgesia without flumazenil compared to the other three groups. Flumazenil shortened the time to emergence regardless of the application of caudal analgesia, and caudal analgesia delayed the time to emergence regardless of flumazenil administration.
  
  
  CONCLUSIONS
  Caudal analgesia and avoiding the use of flumazenil synergistically resulted in the emergence from anesthesia in a less agitated state for children who underwent herniorrhaphy after oral midazolam premedication.
authors: Department of Anesthesiology, Fujita Health University School of Medicine, Banbuntane-Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan.
authors: Hiromi
authors: H
authors: Araki
authors: Yoshihiro
authors: Y
authors: Fujiwara
authors: Yasuhiro
authors: Y
authors: Shimada
mesh_terms: D000762:Anesthesia Recovery Period; D000763:Anesthesia, Caudal; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D005442:Flumazenil / Q000494:pharmacology*; D018757:GABA Modulators / Q000494:pharmacology*; D059685:Herniorrhaphy; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D008297:Male; D008738:Methyl Ethers; D008874:Midazolam; D011229:Preanesthetic Medication; D011595:Psychomotor Agitation; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D005442:Flumazenil; D008874:Midazolam