Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children?
OBJECTIVE
The purpose of this evidence-based clinical update was to identify the best evidence to determine if behavioural outcomes are improved in children after oral midazolam premedication.


METHODS
A literature search was conducted using both PubMed and OVID programs, utilizing the terms "midazolam", and either "premedication" or "preoperative treatment". Search limits that were employed included randomized controlled trials (RCTs), English language, human studies, children aged 0-18 yr, and publication dates 1990 - present (January 2006). A review of the 171 abstracts obtained was undertaken and, of these, 30 papers were identified that concerned oral midazolam in children prior to general anesthesia, and that involved a RCT with a placebo or control arm. These studies were assigned levels of evidence, and grades of recommendation were made according to Centre for Evidence-Based Medicine criteria.


RESULTS
Oral midazolam premedication in children was found to reduce the anxiety associated with separation from parents/guardians, and with induction of anesthesia. Recovery times are not significantly delayed. There is no consistent evidence to suggest a reduction in the phenomenon of emergence agitation. Evidence suggesting an improvement in behavioural outcomes at home is also inconsistent.


CONCLUSIONS
Premedication with midazolam 0.5 mg x kg(-1) po administered 20-30 min preoperatively, is effective in reducing both separation and induction anxiety in children (grade A recommendation), with minimal effect on recovery times. However improved postoperative behavioural outcomes in the postanesthesia care unit, or at home cannot be predicted on a consistent basis.
Cox
Robin G
RG
Division of Pediatric Anesthesia, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada. robin.cox@calgaryhealthregion.ca
Nemish
Ulyana
U
Ewen
Alastair
A
Crowe
Marie-Josée
MJ
D000284:Administration, Oral; D000762:Anesthesia Recovery Period; D001007:Anxiety / Q000517:prevention & control; D002648:Child; D002652:Child Behavior / Q000187:drug effects*; D019317:Evidence-Based Medicine; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D011229:Preanesthetic Medication; D011595:Psychomotor Agitation / Q000517:prevention & control
D006993:Hypnotics and Sedatives; D008874:Midazolam