Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children.
BACKGROUND
Behavioral disturbance in children following sevoflurane anesthesia is a relatively frequent event. The aim of this study was to evaluate whether a higher dose of preoperatively administered rectal midazolam compared with a lower would alleviate this phenomenon. Furthermore the impact of these two doses of midazolam on sedation at induction of anesthesia was compared.


METHODS
A total of 115 children presenting for minor surgery under anesthesia were included in the study. The children were randomized to receive rectally either 1 mg.kg(-1) midazolam (group H) or 0.5 mg.kg(-1) midazolam (group L). General anesthesia was induced with propofol or sevoflurane and maintained with 1.5% sevoflurane in the inspiratory limb. Prior to the start of surgery a regional block was performed to ensure adequate pain relief. Behavior on emergence was assessed using a three point scale. In case of severe agitation propofol was administered IV.


RESULTS
The children in group H were significantly better sedated preoperatively (P < 0.01). There was no significant difference in emergence behavior: 42.1% of children in group H compared with 36.2% of children in group L exhibited severe agitation requiring sedation with propofol (P = 0.37). However, regardless of the preoperative dose of midazolam more children under the age of 36 months (61.4%) were severely distressed at emergence compared with older children (16.7%) (P < 0.01).


CONCLUSIONS
A higher dose of 1 mg.kg(-1) rectal midazolam results in much better sedated children on induction of anesthesia than 0.5 mg.kg(-1). This, however, does not result in a reduced incidence of emergence delirium after sevoflurane anesthesia. Regardless of the premedication negative behavioral changes occur more frequently in children younger than 3 years of age.
Breschan
Christian
C
Department of Anaesthesia, LKH Klagenfurt, Klagenfurt, Austria. breschan.ch@chello.at
Platzer
Manuela
M
Jost
Robert
R
Stettner
Haro
H
Likar
Rudolf
R
D000285:Administration, Rectal; D000367:Age Factors; D017109:Akathisia, Drug-Induced / Q000188:drug therapy; D000768:Anesthesia, General / Q000379:methods; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D003693:Delirium / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D013511:Minor Surgical Procedures / Q000379:methods; D009407:Nerve Block / Q000379:methods; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077149:Sevoflurane; D013315:Stress, Psychological / Q000139:chemically induced / Q000188:drug therapy; D013997:Time Factors; D017211:Treatment Failure
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D008874:Midazolam; D015742:Propofol