title: The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients.
abstract: BACKGROUND
  Although midazolam administration may occasionally induce a paradoxical episode, such as threatened crying and violent behavior in children, systematic studies on the causes of paradoxical reaction are limited. We investigated the effect of children's age and a dose of midazolam on the paradoxical reaction.
  
  
  METHODS
  A total of one hundred sixty four children of 1-3 years and 3-5 years, were enrolled in this study. Each age group randomly received 0.05 mg/kg or 0.1 mg/kg of intravenous midazolam (41 patients/group).
  
  
  RESULTS
  The incidence of paradoxical midazolam reaction in the study groups, 1-3 years with 0.1 mg/kg of intravenous midazolam, 1-3 years with 0.05 mg/kg, 3-5 years with 0.1 mg/kg, and 3-5 years with 0.05 mg/kg were as follows: 29.3%, 12.2%, 7.3% and 2.4%, respectively. The incidence among the 4 groups was significantly different (P = 0.002), highest in the 1-3 years receiving 0.1 mg/kg of midazolam (29.3%). Both age (P = 0.004, OR [95%CI] = 5.3 [1.7-16.8]) and dose of midazolam (P = 0.036, OR [95%CI] = 3.0 [1.1-8.4]) were risk factors. Perioperative clinical data including anxiety scales of children were not associated with the paradoxical midazolam reaction.
  
  
  CONCLUSIONS
  In conclusion, we suggest that children less than 3 years old receiving higher dose of intravenous midazolam are at risk for the paradoxical midazolam reaction.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young Hee
authors.initials: YH
authors.lastname: Shin
authors.forename: Myung Hee
authors.initials: MH
authors.lastname: Kim
authors.forename: Jung Jin
authors.initials: JJ
authors.lastname: Lee
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Choi
authors.forename: Mi Sook
authors.initials: MS
authors.lastname: Gwak
authors.forename: Ae Ryoung
authors.initials: AR
authors.lastname: Lee
authors.forename: Mi Na
authors.initials: MN
authors.lastname: Park
authors.forename: Hyo Sung
authors.initials: HS
authors.lastname: Joo
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Choi
keywords: Child; Midazolam; Paradoxical reaction
references.citation: Anaesth Intensive Care. 1987 Aug;15(3):330-1
references.pmid: 3661967
references.citation: Int J Oral Maxillofac Surg. 1990 Feb;19(1):2-6
references.pmid: 2110954
references.citation: Anesth Prog. 2002 Winter;49(4):128-32
references.pmid: 12779114
references.citation: Anesth Prog. 1980 Nov;27(6):175-83
references.pmid: 19598594
references.citation: Clin Pediatr (Phila). 1997 Dec;36(12):681-4
references.pmid: 9415834
references.citation: Anesth Analg. 1997 Oct;85(4):783-8
references.pmid: 9322455
references.citation: Arch Pediatr Adolesc Med. 1996 Dec;150(12):1238-45
references.pmid: 8953995
references.citation: Br J Anaesth. 2008 Aug;101(2):239-43
references.pmid: 18534971
references.citation: Anesth Analg. 1996 Jul;83(1):192
references.pmid: 8659737
references.citation: Paediatr Anaesth. 2004 Nov;14(11):924-30
references.pmid: 15500492
references.citation: Paediatr Anaesth. 2002 Oct;12(8):685-9
references.pmid: 12472704
references.citation: Gastrointest Endosc. 1994 Jan-Feb;40(1):86-8
references.pmid: 8163147
references.citation: Can J Anaesth. 2006 Jan;53(1):73-8
references.pmid: 16371612
references.citation: Int J Paediatr Dent. 2008 Jul;18(4):256-61
references.pmid: 18328049