title: Melatonin versus midazolam premedication in children undergoing surgery: A pilot study.
abstract: OBJECTIVE
  Melatonin has been proposed as a premedication alternative to midazolam, preceding anaesthesia induction. However, to our knowledge, data concerning interaction between melatonin and intravenous anaesthetic drugs in children are not available. The aim of this prospective, randomized, double-blind pilot study was to investigate the possible effect of melatonin premedication, in comparison to midazolam, on the required infusion of propofol in children undergoing surgery. As a secondary outcome, the effect of oral melatonin on the preoperative sedation level and on the post anaesthesia recovery score was evaluated.
  
  
  METHODS
  Children between the age of 5 and 14 years, scheduled for elective surgery, were prospectively enrolled between January 2012 and December 2013, and randomly assigned to two groups based on whether they received oral melatonin (0.5 mg/kg) or oral midazolam (0.5 mg/kg) premedication before induction of anaesthesia with propofol. Degree of sedation before and after anaesthesia was also evaluated.
  
  
  RESULTS
  Ninety-two patients were studied, 46 for each group. We found that oral administration of melatonin significantly reduced doses of propofol required for induction of anaesthesia in paediatric patients, more than midazolam (P < 0.001). No statistically significant differences were found in the pre- and post-anaesthesia sedation score (P = 0.387 and P = 0.525, respectively) between the two groups.
  
  
  CONCLUSIONS
  The present study demonstrates that melatonin enhances the potency of propofol also in paediatric patients. Moreover, considering the paediatric level of sedation, melatonin was equally as effective as midazolam. These data support the use of melatonin as a premedicant in paediatric surgical patients.
authors.affiliation: Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Gitto
authors.affiliation: Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Marseglia
authors.affiliation: Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: D'Angelo
authors.affiliation: Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Manti
authors.affiliation: Unit of Anesthesiology, University of Messina, Messina, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Crisafi
authors.affiliation: Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Angela Simona
authors.initials: AS
authors.lastname: Montalto
authors.affiliation: Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Impellizzeri
authors.affiliation: Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States.
authors.forename: Russel J
authors.initials: RJ
authors.lastname: Reiter
authors.affiliation: Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Messina, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Romeo
mesh_terms: D000293:Adolescent; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D010865:Pilot Projects; D011292:Premedication / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D008550:Melatonin; D008874:Midazolam; D015742:Propofol
keywords: anaesthesia; child; melatonin; midazolam; premedication; propofol