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PEDIATRIC ANESTHESIA

Premedication with Midazolam Delays Recovery After Ambulatory Sevoflurane Anesthesia in Children

Hanna Viitanen, MD^*, Päivi Annila, MD, PhD, Matti Viitanen, MD^*, and Pekka Tarkkila, MD, PhD

*Department of Surgery and Anaesthesia, Central Hospital of Seinäjoki, Seinäjoki; Department of Anaesthesiology, Tampere University Hospital and Tampere University Medical School, Tampere; and Department of Anaesthesia, Ear Hospital, Helsinki University Central Hospital, Helsinki, Finland

Address correspondence and reprint requests to Hanna Viitanen, MD, Department of Surgery and Anaesthesia, Central Hospital of Seinäjoki, 60220 Seinäjoki, Finland. Address e-mail to msv{at}sci.fi

We studied the effect of oral premedication with midazolam on the recovery characteristics of sevoflurane anesthesia in small children. In a randomized, double-blinded study, 60 children (1–3 yr, ASA physical status I or II) undergoing ambulatory adenoidectomy received either midazolam 0.5 mg/kg (Group M) or placebo (Group P) PO approximately 30 min before the induction of anesthesia. All children received atropine 0.01 mg/kg IV and alfentanil 10 µg/kg IV before the induction of anesthesia with sevoflurane up to 8 vol% inspired concentration in N₂O 67% in O₂. Tracheal intubation was facilitated with mivacurium 0.2 mg/kg. Anesthesia was continued with sevoflurane adjusted to maintain hemodynamic stability. In the postanesthesia care unit, predetermined recovery end points (emergence, recovery, discharge) were recorded. A pain/discomfort scale was used to determine the quality of recovery. A postoperative questionnaire was used to evaluate the well-being of the patient at home 24 h after surgery. Emergence (spontaneous eye opening), recovery (full points on the modified Aldrete scale), and discharge were achieved later in Group M than in Group P (15 ± 6 vs 11 ± 3 min [P = 0.002], 25 ± 17 vs 16 ± 6 min [P = 0.01], and 80 ± 23 vs 70 ± 23 min [P = 0.03]). Side effects, postanesthetic excitement, and analgesic treatment did not differ significantly between groups. At home, more children in Group P (30%) experienced disturbed sleep during the night compared with those in Group M (4%) (P = 0.007).

Implications: In this randomized, double-blinded, placebo-controlled study, premedication with midazolam 0.5 mg/kg PO delayed recovery in children 1–3 yr of age after brief (<30 min) sevoflurane anesthesia. Except for more peaceful sleep at home, premedication did not affect the quality of recovery.

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