Does thiopentone delay recovery in children premedicated with midazolam?

Abstract

This prospective, randomized trial of paediatric surgical outpatients, premedicated with oral midazolam, was designed to determine if an intravenous thiopentone induction of anaesthesia prolongs postoperative recovery compared to an inhalation induction with halothane. One hundred children, one to ten years of age, undergoing ENT surgical procedures of 30-60 min duration received midazolam 0.5 mg.kg-1 with atropine 0.03 mg.kg-1 and were randomized to either halothane (Group 1, n = 50) or a thiopentone induction (Group 2, n = 50) technique, followed by a standardized anaesthetic-protocol. Time to extubation was significantly greater in the thiopentone group (8.8 +/- 4 min vs 7.1 +/- 3 min, P < 0.05). Patients receiving thiopentone were also more sedated than the halothane group on arrival in the PARR (3.9 +/- 1.5, 3.3 +/- 1.7, respectively P < 0.05), but the differences disappeared after 30 min. Children premedicated with oral midazolam who receive an intravenous thiopentone induction have a slightly prolonged emergence from anesthesia compared to children induced with halothane.

Perioperative anxiety and postoperative behavioural disturbances in children undergoing intravenous or inhalation induction of anaesthesia

“…In a double‐blind, placebo‐controlled study of paediatric outpatients induced with thiopental, early recovery time was prolonged 6.3 min, and discharge from hospital 59 min, by midazolam premedication (10). In a subsequent randomized trial of paediatric outpatients premedicated with midazolam, time to extubation was significantly prolonged by induction with thiopental compared with halothane, and children induced with thiopental were significantly more sedated in the first 30 min after anaesthesia (27). Animal and human studies have shown that intravenous midazolam and thiopental interact synergistically on induction of anaesthesia and it is possible that the same mechanism could prolong recovery times (28,29).…”