<p>The effect of midazolam administration for the prevention of emergence agitation in pediatric patients with extreme fear and non-cooperation undergoing dental treatment under sevoflurane anesthesia, a double-blind, randomized study</p>

Abstract

Background: Sevoflurane is generally the preferred anesthetic agent for general anesthesia in pediatric patients, due to its rapid induction and recovery characteristics. However, it has been recognized that a major complication is emergence agitation when awakening from general anesthesia. The aim of this study was to evaluate the occurrence rate of emergence agitation in the operating room and postoperative recovery area following intraoperative administration of midazolam to pediatric patients under general anesthesia. Patients and methods: One hundred and twenty pediatric patients undergoing dental treatment under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=40 each in the 0.1 mg/kg midazolam, 0.05 mg/kg midazolam, and control with saline groups). Midazolam or saline was injected intravenously approximately 30 minutes before the end of the dental treatment. We used the Richmond Agitation and Sedation Scale (RASS) to assess the level of sedation and drowsiness at emergence phase in the operating room. We also used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level of agitation and delirium at the full recovery phase from anesthesia in the recovery area. Results: At the emergence phase, the incidence of emergence agitation in the 0.1 mg/kg midazolam group was significantly lower than in the other groups ( p =0.0010). At the recovery phase, there was no significant difference among the three groups. The odds ratio between PAED score and RASS score was 4.0 using logistic regression analysis. The odds ratio between PAED score and Disability was 2.5. Conclusion: Administration of a single dose of 0.1 mg/kg midazolam dose significantly decreases the incidence of severe emergence agitation at the emergence after sevoflurane anesthesia, but not at the recovery phase. Furthermore, the evaluation of sedative and agitation condition using RASS score at emergence from anesthesia is useful to predict occurrence of agitation in the recovery phase.

Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

“…Dexmedetomidine is a highly selective α-2 agonist that produces sedative, anxiolytic, and analgesic effects without causing respiratory depression. Emergence agitation refers to thrashing, kicking, disorientation, inconsolable crying, hallucinations, and cognitive and memory impairment during the recovery period following the administration of general anesthesia [3]. Agitation can increase the amount of sedation and analgesics used and length of hospital stay and causes the appearance of associated complications [4].…”

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

“…It has the advantages of rapid analepsia, little airway stimulation, and stable hemodynamics. However, the incidence of emergence delirium is as high as 40%, which affects the postoperative recovery of children, increases the difficulty of postoperative nursing and aggravates the psychological burden on children and their families [ 3 , 4 ] . Sufentanil has a strong analgesic capacity and sedative effect and lasts longer [ 5 ] .…”

Study on the preventive effect of ramelteon on the onset of sleep disorder after general anesthesia in patients with autism spectrum disorder

“…In addition, it would be appropriate to use sedative drugs to prevent postoperative acute agitation after general anesthesia which may lead to secondary postoperative sleep disturbance. [ 21 ] We suppose that preoperative treatment for insomnia by administration of such a medicine might be clinically relevant.…”