Melatonin vs. midazolam premedication in children: a double-blind, placebo-controlled study

Samarkandi, Abdulhamid H.; Naguib, Mohamed; Riad, Waleed; Thalaj, A.; Alotibi, W.; Aldammas, Fatma; Albassam, A.A.

doi:10.1097/00003643-200503000-00005

Cited by 77 publications

(68 citation statements)

References 35 publications

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“…Erlandsson et al [12] have also reported the dose to be effective for conscious sedation of unco-operative paediatric dental patients, although their study lacked a control group. Similarly, Samarkandi et al [3] McGraw & Kendrick [25] found more problems as a function of the same dose. The challenge of assessing children's cognitive function peri-operatively, and the implications of their distress for missing data, have been observed before [6,9].…”

Section: Discussionmentioning

confidence: 82%

“…Whilst premedication with midazolam can reduce pre-operative distress and facilitate patient management [2,3], the benefit may be offset by the risk of respiratory depression and disinhibited behaviour during recovery. Moreover, in ambulatory care settings where post-discharge 'street-fitness' becomes relevant, further concern attaches to the potential adverse effects of midazolam upon cognitive function.…”

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confidence: 99%

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A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

et al. 2007

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SummaryThis randomised, placebo-controlled study assessed the effects of midazolam premedication on children's postoperative cognition and physical morbidity. In all, 179 children aged 5-10 years were randomly assigned to receive buccal midazolam (0.2 mg.kg) or placebo before sevofluranenitrous oxide anaesthesia for multiple dental extractions. They performed tests of choice reaction time, attention, psychomotor co-ordination and memory pre-operatively (baseline), before discharge and at 48 h. The reaction time of both groups was significantly slower before discharge compared to baseline, with the midazolam group being significantly slower than placebo. Psychomotor co-ordination was also significantly impaired postoperatively after midazolam. Performance on both tests had recovered to baseline by 48 h. Midazolam was also associated with significant anterograde amnesia, both postoperatively and at 48 h, for information presented in the interval between premedication and surgery. The results show significant short-term impairment of children's cognitive function and amnesia enduring for 48 h after low-dose midazolam premedication.

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Section: Discussionmentioning

confidence: 82%

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confidence: 99%

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

et al. 2007

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“…One study included a control group in which patients did not receive a placebo [23]. Participants had various operations: abdominal [15][16][17]25, Full-text studies excluded (n = 17) -10 studies did not investigate surgical patients -3 studies were protocol studies -2 studies were not randomised -2 studies used melatonin only in combination with other drug interventions 32]; dental [27]; gynaecological [5,6,18,19,30]; ophthalmological [4,14]; orthopaedic [12]; thoracic [28,29]; urological [13]; vascular [26]; and mixed [20][21][22][23][24]31]. The anaesthetic techniques included: general anaesthesia [13,[15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32]; intravenous regional anaesthesia [12]; neuraxial block [5,6,20,…”

Section: Resultsmentioning

confidence: 99%

A systematic review of peri‐operative melatonin

Andersen

Werner²,

Rosenberg

et al. 2014

Anaesthesia

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SummaryWe systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I 2 87% and 94%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements.

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“…Although its degree of preoperative anxiety relief is similar to that of midazolam, melatonin exhibited a lower incidence of postoperative agitation or sleep disorders during 2 weeks' postoperative observation. 36 Another pharmaceutical used as premedication, ketamine, at a dosage of 6 mg/kg -1 given orally, reduced the incidence of emergence agitation by 34% in children under anesthesia with desflurane for adenotonsillectomy. 37 Comparing nalbuphine (0.1 mg/kg -1 ) with ketamine (0.25 mg/kg -1 ), administered at the end of inhaled sevoflurane anesthesia to children aged 6 months to 8 years before cerebral magnetic resonance imaging, a lower incidence of post-emergence agitation was detected in the group of patients given nalbuphine.…”

Section: Anesthetic Premedication and Adjuvant Drugsmentioning

confidence: 99%

Agitação no despertar da anestesia em crianças: aspectos atuais

Silva¹,

Braz²,

Módolo³

2008

J. Pediatr. (Rio J.)

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Objective: Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this agitation. Possible causes include rapid awakening in unfamiliar settings, pain (wounds, sore throat, bladder distension, etc.), stress during induction, hypoxemia, airway obstruction, noisy environment, anesthesia duration, child's personality, premedication and type of anesthesia. The purpose of this paper is to discuss the possible causes of postoperative agitation in children, providing a foundation for better methods of identifying and preventing this problem.Sources: MEDLINE and PubMed were searched using the following words: emergence, agitation, incidence, etiology, diagnosis, treatment, children, pediatric, anesthesia. Summary of the findings:This study includes a review of potential agitation trigger factors and a proposal for a standardized diagnostic score system, in addition to measures to improve prevention and treatment. Conclusion:No single factor can identified as the cause of postoperative agitation, which should therefore be considered a syndrome made up of biological, pharmacological, psychological and social components, and which anesthesiologists and pediatric intensive care specialists should be prepared to identify, prevent and intervene appropriately as necessary.

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Melatonin vs. midazolam premedication in children: a double-blind, placebo-controlled study

Cited by 77 publications

References 35 publications

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

A systematic review of peri‐operative melatonin

Agitação no despertar da anestesia em crianças: aspectos atuais

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