Premedication of the pediatric patient – anesthesia for the uncooperative child

Bozkurt, Pervin

doi:10.1097/aco.0b013e328105e0dd

Cited by 51 publications

(44 citation statements)

References 40 publications

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“…5 Chowdhury and Vargas 3 observed in their study that at the 10th, 30th, and 40th min during the sedation procedure, a higher percentage of children who were given 0.65 mg kg À1 midazolam showed 95% or lower SpO 2 compared with children who received the combination of 25 mg kg À1 chloral hydrate with 1 mg kg À1 meperidine. When they evaluated all groups, they reported that they did not observe a period when SpO 2 dropped below 90%, and the observed period between 90 and 93% was temporary and these cases were instantly resolved with Effectiveness of premedication agents 345 repositioning of the head and neck.…”

Section: Discussionmentioning

confidence: 97%

“…However, the use of midazolam may be associated with paradoxical reactions (delayed recovery, anxiety, behavioural changes, agitation), and irregular breathing patterns, skipped heartbeats, respiratory failure, and unusual or involuntary muscle movements have been observed rarely in some children. 5 Combinations of ketamine and midazolam have been stated to be among the best and safest techniques for sedoanalgesia. 6 This combination seems particularly beneficial because the elimination half-life of each agent is approximately the same.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of premedication agents administered prior to nitrous oxide/oxygen

Baygın

Bodur

Işık

2010

European Journal of Anaesthesiology

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen

Baygın

Bodur

Işık

2010

European Journal of Anaesthesiology

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“…Midazolam serves as a very common choice to achieve anxiolysis in children, adolescents and adults before anesthesia [1, 3, 4]. While children often receive relatively high doses, the standard dosage for adults, if administered po, ranges just around 7.5–15 mg [1].…”

Section: Discussionmentioning

confidence: 99%

Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study

et al. 2016

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BackgroundMidazolam is commonly used as a pre-anesthesia anxiolytic. It`s elimination may not be fast enough for short procedures. In orally premedicated patients we obtained midazolam plasma concentrations at the end of surgical procedures and compared those to concentrations at anesthesia induction.MethodsThe study was conducted prospectively with consent of the local ethics committee (Ethikkomission Kanton Thurgau, Switzerland) and carried out with written informed consent of each patient. Female patients aged 20 to 60 years undergoing elective procedures with general anesthesia were included, and were divided in two groups according to the planned surgical time: group S (<30 min) and group L (90–120 min), respectively. All patients received 7.5 mg Midazolam po as premedication. Blood samples were drawn at anesthesia induction, and at the end of surgery. Data were compared with t-test (independent samples; significance level p <0.05).ResultsTwenty-five patients per group were included. Four patients were excluded from analysis, since midazolam was not detectable in any samples. Time of premedication to the 1st blood sample was not statistically different between groups, neither were Midazolam plasma levels at this time point (p = 0.94). None of the patients from group L (n = 24), but five patients in group S (n = 22) did have a higher plasma level of Midazolam at the end of the case compared to the beginning.ConclusionsThe elimination half-life of oral Midazolam can lead to higher plasma levels at the end of a short procedure compared to those at induction of anesthesia.Trial registrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00005429; date of registration 3rd January 2014

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“…The effect of pre-medication with higher or repeated doses of midazolam has been studied previously. In these studies, midazolam reduced the autonomic and hormonal responses measured as a reduction in catecholamine, cortisol, and insulin levels [30,31,32]. In contrast, N 2 O is known to have a symphaticomimetic effect [19], which could explain the significantly higher norepinephrine levels found as compared to midazolam.…”

Section: Discussionmentioning

confidence: 89%

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

Ekbom¹,

Kalman

Jakobsson

et al. 2012

Horm Res Paediatr

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Objective: Pain, stress as well as drugs may affect metabolic and endocrine measurements, especially in stressed children. The aim was to study how release of glucose and stress hormones are affected when procedural sedation with nitrous oxide or midazolam are used for establishing intravenous access in obese and lean children. Methods: In a prospective, double-blind, randomized study 90 children, 60 obese and 30 growth-retarded (GR), aged 5–18 years, with reported anxiety or difficulties connected with i.v. access, were randomized to 1 of 3 groups: oral midazolam (0.3 mg/kg, max. 15 mg), 50% nitrous oxide (N₂O), and 10% N₂O. In addition, all children received anesthesia cream (EMLA®) locally 1 h before i.v. access. Blood samples were drawn at 4 time points during 30 min after establishing venous access and, when feasible, after 24 h. The 24-hour sample was regarded as obtained during unstressed condition. The effect of procedural sedation was analyzed. Children’s evaluations of pain (Numeric Rating Scale) and procedure (Likert Scale) were correlated with mean values of cortisol and glucose after i.v. access. For the metabolic and hormone control measurements, 60 children aged 4–18 years (40 obese and 20 GR) served as controls. These children underwent a 24-hour blood sampling and did not receive sedation. The control samples were drawn 10–12 h after i.v. access. Results: After midazolam, significantly lower cortisol levels were found compared to both 50% N₂O and 10% N₂O and to unstressed controls. The growth hormone levels decreased with time in the midazolam group compared to 50 and 10% N₂O, where the effect of time was reversed. Glucose levels among GR children increased from 0 to 30 min, whereas the opposite was found in obese children regardless of treatment. A post hoc analysis demonstrated significant correlations between children’s evaluations of the procedure and mean values of cortisol (r = –0.53), growth hormone (r = –0.52), and norepinephrine (r = –0.5) in children treated with a very low dose of N₂O (10%). Conclusions: When sedation is insufficient during i.v. access, and blood sampling pain and stress affect hormone values, treatment with N₂O or midazolam influence the glucose and stress hormone levels differently. These differences need to be accounted for when results are used for diagnosis and clinical decisions.

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Premedication of the pediatric patient – anesthesia for the uncooperative child

Cited by 51 publications

References 40 publications

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen

Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

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