Prophylactic Use of Midazolam or Propofol at the End of Surgery May Reduce the Incidence of Emergence Agitation after Sevoflurane Anaesthesia

Abstract

Sevoflurane is associated with a high incidence of emergence agitation in children. Midazolam and propofol have been examined with the aim of reducing emergence agitation after sevoflurane anaesthesia. However, the effect of both drugs on emergence agitation is still controversial. Therefore we designed this study to measure the effect of midazolam or propofol at the end of surgery on emergence agitation during the recovery period. One hundred and one children, aged one to 13 years, undergoing strabismus surgery were enrolled in this randomised double-blind study. Anaesthesia was induced and maintained with sevoflurane in N2O/O2. Children were randomly assigned to receive midazolam 0.05 mg/kg (group M, n=35), propofol 1 mg/kg (group P, n=31) or saline (group S, n=35). A four-point scale was used to evaluate recovery characteristics upon awakening and during the first hour after emergence from anaesthesia. The incidence of emergence agitation in group M was 42.9% (15/35), in group P 48.4% (15/31) and in group S 74.3% (26/35). The incidence of emergence agitation in groups M and P was significantly less than in group S. The emergence time was prolonged for patients in groups M and P compared to group S. There was no significant difference in the incidence of emergence agitation or in emergence times between the groups P and M. We conclude that propofol or midazolam administration before the end of surgery may be effective in reducing the incidence of emergence agitation in children undergoing strabismus surgery under sevoflurane anaesthesia.

Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children

“…They similarly found that propofol and midazolam decreased the incidence of EA by about 40%, but the final incidence of EA in the prophylactic groups was 40%, which is higher than the 15-20% of Chen and colleagues' study. 17 Furthermore, both of these studies compared propofol and midazolam only in patients undergoing ophthalmological surgery. More comparative studies need to be conducted with additional combinations of drugs and in diverse clinical situations.…”

Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

“…The high incidence of EA has led many investigators to provide prophylactic treatment, such as propofol, opioid, midazolam, nonsteroidal anti‐inflammatory drugs (NSAIDs), nitrous oxide (N 2 O), ketamine, 5‐hydroxytryptamin 3 inhibitors, magnesium and regional block . Another choice is to use dexmedetomidine, an α 2 ‐adrenoceptor (α 2 ‐AR) agonist with sedative, analgesic and anxiolytic actions, which has been widely used in pediatric and adult populations .…”

Effects of remifentanil maintenance during recovery on emergence delirium in children with sevoflurane anesthesia

“…An infusion rate of 0.05 μg/kg/min allows for rapid emergence and maintains patient responsiveness . Similarly, one study reported a significantly lower incidence of ED with administration of midazolam (another widely used sedative drug) just before the end of surgery . This was likely due to residual effects of the midazolam during the postanesthesia period.…”

“…14 Similarly, one study reported a significantly lower incidence of ED with administration of midazolam (another widely used sedative drug) just before the end of surgery. 15 This was likely due to residual effects of the midazolam during the postanesthesia Values are presented as frequency or mean ± SD. Group R, postoperative infusion of remifentanil 0.05 ug/kg/min; Group C, without postoperative infusion of remifentanil; Et Sevo, endtidal sevoflurane concentration; CI, confidence interval; PADC, postanesthetic discharge score.…”