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

Abstract

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.

Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

“…4,5 Intravenous (IV) midazolam has a rapid onset of effect, short duration of action, minimal impact on cardiac function, minimal effect on respiratory depression, and it produces anterograde amnesiawhich is often desirable for preventing recall of distressing stimuli experienced during surgery. [4][5][6][7] Transient postoperative cognitive impairment caused by midazolam has been well described in the literature and this remains a relevant concern in any ambulatory care setting. 6,8,9 Recently, some evidence has suggested that IV midazolam might be associated with prolonged recovery time when administered for outpatient anesthesia for various oral surgical procedures.…”

Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies

“…Impaired post-operative cognitive function has been reported after midazolam premedication in children. 4 The a2 adrenoceptor agonist (a2aa) clonidine has been shown to exhibit anesthetic, sedative, sympathicolytic and analgesic properties. 1,2 Despite the clinical trials and reviews that have focused on the comparison between premedication with clonidine in comparison with benzodiazepines, no quantitative literature analysis has been published.…”

The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

“…26 Interestingly, our cognitive function data confi rmed signifi cant shortterm impairment even at this low dose. 10 The subjects in the present study refl ect the type of child referred for dental extractions under general anaesthesia in Scotland in general and in this unit in particular. 27,28,30 Few recruits dropped out of the study and there was little missing data, and, surprisingly, only one child refused the premedfrom the placebo group.…”

“…10 This paper presents the data that evaluates the benefi t of 0.2 mg/ kg midazolam premedication on dental anxiety, anaesthetic induction distress, psychological morbidity and subsequent dental attendance.…”