Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy

Abstract

Background Midazolam is commonly used preoperatively for anxiety. Adverse effects data in pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy (T&A) is limited. Aims We hypothesized that preoperative midazolam increases the time to emergence from anesthesia and postoperative discharge. Secondary objectives assessed if patients receiving midazolam experienced increased side effects or complications from treatment. Methods This study was a retrospective chart review of patients undergoing T&A from July 2014 to December 2015. Midazolam receiving patients (midazolam group: MG) were compared to patients who did not (non-midazolam group: NMG). Multivariable analyses were performed and adjusted for predefined potential cofounder variables. Results Emergence and discharge times were 5.2 minutes (95% CI [-7.1, 17.4]; p=0.41) and 10.1 minutes (95% CI [-6.7, 26.8]; p=0.24) longer in MG. These results were not statistically significant. Comparing by OSA status, there was no statistical difference in emergence and discharge times between mild, moderate and severe OSA groups or between MG and NMG within each OSA group. Emergence and discharge times in moderate OSA was 6.1 minutes (95% CI [-17.6, 29.8]; p=0.61) and 18.8 minutes (95% CI [-16.4, 53.9]; p=0.29) longer than mild OSA, and in the severe OSA group, 2.6 minutes (95% CI [-19.9, 25.1]; p=0.82) shorter and 2.8 minutes (95% CI [-30.3, 35.9]; p=0.87) longer. The incidence of postoperative complications was comparable between MG and NMG groups. Conclusions Premedication with midazolam was not associated with prolonged emergence or discharge time or higher incidence of complications after anesthesia for T&A in patients with OSA.

Pharmacological strategies to reduce perioperative anxiety in children – a narrative review

“…Some authors suggest that this might be a result of the decrease of the upper airway tone. Nonetheless, limited research suggests that midazolam premedication was not associated with higher incidence of complications in children with obstructive sleep apnea or Down syndrome [53][54][55] .…”

Midazolam for Anesthetic Premedication in Children: Considerations and Alternatives

“…The primary undesired side effect is oxygen desaturation, especially when combined with opioids and other depressant medication, which is caused by reduced respiratory drive, relaxation of airway musculature, or a combination of the two. This has been reported in less than 1% of cases and is thought to be dose-dependent, with obstructive sleep apnea as a significant risk factor [ 17 ]. Other reactions, including agitation, delirium, and uncontrollable crying, have also been observed.…”

Dexmedetomidine premedication increases preoperative sedation and inhibits stress induced by tracheal intubation in adult: a prospective randomized double-blind clinical study

“…Opioids are the most usually used premedication [ 5 ], however which have to do with respiratory depression, nausea, and urinary retention. Midazolam, a benzodiazepine anxiolytic, is common for patients to experience preoperative anxiety because adequate sedation might ameliorate anxiety [ 6 ], which with not only rapid onset of action and a minimum hemodynamic effect, but also muscle relaxant properties [ 7 ]. However the most adverse effects secondary to midazolam include respiratory depression and postoperative cognitive changes [ 8 ].…”