Efficacy of premedication with intravenous midazolam on preoperative anxiety and mask compliance in pediatric patients: a randomized controlled trial

Abstract

Background: To alleviate anxiety before surgery is a significant concern for the pediatric anesthesiologist.Midazolam has been generally used as a premedication, and compelling data regarding effective dose to mitigate anxiety is lacking. The current trial addressed the comparable efficacy of intravenous midazolam with different doses regarding the anxiety state, ease of child-parental separation, and mask compliance as premedication in pediatric patients undergoing tonsillectomy.Methods: Three hundred and twelve children aged 2-8 years were randomly assigned, 104 per group, to receive intravenous 0.03 mg/kg midazolam (group A), 0.05 mg/kg midazolam (group B), or saline control (group C), 40 minutes before surgery. We assessed the anxiety state every 10 min after premedication with modified Yale preoperative anxiety scale (mYPAS), evaluated the emotional state during separation with parental separation anxiety scale (PSAS), and compared their compliance to mask oxygen supply with mask acceptance score (MAS).Results: Children premedicated with 0.05 mg/kg midazolam achieved a sedated state more rapidly than those who received 0.03 mg/kg midazolam (5.9±2.3 vs. 7.0±3.9, P=0.02). The proportion of satisfactory parental separation and compliance to mask ventilation was not different between midazolam groups, which was superior to saline control. The children receiving 0.05 mg/kg midazolam stayed longer in postoperative care unit than those receiving 0.03 mg/kg midazolam and saline. The incidence of postoperative adverse events was rare and comparable among groups.Conclusions: Intravenous administration of a single dose of midazolam 0.05 and 0.03 mg/kg produces similar effects on sedation status, parental separation, and mask induction acceptance, except for rapid-onset and long sedation duration in pediatric patients premedicated with 0.05 mg/kg midazolam.Trial Registration: ClinicalTrials.gov NCT04266340.

Augmented Reality Improves Pediatric Mask Induction: A Prospective, Matched Case-Control Study

“…First, although the MAS is a commonly used scale for assessing mask acceptance and is integrated into the standard EMR form, the scale itself has never been appropriately validated. 29 Second, the MAS does not measure anxiety directly. The scale incorporates behavior and cooperation into categories, making it difficult to differentiate nuances between a child that is cooperative but still fearful at mask induction.…”

“…The primary outcome was assessed using the Mask Acceptance Scale (MAS), which is a commonly used tool for determining mask acceptance during inhalational induction of anesthesia. 29 The MAS is scored on a 4-point scale: 1 = unafraid, cooperative, accepts mask readily , 2 = slight fear of mask, easily reassured , 3 = moderate fear of mask, calmed with reassurance , 4 = terrified, crying or combative . We compared patients with MAS scores of 1 to those with scores of 2 or greater between the AR and SOC groups.…”

The association between aldehydes exposure and female infertility: A cross-sectional study from NHANES

“…As per the WHO, infertility and sterility will rank third on the global health agenda in the 21st century, after cancer and heart disease. [17] Estimates have demonstrated that 48 million couples and 186 million individuals suffer from infertility globally. [18–20] The pathophysiology of female infertility has been identified to be attributed to OS, a condition marked by an imbalance between pro-oxidant molecules and antioxidant defenses.…”

The late-follicular-phase progesterone to retrieved oocytes ratio in normal ovarian responders treated with an antagonist protocol can be used as an index for selecting an embryo transfer strategy and predicting the success rate: a retrospective large-scale study

“…According to the World Health Organization (WHO), infertility and sterility will be the third most serious condition worldwide in the 21st century. Furthermore, it is estimated that 15% to 20% (40–50 million) of women of reproductive age in China suffer from infertility, and 822,246 assisted reproductive technology (ART) cycles were conducted between 1981 and 2011 ( 1 ). Although IVF/ICSI is an effective method for treating infertility, overcoming the pregnancy rate bottleneck has always been a research hotspot in the field of reproductive medicine, and a premature surge in serum progesterone (P) in the late follicular phase may significantly influence the success rate of IVF/ICSI.…”