High levels of impulsivity may contraindicate midazolam premedication in children

Abstract

Purpose:To investigate the effects of midazolam on emotional reactivity during induction of anesthesia in a pediatric day surgery setting. A secondary purpose was to determine if these effects were influenced by child temperament factors. Methods: Forty children (age four to six years) scheduled for myringotomy were randomly assigned, in a double blind fashion, to receive either oral midazolam 0.5 mg·kg -1 mixed with acetaminophen suspension or acetaminophen alone. The Emotionality, Activity, Sociability, and Impulsivity (EASI) scale was used as a measure of child temperament. The modified Yale Preoperative Anxiety Scale (m-YPAS), an observer-rated measure of state anxiety, was employed to assess anxiety preand post-drug, and also at induction of anesthesia. Results: Children who received midazolam reacted significantly less to induction of anesthesia than did children in the placebo control group, F (1, 38) = 7.46, P = 0.01. A significant positive association was observed between baseline levels of anxiety and observer-rated anxiety at anesthetic induction, but only in the placebo group, r = 0.58, P < 0.01. A significant positive association was observed between levels of impulsivity at baseline and observer-rated anxiety at anesthetic induction, but only in the midazolam group, r = 0.42, P < 0.05. Conclusions: Midazolam dampened adverse reactivity during anesthetic induction, particularly among children with high baseline levels of anxiety. Baseline level of impulsivity was positively associated with adverse reactions to anesthesia induction in the drug group, but not in the placebo group, suggesting that high levels of trait impulsivity may contraindicate the use of midazolam as a preoperative medication. Objectif

Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

“…The combination of the sedative and anxiolytic characteristics is believed to create a calming effect which makes children less anxious at the time of separation from their parents and mask placement [15]. Finley et al [15] showed that a midazolam-induced decrease in anxiety was effective for children with higher baseline levels of anxiety.…”

When are parents helpful? A randomized clinical trial of the efficacy of parental presence for pediatric anesthesia

“…Partial weights for each category are calculated and then added together to obtain a total score that ranges from 0-100 for each time-point. The mYPAS has shown good concurrent validity (r = 0.79) in predicting children's State Trait Anxiety Inventory for Children -State subscale scores 17 in the surgery context .14 The scale also has good construct validity, as scores have been shown to increase from baseline to anesthetic induction 18 , and to have good inter-rater reliability. 14 Since there was an inconsistency in the availability of parent to child throughout the five time-points (i.e., only half of the parents accompanied their child during the induction), we dropped the use of the parent scale.…”

Effects of midazolam on explicit vs implicit memory in a pediatric surgery setting

“…Midazolam is an established anxiolytic for children in the pediatric surgery context. For example, placebo-controlled research has shown midazolam to dampen the increase in anxiety that occurs at mask induction of anesthesia (e.g., Finley et al 2006). Nonetheless, there are anecdotal reports of children previously administered with midazolam who continue to display anticipatory anxiety at subsequent surgeries/medical procedures (for a review, see Chen et al 2000).…”