Oral Premedication in Children: A Comparison of Chloral Hydrate, Diazepam, Alprazolam, Midazolam and Placebo for Day Surgery

Abstract

A double-blind study consisting of 339 randomly selected children investigated the effects of several premedicants on the preoperative and postoperative behaviour of children who underwent day-stay surgery. Patients were allocated into two groups. Group 1 consisted of 165 children aged between 6 and 47 months. Group 2 consisted of 174 children aged four years and older to a body weight of 50 kg. Each child received one premedicant. Both groups included alprazolam 0.005 mglkg, midazolam 0.3 mglkg and placebo. In addition Group 1 included chloral hydrate 40 mglkg and Group 2 diazepam 0.25 mglkg. Chloral hydrate produced superior conditions (more patients calm or asleep) at induction of anaesthesia. Postoperative behaviour and incidence of vomiting were similar for all drugs. No premedicant reduced anxiety in the older group. The time to awaken postoperatively with diazepam was longer than with placebo. Alprazolam and midazolam were unpalatable for children over four years and conferred no advantage over placebo.

Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics

“…Despite this, even relatively recent studies of paediatric premedication have failed to differentiate children by age ( 4–7). Our results support those of previous studies that younger children are most at risk of displaying distress at induction of anaesthesia ( 8–10 ) even if they appear cooperative preoperatively.…”

“…The results in this area largely confirm earlier findings and clinical impressions ( 9, 10). The delay in wake up time associated with premedication is moderate, as is the effect of intravenous agents.…”

“…The results in this area largely confirm earlier findings anaesthesia. Despite this, even relatively recent and clinical impressions (9,10). The delay in wake studies of paediatric premedication have failed to up time associated with premedication is moderate, differentiate children by age (4)(5)(6)(7).…”

Pain management in pediatric day surgery patients at The Maternal and Child Medical Research Center in Mongolia

“…Many older children may be more upset by introducing the drug into their rectums than by receiving an injection [21]. Chloral hydrate has a disagreeable taste and it is often unsatisfactory if given less than sixty minutes prior to surgery [22]. …”

Use of oral midazolam in pediatric upper gastrointestinal endoscopy

“…Routes of administration that are often thought of as more appropriate for children include the oral, rectal, and intranasal routes. Rectally administered midazolam is sometimes unpleasant and poorly accepted by children and may be erratically absorbed 4–7 . I.v.…”