Postoperative behavioral outcomes in children - Effects of sedative premedication

Background: Although multiple studies document the effect of sedative preme dication on preoperative anxiety in children, there is a paucity of data re garding its effect on postoperative behavioral outcomes. Methods: After screening for recent stressful life events, children undergo ing anesthesia and surgery were assigned randomly to receive either 0.5 mg/ kg midazolam in 15 mg/kg acetaminophen orally (n = 43) or 15 mg/kg acetamin ophen orally (n = 43), Using validated measures of anxiety, children were e valuated before and after administration of the intervention and during ind uction of anesthesia. On postoperative days 1, 2, 3, 7, and 14, the behavio ral recovery of the children was assessed using the Post Hospitalization Be havior Questionnaire. Results: The intervention group demonstrated significantly lower anxiety le vels compared with the placebo group on separation to the operating room an d during induction of anesthesia (F[1,77] = 3.95, P = 0.041). Using a multi variate logistic regression model, the authors found that the presence or a bsence of postoperative behavioral changes was dependent on the group assig nment (R = 0.18, P = 0.0001) and days after operation (R = -0,20, P = 0.000 1). Post hoc analysis demonstrated that during postoperative days 1-7, a si gnificantly smaller number of children in the midazolam group manifested ne gative behavioral changes. At week 2 postoperatively, however, there were n o significant differences between the midazolam and placebo groups. Conclusions: Children who are premedicated with midazolam before surgery ha ve fewer negative behavioral changes during the first postoperative week.