Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr

Purpose: To study the effect of midazolam premedication on the recovery cha racteristics of sevoflurane anesthesia induced with propofol in pediatric o utpatients, Methods: Sixty children, one to three years, presenting for ambulatory aden oidectomy were randomly assigned in a double-blind fashion, to receive eith er 0.5 mg.kg(-1) midazolam (Group M) or placebo (Group P) po 30 min before anesthesia. Anesthesia was induced with 10 mu g.kg(-1) atropine, 10 mu g.kg (-1) alfentanil, and 3-4 mg.kg(-1) propofol iv. Tracheal intubation was fac ilitated with 0.2 mg.kg(-1) mivacurium. Anesthesia was maintained with nitr ous oxide/oxygen (FiO(2) 0.3) and sevoflurane with controlled ventilation. Recovery characteristics were compared using the modified Aldrete scoring s ystem, the Pain/Discomfort scale and measuring specific recovery end-points (emergence, full Aldrete score, discharge). A postoperative questionnaire was used to evaluate the children's wellbeing at home until 24 hr after dis charge. Results: Emergence from anesthesia (22 +/- 9 vs 16 +/- 6 min (mean +/- SD), P = 0.005) and achieving full Aldrete scores (30 +/- 11 vs 24 +/- 16 min, P = 0.006) were delayed in patients receiving midazolam. Children in the pl acebo group were given postoperative analgesia sooner than those in the mid azolam group (18 +/- 11 vs 23 +/- 8 min, P = 0.009). More children premedic ated with midazolam suffered from arousal distress (20% vs 3%, P = 0.04) an d scored higher on the Pain/Discomfort scale (P = 0.004) at 20 min after ar rival in the recovery room. Discharge was not affected by premedication and well-being at home was similar in the groups. Conclusions: Oral premedication with midazolam delays early recovery but no t discharge after ambulatory sevoflurane anesthesia induced with propofol i n children one to three years. Midazolam did not improve the quality of rec overy.