MIDAZOLAM PREMEDICATION DELAYS RECOVERY AFTER PROPOFOL WITHOUT MODIFYING INVOLUNTARY MOVEMENTS

Midazolam has GABAergic effects in children that may modify propofol-i nduced involuntary movements, yet delay recovery. In a double-blind, r andomized study, 24 children (2-7 yr of age, ASA physical status I or II) undergoing short surgical procedures received midazolam 0.5 mg/kg (Group M) or placebo (Group P) per os 20-30 min before propofol anesth esia (5 mg/kg intravenously followed by an infusion). Blind observers scored sedation and anxiety levels (scale 1-4) before premedication, a t separation from parents, and at induction of anesthesia. Induction a nd emergence were videotaped, and body movements were recorded. During recovery, times to eye opening and maximum Steward (SS = 6) and Vanco uver Sedative Recovery (VSRS = 22) scores were noted. Parents were que stioned about side effects that may have occurred during the following week. Both groups were similar in age, sex, weight, timing of premedi cation, propofol dose, and duration of surgery. The incidence of invol untary movements did not differ between groups but was higher at induc tion (79%) than on emergence (25%) (P < 0.05). Anxiety and sedation sc ores were similar in Group P and Group M,but recovery took longer afte r midazolam, with eye opening (mean +/- so) 24 +/- 7 vs 43 +/- 18 min, maximum SS (median and range) 27 (13-37) vs 55 (24-138) min, and maxi mum VSRS 51 (30-100) vs 80 (50-130) min. Children returned to normal a ctivity in 1 (0-5) day, and none exhibited neurological complications. We conclude that an oral premedicant dose of midazolam prolongs recov ery from anesthesia in children without affecting dystonic movements a fter propofol.