A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient

We compared the effects of oral clonidine (4 mug/kg) and midazolam (0.5 mg/ kg) on the preanesthetic sedation and postoperative recovery profile in chi ldren during tonsillectomy with or without adenoidectomy. In a double-blind ed, double-dummy study design, 134 ASA physical status I II children aged 4 -12 yr were randomized to receive a combination of either clonidine and pla cebo (Group A), or placebo and midazolam (Group B) at 60-90 min and 30 min, respectively, before the induction of anesthesia. Children in the clonidin e group exhibited more intense anxiety on separation and during induction o f anesthesia via a mask as measured by the modified Yale Preoperative Anxie ty Scores. They also had significantly lower mean intraoperative arterial b lood pressures, shorter surgery, anesthesia, and emergence times, and a dec reased need for supplemental oxygen during recovery compared with the midaz olam group. However, the clonidine group had larger postoperative opioid re quirements, maximum excitement and pain scores based on the Children's Hosp ital of Eastern Ontario scale in the Phase 1 postanesthetic care unit. Ther e were no differences between the two groups in the times to discharge read iness, postoperative emesis, unanticipated hospital admission rates, postdi scharge maximum pain scores, and 24 h analgesic requirements. The percentag e of parents who were completely satisfied with the child's preoperative ex perience was significantly higher in the midazolam group. There were no dif ferences in parental satisfaction with the recovery period. We conclude tha t under the conditions of this study, oral midazolam is superior to oral cl onidine as a preanesthetic medication in this patient population.