Midazolam prophylaxis for post-seviflurane agitation

In a randomized double-blind placebo-controlled trial in children 2-7 years of age, we investigated the effect of a single prophylactic midazolam bolu s (0.1 mg/kg b.w.) prior to the termination of anaesthesia, on the incidenc e and severity of agitation occurring after sevoflurane administration. Com pared to the placebo group, midazolam prophylaxis significantly decreased t he incidence of postanaesthetic delirium. However, the incidence of severe agitation requiring treatment was not different between the groups (placebo : n=6; midazolam: n=4). The mean severity of agitation was significantly lo wer in patients with midazolam prophylaxis. When midazolam was administered for the treatment of severe agitation it reduced the severity but did not abolish agitation. All patients were discharged from the recovery room afte r the 2 h observation period. From our study we conclude that a small proph ylactic midazolam bolus is able to reduce the incidence and severity of agi tation after sevoflurane anesthesia in some patients but is insufficiently effective in patients with severe agitation. Thus, the prophylactic adminis tration of midazolam extenuates but does not solve the problem of post-sevo flurane agitation.