Abstract
Purpose
To investigate the effects of midazolam on emotional reactivity during induction of anesthesia in a pediatric day surgery setting. A secondary purpose was to determine if these effects were influenced by child temperament factors.
Methods
Forty children (age four to six years) scheduled for myringotomy were randomly assigned, in a double blind fashion, to receive either oral midazolam 0.5 mg·kg-1 mixed with acetaminophen suspension or acetaminophen alone. The Emotionality, Activity, Sociability, and Impulsivity (EASI) scale was used as a measure of child temperament. The modified Yale Preoperative Anxiety Scale (m-YPAS), an observer-rated measure of state anxiety, was employed to assess anxiety preand post-drug, and also at induction of anesthesia.
Results
Children who received midazolam reacted significantly less to induction of anesthesia than did children in the placebo control group, F (1, 38) = 7.46, P = 0.01. A significant positive association was observed between baseline levels of anxiety and observer-rated anxiety at anesthetic induction, but only in the placebo group, r = 0.58, P < 0.01. A significant positive association was observed between levels of impulsivity at baseline and observer-rated anxiety at anesthetic induction, but only in the midazolam group, r = 0.42, P < 0.05.
Conclusions
Midazolam dampened adverse reactivity during anesthetic induction, particularly among children with high baseline levels of anxiety. Baseline level of impulsivity was positively associated with adverse reactions to anesthesia induction in the drug group, but not in the placebo group, suggesting that high levels of trait impulsivity may contraindicate the use of midazolam as a preoperative medication.
Résumé
Objectif
Rechercher les effets du midazolam sur la réactivité émotionnelle pendant ľinduction de ľanesthésie dans le contexte de la chirurgie pédiatrique ďun jour. Aussi, déterminer si ces effets sont soumis à des facteurs de tempérament de ľenfant.
Méthode
Quarante enfants, de quatre à six ans, devant subir une myringotomie, ont été répartis au hasard et à double insu. Ils ont reçu 0,5 mg·kg-1 de midazolam oral mêlé à une suspension ďacétaminophène ou seulement de ľacétaminophène. Ľéchelle EASI (Émotivité, Activité, Sociabilité et Impulsivité) a permis de mesurer le tempérament des enfants. Ľéchelle modifiée ďanxiété préopératoire de Yale, une mesure de ľétat ďanxiété cotée par un observateur, a servi à évaluer ľanxiété avant et après la médication et à ľinduction anesthésique.
Résultats
Les réactions ont été significativement moindres à ľinduction de ľanesthésie avec le midazolam qu’avec le placebo, F (1, 38) = 7,46, P = 0,01. Une association positive significative a été notée entre les niveaux ďanxiété de base et ľanxiété cotée par ľobservateur à ľinduction dans le groupe témoin seulement, r = 0,58, P < 0,01. Une association positive significative a été notée entre les niveaux ďimpulsivité de base et ľanxiété cotée par ľobservateur à ľinduction chez les enfants sous médication seulement, r = 0,42, P < 0,05.
Conclusion
Le midazolam a diminué la réactivité indésirable pendant ľinduction anesthésique, surtout chez les enfants qui avaient des niveaux de base élevés ďanxiété. La présence ďune impulsivité de base a été positivement associée aux réactions indésirables à ľinduction seulement chez les enfants qui ont reçu le médicament, ce qui indique que de hauts niveaux ďimpulsivité peuvent être contre-indiqués à ľusage de midazolam comme médication préopératoire.
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Finley, G.A., H.Stewart, S., Buffett-Jerrott, S. et al. High levels of impulsivity may contraindicate midazolam premedication in children. Can J Anesth 53, 73–78 (2006). https://doi.org/10.1007/BF03021530
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DOI: https://doi.org/10.1007/BF03021530