Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery
Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery
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DOI：
10.1097/aln.0000000000000181
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发表时间：
2014-06-01
期刊：
影响因子：
8.8
通讯作者：
Lee, Hye Won
中科院分区：
文献类型：
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作者：
Cho, Eun Jung;Yoon, Seung Zhoo;Lee, Hye Won
背景：咪达唑仑已被广泛研究用于预防苏醒期躁动。作者先前报告称，在七氟烷麻醉的儿童中，手术结束前静脉注射咪达唑仑（0.05 mg/kg）可降低苏醒期躁动的发生率，但延长苏醒时间。本研究旨在验证以下假设，即较低剂量的咪达唑仑可以抑制七氟醚麻醉儿童的苏醒躁动，同时对苏醒时间的影响最小。在手术结束前，将接受斜视手术的30名患者（1 - 13岁）随机分为1：1：1组，分别接受0.03 mg/kg咪达唑仑、0.05 mg/kg咪达唑仑或生理盐水。使用小儿麻醉苏醒期谵妄量表和四点激越量表评价主要结局，即苏醒期激越的发生率。次要结局是至苏醒时间，定义为从七氟烷停药到拔管的时间。给予0.03 mg/kg咪达唑仑的患者出现激越的发生率较低（5/30，16.7%）和接受0.05 mg/kg咪达唑仑的患者（5/30，16.7%）与接受生理盐水的患者（13/30，43.3%; P = 0.036）。咪达唑仑0.05 mg/kg组患者苏醒时间较长（17.1 +/- 3.4 min，平均值+/- SD），与0.03 mg/kg咪达唑仑组患者相比（14.1 ± 3.6 min; P = 0.0009）或生理盐水（12.8 +/- 4.1 min; P = 0.0003）。静脉给药0.03 mg/在手术结束前给予1 kg咪达唑仑可减少斜视手术患儿的苏醒躁动，而不会延迟其苏醒时间，七氟醚麻醉
Background: Midazolam has been widely studied for preventing emergence agitation. The authors previously reported that in children with sevoflurane anesthesia, intravenous administration of midazolam (0.05 mg/kg) before the end of surgery reduced the incidence of emergence agitation but prolonged the emergence time. This study was designed to test the hypothesis that a lower midazolam dose could suppress emergence agitation with minimal disturbance of the emergence time in children with sevoflurane anesthesia.Methods: In this randomized, double-blind, placebo-controlled trial, 90 children (1 to 13 yr of age) having strabismus surgery were randomized to 1: 1: 1 to receive 0.03 mg/kg of midazolam, 0.05 mg/kg of midazolam, or saline just before the end of surgery. The primary outcome, the incidence of emergence agitation, was evaluated by using the pediatric anesthesia emergence delirium scale and the four-point agitation scale. The secondary outcome was time to emergence, defined as the time from sevoflurane discontinuation to the time to extubation.Results: The incidence of emergence agitation was lower in patients given 0.03 mg/kg of midazolam (5 of 30, 16.7%) and patients given 0.05 mg/kg of midazolam (5 of 30, 16.7%) compared with that in patients given saline (13/of 30, 43.3%; P = 0.036 each). The emergence time was longer in patients given 0.05 mg/kg of midazolam (17.1 +/- 3.4 min, mean +/- SD) compared with that in patients given 0.03 mg/kg of midazolam (14.1 +/- 3.6 min; P = 0.0009) or saline (12.8 +/- 4.1 min; P = 0.0003).Conclusion: Intravenous administration of 0.03 mg/kg of midazolam just before the end of surgery reduces emergence agitation without delaying the emergence time in children having strabismus surgery with sevoflurane anesthesia.