Kain Z N, Mayes L C, Wang S M, Hofstadter M B
Department of Anesthesiology and Pediatrics, Children's Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Anesthesiology. 1999 Mar;90(3):758-65. doi: 10.1097/00000542-199903000-00018.
Although multiple studies document the effect of sedative premedication on preoperative anxiety in children, there is a paucity of data regarding its effect on postoperative behavioral outcomes.
After screening for recent stressful life events, children undergoing anesthesia and surgery were assigned randomly to receive either 0.5 mg/kg midazolam in 15 mg/kg acetaminophen orally (n = 43) or 15 mg/kg acetaminophen orally (n = 43). Using validated measures of anxiety, children were evaluated before and after administration of the intervention and during induction of anesthesia. On postoperative days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed using the Post Hospitalization Behavior Questionnaire.
The intervention group demonstrated significantly lower anxiety levels compared with the placebo group on separation to the operating room and during induction of anesthesia (F[1,77] = 3.95, P = 0.041). Using a multivariate logistic regression model, the authors found that the presence or absence of postoperative behavioral changes was dependent on the group assignment (R = 0.18, P = 0.0001) and days after operation (R = -0.20, P = 0.0001). Post hoc analysis demonstrated that during postoperative days 1-7, a significantly smaller number of children in the midazolam group manifested negative behavioral changes. At week 2 postoperatively, however, there were no significant differences between the midazolam and placebo groups.
Children who are premedicated with midazolam before surgery have fewer negative behavioral changes during the first postoperative week.
尽管多项研究记录了镇静性术前用药对儿童术前焦虑的影响，但关于其对术后行为结果影响的数据却很匮乏。
在筛查近期应激性生活事件后，接受麻醉和手术的儿童被随机分配，分别口服15mg/kg对乙酰氨基酚加0.5mg/kg咪达唑仑（n = 43）或仅口服15mg/kg对乙酰氨基酚（n = 43）。使用经过验证的焦虑测量方法，在干预给药前后以及麻醉诱导期间对儿童进行评估。在术后第1、2、3、7和14天，使用《出院后行为问卷》评估儿童的行为恢复情况。
与安慰剂组相比，干预组在被送往手术室和麻醉诱导期间的焦虑水平显著更低（F[1,77] = 3.95，P = 0.041）。作者通过多元逻辑回归模型发现，术后行为变化的有无取决于分组（R = 0.18，P = 0.0001）和术后天数（R = -0.20，P = 0.0001）。事后分析表明，在术后第1至7天，咪达唑仑组出现负面行为变化的儿童数量明显较少。然而，在术后第2周，咪达唑仑组和安慰剂组之间没有显著差异。
术前使用咪达唑仑进行术前用药的儿童在术后第一周出现的负面行为变化较少。
