From the Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea.
Anesthesiology. 2014 Jun;120(6):1354-61. doi: 10.1097/ALN.0000000000000181.
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.
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.
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).
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.
咪达唑仑已广泛用于预防苏醒期躁动。作者先前报道，对于七氟醚麻醉的儿童，在手术结束前静脉给予咪达唑仑（0.05mg/kg）可降低苏醒期躁动的发生率，但会延长苏醒时间。本研究旨在验证以下假说，即对于七氟醚麻醉的儿童，给予较低剂量的咪达唑仑可抑制苏醒期躁动，同时最小程度地干扰苏醒时间。
在这项随机、双盲、安慰剂对照试验中，90 名（1 至 13 岁）斜视手术患儿被随机分为 1:1:1 组，分别在手术结束前接受 0.03mg/kg 咪达唑仑、0.05mg/kg 咪达唑仑或生理盐水。主要结局是通过儿科麻醉苏醒期谵妄量表和 4 分躁动量表评估苏醒期躁动的发生率。次要结局是苏醒时间，定义为七氟醚停用至拔管时间。
接受 0.03mg/kg 咪达唑仑（5/30，16.7%）和 0.05mg/kg 咪达唑仑（5/30，16.7%）的患儿苏醒期躁动发生率低于接受生理盐水的患儿（13/30，43.3%；P=0.036 各）。接受 0.05mg/kg 咪达唑仑的患儿苏醒时间较长（17.1±3.4min，平均值±标准差），而接受 0.03mg/kg 咪达唑仑的患儿（14.1±3.6min；P=0.0009）和生理盐水的患儿（12.8±4.1min；P=0.0003）。
斜视手术患儿七氟醚麻醉结束前静脉给予 0.03mg/kg 咪达唑仑可减少苏醒期躁动，而不延迟苏醒时间。
