Wang R, Wang W H
Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
Zhonghua Yi Xue Za Zhi. 2016 Jun 28;96(24):1907-11. doi: 10.3760/cma.j.issn.0376-2491.2016.24.007.
To evaluate the effects of intranasal midazolam premedication on children who undergoing inhaled induction of anesthesia with sevoflurane.
One hundred American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ children undergoing elective operations in Tianjin Medical University Cancer Institute and Hospital from June 2014 to June 2015 were randomly assigned into 2 groups, and 50 cases in each group. Patients received different intranasal premedication giving 30 min before anesthesia: midazolam 0.3 mg/kg (control group) and normal saline (placebo group) 2 ml. The following data were observed: the anxiety scores of the children in the preoperative interview (T1), before intranasal premedication (T2), during the induction room play (T3) and in the beginning of sevoflurane-inhaled induction (T4) using Modified Yale Preoperative Anxiety Scale (m-YPAS); the satisfaction scores of parents when children entering the operating room using Visual Analogue Scale (VAS); and the cooperation scores of the children receiving the sevoflurane-inhaled induction using Induction Compliance Checklist (ICC). The process of induction, the induction of sevoflurane and adverse incident were recorded.
The scores of m-YPAS of the induction room play (T3) and in the beginning of sevoflurane-inhaled induction (T4) of the control group were (26.48±9.04) and (40.88±17.31)scores, while those of the placebo group were (32.38±10.67) and (56.50±20.02) scores. The m-YPAS scores of the control group were significantly lower than those of the placebo group (t=2.983, 4.173, all P<0.05). The VAS of the control group and placebo group were (6.55±1.55) and (8.18±1.46) scores, the VAS of the control group was significantly lower than that of the placebo group (t=5.504, P<0.05). The total time of induction of the control group was (84.35±22.47)s, which was significantly shorter than that of the placebo group((104.21±31.05)s, t=3.664, P<0.05). The scores of m-YPAS in the preoperative interview (T1), before intranasal premedication (T2), the scores of ICC, the time of closing eyes and excitement phase of 2 groups had no significant difference (all P>0.05). There was no adverse incident happened in both groups.
Intranasal midazolam provided as premedication can reduce the anxiety for children undergoing inhaled induction of anesthesia with sevoflurane, and shorten the time of induction. It's a safe and effective method for premedication of pediatric anesthesia.
评估鼻内给予咪达唑仑作为术前用药对接受七氟醚吸入诱导麻醉儿童的影响。
选取2014年6月至2015年6月在天津医科大学肿瘤医院接受择期手术的100例美国麻醉医师协会（ASA）Ⅰ-Ⅱ级儿童，随机分为2组，每组50例。患者在麻醉前30分钟接受不同的鼻内术前用药：咪达唑仑0.3mg/kg（对照组）和2ml生理盐水（安慰剂组）。观察以下数据：使用改良耶鲁术前焦虑量表（m-YPAS）评估术前访视（T1）、鼻内术前用药前（T2）、诱导室玩耍期间（T3）和七氟醚吸入诱导开始时（T4）儿童的焦虑评分；使用视觉模拟量表（VAS）评估儿童进入手术室时家长的满意度评分；使用诱导顺应性检查表（ICC）评估接受七氟醚吸入诱导儿童的合作评分。记录诱导过程、七氟醚诱导情况及不良事件。
对照组诱导室玩耍期间（T3）和七氟醚吸入诱导开始时（T4）的m-YPAS评分分别为（26.48±9.04）分和（40.88±17.31）分，而安慰剂组分别为（32.38±10.67）分和（56.50±20.02）分。对照组的m-YPAS评分显著低于安慰剂组（t=2.983，4.173，均P<0.05）。对照组和安慰剂组的VAS评分分别为（6.55±1.55）分和（8.18±1.46）分，对照组的VAS评分显著低于安慰剂组（t=5.504，P<0.05）。对照组的诱导总时间为（84.35±22.47）秒，显著短于安慰剂组（（104.21±31.05）秒，t=3.664，P<0.05）。两组术前访视（T1）、鼻内术前用药前（T2）的m-YPAS评分、ICC评分、闭眼时间和兴奋期无显著差异（均P>0.05）。两组均未发生不良事件。
鼻内给予咪达唑仑作为术前用药可降低接受七氟醚吸入诱导麻醉儿童的焦虑，并缩短诱导时间。这是一种安全有效的小儿麻醉术前用药方法。
