Schwartz Cynthia M, Honsinger Kristen, Fischer Beth A, Elmaraghy Charles A
The Ohio State University College of Medicine, USA.
Department of Otolaryngology, Cook Children's Health Care System, USA.
Int J Pediatr Otorhinolaryngol. 2018 Oct;113:248-251. doi: 10.1016/j.ijporl.2018.08.011. Epub 2018 Aug 10.
The objective of this study was to determine if pre-operative oral midazolam administration decreased postoperative oral fluid intake after tonsillectomy with or without adenoidectomy.
A retrospective chart review identified 104 patients who were undergoing tonsillectomy with and without adenoidectomy who were not given midazolam preoperatively and 182 who were given midazolam preoperatively. Indications for tonsillectomy with or without adenoidectomy included obstructive sleep apnea, recurrent acute streptococcal pharyngotonsillitis, and, in selected cases, periodic fever with aphthous stomatitis, pharyngitis and adenopathy. All patients were evaluated in the pre-operative area by the attending anesthesiologist, who then determined whether or not he/she felt the patient would benefit from premedication with oral midazolam prior to surgery. Patients whom the attending anesthesiologist judged would benefit from midazolam were then given a 0.12-1.06 mg/kg dose (mean 0.35 mg/kg, STD 0.12), at the discretion of the anesthesiologist. Various methods were used to perform tonsillectomy, such as coblation and electrocautery, at the discretion of the otolaryngologist. Results were not stratified by surgical technique. Oral fluid intake was calculated by establishing the time of return to the floor from surgery and determining the documented oral fluid intake for the next 12 h. Oral fluid intake per kg per hour was then calculated. The amount of midazolam given was documented.
There was no significant difference in oral fluid intake by group when adjusting for age and weight, F(1, 282) = 0.383, p = 0.537. Also, there was no significant difference in ml/kg/hr by group when adjusting for age and weight, F(1, 282) = 2.813, p = 0.095.
There was no significant difference in oral fluid intake between the no midazolam and midazolam groups, indicating that clinicians can continue to use their judgement in administering midazolam to select anxious patients prior to tonsillectomy with or without adenoidectomy. Future work could include multi-center retrospective reviews or a randomized placebo-controlled trial to examine more carefully the effects of midazolam on postoperative oral fluid intake.
Level IV.
本研究的目的是确定术前口服咪达唑仑是否会减少扁桃体切除术（无论是否同时行腺样体切除术）后的术后口服液体摄入量。
一项回顾性病历审查确定了104例接受扁桃体切除术（无论是否同时行腺样体切除术）且术前未给予咪达唑仑的患者以及182例术前给予咪达唑仑的患者。扁桃体切除术（无论是否同时行腺样体切除术）的适应证包括阻塞性睡眠呼吸暂停、复发性急性链球菌性咽扁桃体炎，以及在某些情况下的周期性发热伴口疮性口炎、咽炎和腺病。所有患者均在术前区域由主治麻醉医师进行评估，然后由其决定患者在手术前是否会从口服咪达唑仑的术前用药中获益。主治麻醉医师判断会从咪达唑仑中获益的患者，然后由麻醉医师酌情给予0.12 - 1.06mg/kg剂量（平均0.35mg/kg，标准差0.12）。耳鼻喉科医师可酌情采用各种方法进行扁桃体切除术，如等离子消融术和电灼术。结果未按手术技术分层。通过确定从手术返回病房的时间并确定接下来12小时记录的口服液体摄入量来计算口服液体摄入量。然后计算每千克每小时的口服液体摄入量。记录给予的咪达唑仑量。
在调整年龄和体重后，两组的口服液体摄入量无显著差异，F(1, 282) = 0.383，p = 0.537。此外，在调整年龄和体重后，两组每千克每小时的毫升数也无显著差异，F(1, 282) = 2.813，p = 0.095。
未使用咪达唑仑组和使用咪达唑仑组的口服液体摄入量无显著差异，这表明临床医生在扁桃体切除术（无论是否同时行腺样体切除术）前给予咪达唑仑以选择焦虑患者时可继续运用其判断力。未来的工作可包括多中心回顾性审查或随机安慰剂对照试验，以更仔细地研究咪达唑仑对术后口服液体摄入量的影响。
四级。
