Garcia Andrew, Clark Elizabeth A, Rana Sohel, Preciado Diego, Jeha George M, Viswanath Omar, Urits Ivan, Kaye Alan D, Abdallah Claude
Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Anesthesiology, Children's National Medical Center, Washington, D.C., USA.
Cureus. 2021 Feb 3;13(2):e13101. doi: 10.7759/cureus.13101.
Background Midazolam is commonly used preoperatively for anxiety. Adverse effects data in pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy (T&A) is limited. Aims We hypothesized that preoperative midazolam increases the time to emergence from anesthesia and postoperative discharge. Secondary objectives assessed if patients receiving midazolam experienced increased side effects or complications from treatment. Methods This study was a retrospective chart review of patients undergoing T&A from July 2014 to December 2015. Midazolam receiving patients (midazolam group: MG) were compared to patients who did not (non-midazolam group: NMG). Multivariable analyses were performed and adjusted for predefined potential cofounder variables. Results Emergence and discharge times were 5.2 minutes (95% CI [-7.1, 17.4]; p=0.41) and 10.1 minutes (95% CI [-6.7, 26.8]; p=0.24) longer in MG. These results were not statistically significant. Comparing by OSA status, there was no statistical difference in emergence and discharge times between mild, moderate and severe OSA groups or between MG and NMG within each OSA group. Emergence and discharge times in moderate OSA was 6.1 minutes (95% CI [-17.6, 29.8]; p=0.61) and 18.8 minutes (95% CI [-16.4, 53.9]; p=0.29) longer than mild OSA, and in the severe OSA group, 2.6 minutes (95% CI [-19.9, 25.1]; p=0.82) shorter and 2.8 minutes (95% CI [-30.3, 35.9]; p=0.87) longer. The incidence of postoperative complications was comparable between MG and NMG groups. Conclusions Premedication with midazolam was not associated with prolonged emergence or discharge time or higher incidence of complications after anesthesia for T&A in patients with OSA.
咪达唑仑常用于术前缓解焦虑。关于接受扁桃体切除术和腺样体切除术（T&A）的阻塞性睡眠呼吸暂停（OSA）儿科患者的不良反应数据有限。目的：我们假设术前使用咪达唑仑会延长麻醉苏醒时间和术后出院时间。次要目标是评估接受咪达唑仑治疗的患者是否出现更多的副作用或治疗并发症。方法：本研究是对2014年7月至2015年12月期间接受T&A手术患者的回顾性病历审查。将接受咪达唑仑治疗的患者（咪达唑仑组：MG）与未接受治疗的患者（非咪达唑仑组：NMG）进行比较。进行多变量分析，并对预先定义的潜在混杂变量进行调整。结果：MG组的苏醒时间和出院时间分别延长了5.2分钟（95%CI[-7.1,17.4]；p=0.41）和10.1分钟（95%CI[-6.7,26.8]；p=0.24）。这些结果无统计学意义。按OSA状态比较，轻度、中度和重度OSA组之间以及各OSA组内MG组和NMG组之间的苏醒时间和出院时间无统计学差异。中度OSA组的苏醒时间和出院时间分别比轻度OSA组长6.1分钟（95%CI[-17.6,29.8]；p=0.61）和18.8分钟（95%CI[-16.4,53.9]；p=0.29），而重度OSA组的苏醒时间短2.6分钟（95%CI[-19.9,25.1]；p=0.82），出院时间长2.8分钟（95%CI[-30.3,35.9]；p=0.87）。MG组和NMG组术后并发症的发生率相当。结论：对于OSA患者，术前使用咪达唑仑与T&A麻醉后苏醒时间延长、出院时间延长或并发症发生率升高无关。
