Davis P J, Tome J A, McGowan F X, Cohen I T, Latta K, Felder H
Department of Anesthesiology, Children's Hospital of Pittsburgh, Pennsylvania 15213-2583.
Anesthesiology. 1995 Jan;82(1):2-5. doi: 10.1097/00000542-199501000-00002.
The perfect preanesthesia medication and its ideal route of administration are still debated, but for pediatric surgical patients undergoing brief procedures, preanesthesia medication is frequently omitted because of the concern that it will prolong the child's recovery from anesthesia. The effects of nasally administered midazolam on anesthetic recovery and hospital discharge times were determined in 88 ASA physical status 1 and 2 ambulatory surgical patients undergoing a brief surgical procedure.
Using a randomized, double-blind, placebo-controlled design, 88 ambulatory surgical patients 10-36 months of age undergoing myringotomy and tube insertion were entered into the study. All patients were randomly assigned to one of three medication groups. One group received 0.2 mg/kg intranasal midazolam; a second group received 0.3 mg/kg intranasal midazolam; and the third group received intranasal saline drops. All patients were anesthetized with nitrous oxide, oxygen, and halothane administered via mask. The duration of anesthesia lasted between 9 and 10 min. After preanesthetic medication, the children were evaluated for ease of separation and induction of anesthesia. In addition, the time from when the anesthetic was discontinued until the child recovered from anesthesia and the time the child was discharged home were recorded by a nurse observer blinded to the patient grouping.
Children receiving midazolam had smoother, calmer parent-child separation and anesthesia induction scores, and their anesthesia recovery times and hospital discharge times were the same as those receiving placebo.
For children undergoing brief surgical procedures, nasal midazolam provides satisfactory anxiolysis without delaying anesthesia recovery and hospital discharge.
理想的麻醉前用药及其最佳给药途径仍存在争议，但对于接受简短手术的小儿外科患者，由于担心会延长患儿从麻醉中苏醒的时间，常常不使用麻醉前用药。本研究旨在确定88例接受简短手术的美国麻醉医师协会（ASA）身体状况1级和2级的门诊手术患者经鼻给予咪达唑仑对麻醉苏醒和出院时间的影响。
采用随机、双盲、安慰剂对照设计，将88例年龄在10 - 36个月、接受鼓膜切开置管术的门诊手术患者纳入研究。所有患者被随机分为三个用药组。一组接受0.2 mg/kg经鼻咪达唑仑；第二组接受0.3 mg/kg经鼻咪达唑仑；第三组接受经鼻滴注生理盐水。所有患者均通过面罩吸入氧化亚氮、氧气和氟烷进行麻醉。麻醉持续时间为9至10分钟。给予麻醉前用药后，评估患儿与父母分离的难易程度及麻醉诱导情况。此外，由对患者分组不知情的护士观察者记录从停止麻醉到患儿从麻醉中苏醒的时间以及患儿出院回家的时间。
接受咪达唑仑的患儿在与父母分离及麻醉诱导时评分更平稳、安静，其麻醉苏醒时间和出院时间与接受安慰剂的患儿相同。
对于接受简短手术的患儿，经鼻给予咪达唑仑可提供满意的抗焦虑效果，且不延迟麻醉苏醒和出院时间。
