Effects of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children under-going adenotonsillectomy
AIM:To investigate the effect of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recov-ery in children undergoing adenotonsillectomy.METHODS:A total of 147 children undergoing elec-tive adenotonsillectomy,with ASA physical status Ⅰor Ⅱ,aged 2-7 years were selected from November 2022 to June 2023 in the Second Affiliated Hospital of Wenzhou Medical University.The children were orally administered 0.5 mg/kg midazolam in preop-erative waiting area and were divided into 10-20 min(rapid onset,M1 group)and 21-30 min(slow onset,M2 group)based on the satisfactory seda-tion time,or equal volume of sugar pear drink oral-ly(blank control group,C group).Children in all three groups received a general anesthesia method of propofol+fentanyl combined with sevoflurane in-duction and sevoflurane maintenance.The primary outcome measures were the induction compliance checklist(ICC)score and the pediatric anesthesia emergence delirium(PAED)score in the post-anes-thesia care unit(PACU)to assess the occurrence of emergence agitation(EA),and the secondary out-come measures included the parental separation anxiety scale(PSAS),sedation Ramsay score,sur-gery duration,recovery time,PACU stay time,dis-charge time,the incidence of perioperative respira-tory adverse events(PRAE)and other adverse events in the ward.RESULTS:147 children were in-cluded in the result analysis,with 49 cases in each group.The proportion of perfect induction(ICC=0)were significantly higher in two M groups than that in group C(95.9％vs.91.8％vs.61.2％,P=0.001).The maximum and average PAED score in PACU in group M1 showed a significantly higher(6.4±5.0 vs.4.4±4.1,P=0.029;5.2±4.5 vs.3.4±3.6,P=0.030),and the incidence of EA was significantly higher than those in group C(10.2％vs.30.6％,P=0.022),and increased compared to the group M2(OR=0.581,95％CI 0.231-1.463,P=0.354).There was no statistically significant difference in the maximum and average PAED scores,incidence of EA between group M2 and group C(P＞0.05).The Ramsay score and PSAS score in two M groups were higher,PACU stay time and recovery time was longer than those in group C(P＜0.05).The pain scores in PACU in group M1 was higher than that of group C(P＜0.05).There was no statistically significant difference in the surgical time,discharge time,the incidence of PRAE and other adverse events in the ward among three groups(P＞0.05).CONCLUSION:Preoperative oral midazolam can improve the ICC and PSAS scores of children during induction,but it also leads to prolonged recovery time and PACU reten-tion time.The rapid onset of midazolam did not re-sult in better induction and recovery quality,but in-stead increased the incidence of EA and postopera-tive pain score.
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