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Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone

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Abstract

Seventy five ASA 1 and 2 children, aged between six months and five years were randomized to receive oral midazolam 0.5 mg · kg−1, rectal thiopentone 35 mg · kg−1 or no premedication to compare the safety and efficacy of, and parental attitudes to, both premedicants. Cardio-respiratory variables were recorded from the time of premedication to awakening from anaesthesia. In addition, anxiety and sedation scores and patients’ acceptance of both premedicant and mask at induction, were all recorded using four-point rating scales. Times to recovery and discharge, and parental satisfaction with the pre-medication their child had received were also recorded Children receiving rectal thiopentone had higher sedation scores and were more accepting of the mask than were the other two groups (P < 0.001). Their acceptance of the premedication was similar to that of the midazolam group. Times to spontaneous eye opening and discharge were longer in the thiopentone group (P< 0.005). Parental preoperative satisfaction rating was higher for thiopentone, but not midazolam, than no premedication (P < 0.05). When asked their premedication preferences for subsequent general anaesthetics, a higher proportion of parents whose children were not premedicated requested an alternative regimen (P < 0.01). In conclusion the study found that pre-medication with rectal thiopentone provided superior induction characteristics to oral midazolam, but with a longer recovery period.

Résumé

Cette étude vise à comparer l’efficacité et la sécurité de deux prémédications et l’opinion des parents sur celles-ci. Soixante-quinze enfants ASA 1 et 2 âgés de six mois à cinq ans sont répartis au hasard pour recevoir une prémédication soit au midazolam, 0,5 mg · kg−1, per os ou au thiopentone rectal, 35 mg · kg−1, soit aucune prémédication. Les paramètres cardio-respiratoires sont enregistrés à partir du moment de la prémédication jusqu’au réveil. En outre, les scores de sédation et d’anxiété et d’acceptation des deux prémédications par les parents ainsi que du masque à l’induction par l’enfant sont enregistrés sur une échelle à quatre niveaux. On enregistre aussi le moment du réveil et du congé ainsi que la satisfaction des parents vis-à-vis la prémédication que l’enfant a reçue. Les enfants qui reçoivent le thiopentone rectal ont un score de sédation plus élevé et acceptent plus facilement le masque que les deux autres groupes (P < 0.001). Leur acceptation de la prémédication est identique à celle du groupe midazolam. L’intervalle mesuré jusqu’à l’ouverture des yeux et jusqu’au congé est plus long dans le groupe thiopentone (P < 0.005). À la période pré-opératoire, la cote de satisfaction des parents est plus élevée pour le thiopentone, mais non pour le midazolam, que pour l’absence de prémédication (P < 0.05). Lorsqu’on leur demande quelle serait leur préférence pour une anesthésie générale subséquente, une plus grande proportion de parents dont les enfants n’ont pas reçu de prémédication, répondent qu’ils préféreraient une autre méthode (P < 0.01). Pour conclure, cette étude révèle que la prémédication au thiopentone rectal produit des caractéristiques d’induction supérieurs au midazolam oral, mais qu’elle prolonge la période de récupération.

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Correspondence to Barry Lyons.

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Lyons, B., Cregg, N., Conway, F. et al. Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone. Can J Anaesth 42, 473–478 (1995). https://doi.org/10.1007/BF03011683

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Key words

  • premedication: midazolam, thiopentone
  • anaesthesia: paediatric
  • anaesthesia techniques: general, inhalation