Effect Of Preoperative Oral Midazolam Sedation On Preoperative Anxiety And Emergence Agitation Among Children Undergoing Adenotonsillectomy Under Sevoflurane Anesthesia

Objective To compare the efficacy of different doses of oral midazolam premedication on preoperative anxiety and emergence agitation among children undergoing adenotonsillectomy under sevoflurane anesthesia.Methods Sixty children aged 2 to 7 years,receiving sevoflurane for adenotonsillectomy were randomly divided into 3 groups（n=20 each）.The 5ml mixture of midazolam 0.5mg·kg^-1,0.75 mg·kg^-1and 10%glucose was taken orally 20³0 min before anesthesia in low dose midazolam group and high dose midazolam group,respectively.While 5ml of10%glucose was taken by the control group.Anesthesia was induced with inhalation of sevoflurane and maintained with iv infusion of remifentanil and inhalation of sevoflurane.Scores of mYPAS,PSAS,MAS,PAED scale and FLACC scale were compared.Times to extubation and discharege from PACU were also recorded.Results The two midazolam groups showed lower mYPAS scores,parental separation scores and higher acceptance rate for anesthetic mask than the control group（P<0.05）.While there was no significant difference between the two midazolam groups（P>0.05）.The incidence and severity of emergence agitation,FLACC scores and time to tracheal extubation were similar among the 3 groups（P>0.05）.Time to discharge from PACU was longer in the high dose midazolam group（P<0.05）.Conclusion Preoperative oral midazolam in a dose of 0.5 mg·kg^-1or 0.75 mg·kg^-120³0 min before anesthesiacan be a useful adjunct in preoperative anxiety management for children undergoing adenotonsillectomy under sevoflurane anesthesia.This,however,dose not result in a reduced incidence of emergence agitation.Oral midazolam 0.75mg·kg^-11 prolongs the time to discharge from PACU while offering no additional benefit.Oral midazolam at a dose of 0.5 mg·kg^-11 may be more appropriate for premedication.