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EFFECTS OF MIDAZOLAM ON PRE-OPERATIVE ANXIETY IN CHILDREN

Departments of Anesthesia and Psychology, Dalhousie University, Halifax, NS, B3J 3G9

INTRODUCTION

Children often demonstrate anxiety during arrival in the operating room and anesthetic induction. It has become a common practice to administer oral midazolam to increase cooperation and reduce anxiety behaviour in young children¹. This study investigated the effects of midazolam on anxiety behaviour at anesthesia induction in pediatric day surgery patients.

METHOD

Participants were forty 4-6 year old children scheduled for myringotomy. Children were assigned, randomly and double blind, to receive either oral midazolam 0.50 mg/kg, mixed with acetaminophen suspension 15 mg/kg (midazolam group), or acetaminophen alone (control group). The E.A.S.I. (Emotionality-Activity-Scalability-Impulsivity) scale² is a parent-administered measure of temperament that was administered before surgery. The Venham picture tasks tool³ was administered both pre- and post-drug as a subjective measure of preoperative state anxiety. The m-YPAS⁴ is an observer rated measure of state anxiety and was recorded pre- and post-drug and also at the induction of anesthesia. The study was approved by the institution's Research Ethics Board. Parental consent and child assent were obtained.

RESULTS

Children in the midazolam group had significantly lower m-YPAS at anesthesia induction than did children in the control group. Trait emotionality and subjective state anxiety of the child were not related to m-YPAS at anesthesia induction. In the control group, pre-drug m-YPAS correlated with the anesthesia induction m-YPAS (Pearson's r = 0.58, p = 0.007). This correlation was not found in the midazolam group, suggesting that midazolam dampened anxiety behaviour in highly anxious children. However, the child's baseline level of impulsivity (E.A.S.I.-I subscale) did correlate with induction m-YPAS in the midazolam group (r = 0.418, p = 0.03). Children with high levels of impulsivity in the midazolam group reacted more to the induction of anesthesia than did children with low impulsivity in the midazolam group.

CONCLUSION

Although midazolam reduced anxiety behaviour at induction of children with baseline high anxiety levels, there is a sub-group of impulsive children who fail to benefit from midazolam. Future studies will refine our ability to predict this temperament characteristic and make informed decisions regarding premedication.

REFERENCES

1 Anesthesiology 1998; 89: 1147–1156[Medline]

2 J Personality 1973; 41: 513–524

3 J Dent Res 1977; 56: 454–459[Abstract/Free Full Text]

4 Anesth Analg 1997; 85: 783–788[Abstract]

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