Letters to the Editor
In the study of Viitanen et al (1), unfortunately, only children 1–3 yr old are included. We feel it would have been better if children of all age groups were included.
According to their study, routine oral premedication with midazolam delays recovery and emergence. But some groups of children may benefit from preoperative sedation before day surgery. These include the unduly anxious child, the child presenting for repeated procedures at short intervals, and the child with learning difficulties with whom it may be difficult to gain rapport. In recent years, considerable interest has been focused on the use of midazolam for sedating these groups of children. With a dose of 0.5–0.75 mg/kg it is effective in terms of rapid onset sedation and anxiolysis, which is needed in children. The main advantage claimed for midazolam premedication is that it does not delay recovery after day surgery and is not associated with an increased incidence of inpatient admission (2). In this usual preanaesthetic dose, it produces amnesia with few side effects, and mental function returns to normal within 4 h, making it a popular choice for ambulatory surgery (3). Further midazolam given as premedicant may combat the emergence delirium which may occur after sevoflurane anaesthesia in children including agitation, restlessness, combativeness and extreme fright (4).
In conclusion, I strongly support their study and discourage the routine use of midazolam as a premedication in children.
I thank Dr Chris Secker, FRCA, Consultant Anaesthetist, Department of Anaesthesia, Staffordshire General Hospital, for his encouragement and teaching on this topic.
S. Sathish Kumar MB, BS
1. Viitanen H, Annila P, Viitanen M, Tarkkila P. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg 1999; 89:75–9.
2. Brennan LJ. Modern day-case anaesthesia for children. Br J Anaesth 1999; 83:91–103.
3. Kennedy SK, Longnecker DE. History and principles of anaesthesiology. In: Gilman AG, Rall TW, Nies AS, Taylor P, eds. Vol 1. The pharmacological basis of therapeutics. New York: Pergamon Press, 1991:269–84.
4. Wells LT, Rasch DK. Emergence “ delirium” after sevoflurane anaesthesia: a paranoid delusion? Br J Anaesth 1999; 83:1308–10.