Letters to the Editor
We appreciate Dr. Kumar’s letter and fully agree with him that routine premedication with midazolam is not necessary in children. However, it can be very beneficial in many circumstances and should not be fully rejected, even in day-case anesthesia.
The reason for studying only 1–3-yr-old children in our study stems from the fact that this age group of children often has the most problematic recovery from anesthesia, namely postoperative agitation (1) and psychological disturbances at home (2), as a result of their inexperience in social contact and reduced benefit from psychological preparation (3). In our own study, we could not detect improvement on the quality of recovery in children after midazolam premedication except for improved pattern of sleep the night after surgery (4). Therefore, we do not altogether agree with Dr. Kumar that midazolam may combat the emergence delirium after sevoflurane anesthesia. Incidentally, in the case report by Wells et al. (5) on delirium after sevoflurane anesthesia, all of the children had been given midazolam before anesthesia. Could midazolam also have been a cause for postoperative confusion caused by amnesia?
Hanna Viitanen MD
PhD Päivi Annila MD, PhD
1. Beskow A, Westrin P. Sevoflurane causes more postoperative agitation in children than does halothane. Acta Anaesthesiol Scand 1999; 43:536–41.
2. Kotiniemi LH, Ryhänen PT, Moilanen IK. Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children. Anaesthesia 1997; 52:963–9.
3. Kain ZN, Mayes LC, O’Connor TZ, Cichetti DV. Preoperative anxiety in children. Arch Pediatr Adolesc Med 1996; 150:1238–45.
4. 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.
5. Wells LT, Rasch DK. Emergence “ delirium” after sevoflurane anesthesia: a paranoid delusion? Anesth Analg 1999; 88:1308–10.