Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 140-144

Does midazolam premedication attenuate the emergence agitation of sevoflurane in children?

Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt, Egypt

Correspondence Address:
Fatma A Abd El Aal
Department of Anesthesia, Faculty of Medicine, Assiut University, 71111 Assiut
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Source of Support: None, Conflict of Interest: None

DOI: 10.7123/01.ASJA.0000428202.75638.ac

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Agitation during emergence from general anesthesia is a major postoperative problem that often results in injuries to the patients. It requires the medical staff to restrain and calm patients.


The aim of the study was to determine the effect of midazolam as a sedative–hypnotic drug on the emergence agitation effect of sevoflurane and also to determine whether the effect of sevoflurane inhalational agents on emergence agitation is because of the nature of anesthetic drugs or because of other predisposing factors such as pain and stress.

Patients and methods

After approval from the local ethics committee was obtained, 60 children were included in this double-blind randomized study; the inclusion criteria were ASA I and children aged 1–5 years undergoing nonpainful ocular examination. The children were randomly allocated to two groups. Group S (N=30) received sevoflurane and group SM (N=30) received sevoflurane after premedication with midazolam. A graded inhalational induction technique was used. After discontinuation of anesthesia, all children were allowed to have a calm recovery; on admission to the recovery room, assessment started every 5 min for 15 min according to the Pediatric Anesthesia Emergence Delirium (PAED) scale. Monitoring included calculation of the mean arterial blood pressure, heart rate, and SpO2.


The two groups were comparable in patient characteristics and operative time. After induction, there was a decrease in heart rate and mean arterial blood pressure in all the groups studied. During the recovery and postoperative period, there was an increase in heart rate that was less sharp in groups that received midazolam. The PAED scale score showed statistically significantly higher values in the S group compared with the SM group.


Not only pain control but sedation may also be the proper management for prevention of sevoflurane emergence agitation in children. Addition of midazolam (0.1 mg/kg) produced an efficient sedation and may reduce the intensity of emergence agitation.

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