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KMID : 0356920130650010009
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Korean Journal of Anesthesiology
2013 Volume.65 No. 1 p.9 ~ p.13
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The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients
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Shin Young-Hee
Lee Jung-Jin
Kim Myung-Hee
Choi Soo-Joo
Gwak Mi-Sook
Lee Ae-Ryoung
Park Mi-Na
Joo Hyo-Sung
Choi Jung-Hee
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Abstract
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Background: Although midazolam administration may occasionally induce a paradoxical episode, such as threatened crying and violent behavior in children, systematic studies on the causes of paradoxical reaction are limited. We investigated the effect of children’s age and a dose of midazolam on the paradoxical reaction.
Methods: A total of one hundred sixty four children of 1-3 years and 3-5 years, were enrolled in this study. Each age group randomly received 0.05 mg/kg or 0.1 mg/kg of intravenous midazolam (41 patients/group).
Results: The incidence of paradoxical midazolam reaction in the study groups, 1-3 years with 0.1 mg/kg of intravenous midazolam, 1-3 years with 0.05 mg/kg, 3-5 years with 0.1 mg/kg, and 3-5 years with 0.05 mg/kg were as follows: 29.3%, 12.2%, 7.3% and 2.4%, respectively. The incidence among the 4 groups was significantly different (P = 0.002), highest in the 1-3 years receiving 0.1 mg/kg of midazolam (29.3%). Both age (P = 0.004, OR [95%CI] = 5.3 [1.7-16.8]) and dose of midazolam (P = 0.036, OR [95%CI] = 3.0 [1.1-8.4]) were risk factors. Perioperative clinical data including anxiety scales of children were not associated with the paradoxical midazolam reaction.
Conclusions: In conclusion, we suggest that children less than 3 years old receiving higher dose of intravenous midazolam are at risk for the paradoxical midazolam reaction.
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KEYWORD
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Child, Midazolam, Paradoxical reaction
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