A comparison of midazolam and zolpidem as oral premedication in children

Abstract

Purpose of Study: Pediatric surgical procedures are stressful for the patient as well as the parents. To minimize distress, premedication is often administered to decrease anxiety prior to surgery. Midazolam is most commonly used, however previous studies have shown it to be effective only 57% of the time at parental separation (Can J Anaesth 2006; 53:1213-19). This study was designed to determine if zolpidem is more effective at alleviating patient and parental anxiety than midazolam. Methods Used: We designed a prospective randomized double-blinded clinical trial in which pediatric patients undergoing inpatient surgical procedures were evaluated. The level of patient anxiety was determined using the Modified Yale Preoperative Anxiety Score both prior to medication administration and at parental separation. The parental anxiety pre- and postseparation was measured using the State-Trait Anxiety Inventory for Adults. Patients were also evaluated for mask acceptance and presence of emergence agitation during recovery. Summary of Results: Preliminary analysis of blinded data from the initial 21 patients shows no difference between anxiety scores at separation compared to baseline (fig 1), which may indicate effectiveness of the sedative medications being administered. Results of our planned interim analysis of unblinded data will be presented. Conclusions: Reliably produced anxiety reduction from premedication could decrease patient and parental anxiety at the time of separation. Ongoing subject enrollment and further study is needed to ascertain the potential role of zolpidem for this use. (Figure Presented).