• Hiromi Araki, Yoshihiro Fujiwara, and Yasuhiro Shimada.
• Department of Anesthesiology, Fujita Health University School of Medicine, Banbuntane-Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan.
• J Anesth. 2005 Jan 1;19(3):204-7.

PurposeOral midazolam is frequently used to treat children, but its effect on recovery from anesthesia is controversial. This study was designed to evaluate the effect of flumazenil on reversal of midazolam during recovery from sevoflurane-induced anesthesia in children who underwent caudal analgesia compared to those who did not.MethodsA series of 60 children 1-8 years of age, with an American Society of Anesthesiologists (ASA) physical status of 1 or 2, who were scheduled to undergo herniorrhaphy were randomly assigned to one of four groups: group 1, control/placebo; group 2, control/flumazenil; group 3, caudal/placebo; group 4, caudal/flumazenil. After oral administration of midazolam 0.5 mg x kg(-1), anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen via a face mask with spontaneous ventilation. The time from the discontinuation of anesthetics to emergence was recorded, and at the time of discharge from the operating room each patient's recovery characteristics were assessed using a three-point scale.ResultsEmergence from anesthesia was significantly less agitated in the group of children who underwent caudal analgesia without flumazenil compared to the other three groups. Flumazenil shortened the time to emergence regardless of the application of caudal analgesia, and caudal analgesia delayed the time to emergence regardless of flumazenil administration.ConclusionCaudal analgesia and avoiding the use of flumazenil synergistically resulted in the emergence from anesthesia in a less agitated state for children who underwent herniorrhaphy after oral midazolam premedication.

This article appears in the collection: Is pre-medication useful in pediatric anesthesia?.

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