Can we decrease incidence of postoperative delirium in children by changing premedication?

Česká verzia

Authors: A. Kurzová ¹; J. Málek ¹; L. Hess ²
Authors place of work: KAR 3. LF UK a FNKV, Praha ¹; IKEM, Praha, Česká republika ²
Published in the journal: Anest. intenziv. Med., 26, 2015, č. 6, s. 328-332
Category: Anesteziologie - Původní práce

Summary

Objective:
Causes of postoperative delirium in children are probably multifactorial. The aim of our study was to assess if using tramadol instead of midazolam in premedication would decrease incidence of postoperative delirium without worsening conditions for induction to anaesthesia.

Design:
Randomised, double blinded trial.

Setting:
University hospital.

Methods:
After ethics committee approval and parents’ consent, 63 children scheduled for adenoidectomy or tympanostomy were included in the study. Oral premedication of atropine drops 0.02 mg/kg + ibuprofen syrup5 mg/kg and either midazolam 0.4–0.5 mg/kg (group Midazolam), or tramadol 1.0–1.5 mg/kg (group Tramadol) was given 30 minutes before induction. Induction and maintenance of anaesthesia were standardised. The level of anxiety on arrival to operation theatre (OT) (1–5), quality of induction to anaesthesia, postoperative delirium in OT and on ward (during postanaesthetic ward round), incidence of PONV and the interval to the first analgesic request were recorded. Statistical analysis was performed by Mann-Whitney and Pearson xi-square tests with Yates correction, P value < 0.05 was considered significant.

Results:
There were 35 patients in the Midazolam and 28 patients in the Tramadol groups. There were no differences in demography, anxiety on arrival to OT, induction to anaesthesia, need of perioperative analgesics and incidence of PONV. The main difference was in the incidence of postoperative delirium both in OT (24 vs. 8 patients, p = 0.0016) and on the ward (26 vs. 3 patients, p = 0.0000).

Conclusion:
Premedication of children with tramadol instead of midazolam results in significantly reduced incidence of postoperative delirium with unchanged conditions for induction to anaesthesia. Tramadol does not increase the incidence of PONV.

Keywords:
premedication – paediatric anaesthesia – general anaesthesia – postoperative complication – delirium – midazolam – tramadol

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