术前口服咪达唑仑达满意镇静的时机对扁桃体腺样体切除术儿童麻醉诱导及苏醒期的影响OA北大核心CSTPCD

AIM:To investigate the effect of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recov-ery in children undergoing adenotonsillectomy.METHODS:A total of 147 children undergoing elec-tive adenotonsillectomy,with ASA physical status Ⅰor Ⅱ,aged 2-7 years were selected from November 2022 to June 2023 in the Second Affiliated Hospital of Wenzhou Medical University.The children were orally administered 0.5 mg/kg midazolam in preop-erative waiting area and were divided into 10-20 min(rapid onset,M1 group)and 21-30 min(slow onset,M2 group)based on the satisfactory seda-tion time,or equal volume of sugar pear drink oral-ly(blank control group,C group).Children in all three groups received a general anesthesia method of propofol+fentanyl combined with sevoflurane in-duction and sevoflurane maintenance.The primary outcome measures were the induction compliance checklist(ICC)score and the pediatric anesthesia emergence delirium(PAED)score in the post-anes-thesia care unit(PACU)to assess the occurrence of emergence agitation(EA),and the secondary out-come measures included the parental separation anxiety scale(PSAS),sedation Ramsay score,sur-gery duration,recovery time,PACU stay time,dis-charge time,the incidence of perioperative respira-tory adverse events(PRAE)and other adverse events in the ward.RESULTS:147 children were in-cluded in the result analysis,with 49 cases in each group.The proportion of perfect induction(ICC=0)were significantly higher in two M groups than that in group C(95.9％vs.91.8％vs.61.2％,P=0.001).The maximum and average PAED score in PACU in group M1 showed a significantly higher(6.4±5.0 vs.4.4±4.1,P=0.029;5.2±4.5 vs.3.4±3.6,P=0.030),and the incidence of EA was significantly higher than those in group C(10.2％vs.30.6％,P=0.022),and increased compared to the group M2(OR=0.581,95％CI 0.231-1.463,P=0.354).There was no statistically significant difference in the maximum and average PAED scores,incidence of EA between group M2 and group C(P＞0.05).The Ramsay score and PSAS score in two M groups were higher,PACU stay time and recovery time was longer than those in group C(P＜0.05).The pain scores in PACU in group M1 was higher than that of group C(P＜0.05).There was no statistically significant difference in the surgical time,discharge time,the incidence of PRAE and other adverse events in the ward among three groups(P＞0.05).CONCLUSION:Preoperative oral midazolam can improve the ICC and PSAS scores of children during induction,but it also leads to prolonged recovery time and PACU reten-tion time.The rapid onset of midazolam did not re-sult in better induction and recovery quality,but in-stead increased the incidence of EA and postopera-tive pain score.