Journal of anesthesia · 2026
Association between midazolam premedication and deep sedation following general anesthesia in pediatric patients: a retrospective cohort study.
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Zodl Aurelia, Weingarten Toby N, Schroeder Darrell R, Sprung Juraj, Harrison Tracy E
Аннотация
PURPOSE: We examined if midazolam premedication via oral (PO) vs. intravenous (IV) route in pediatric patients was associated with risk for deep sedation in the postanesthesia care unit.
METHODS: Medical records from May 2018 to December 2023 of patients aged 2-17 years premedicated with midazolam were reviewed and stratified according to administration route. Sedation level was classified using the Richmond Agitation-Sedation Scale: deeply sedated (≤ - 4) or not (≥ - 3). Inverse probability of treatment weighting (IPTW) analysis was performed to assess whether midazolam administration route was associated with postoperative deep sedation.
RESULTS: Among 5245 pediatric patients, 608 (11.6%) experienced deep sedation. In unadjusted analyses, deep sedation occurred more frequently with PO than IV midazolam (13.7% vs. 5.3%, P < 0.001). After IPTW adjustment, this association remained significant (13.3% vs. 6.6%; OR 2.17, 95% CI 1.35-3.48; P = 0.001). The incidence of deep sedation decreased with increasing age and surgical duration. In IPTW-adjusted analyses, route-related differences were significant in patients aged 2-5 years (17.0% vs. 7.3%, P = 0.013) and 6-11 years (12.3% vs. 6.2%, P = 0.018), but not in adolescents (P = 0.632). Deep sedation rates were higher after procedures lasting ≤ 1 h (20.0% vs. 7.6%, P = 0.018), but not for longer procedures. No sedation-related adverse events were observed.
CONCLUSIONS: Oral midazolam is a key driver of postoperative deep sedation in premedicated patients aged 2-11, especially following shorter procedures likely due to limited drug elimination time. Notably, deep sedation was not linked to adverse outcomes.
METHODS: Medical records from May 2018 to December 2023 of patients aged 2-17 years premedicated with midazolam were reviewed and stratified according to administration route. Sedation level was classified using the Richmond Agitation-Sedation Scale: deeply sedated (≤ - 4) or not (≥ - 3). Inverse probability of treatment weighting (IPTW) analysis was performed to assess whether midazolam administration route was associated with postoperative deep sedation.
RESULTS: Among 5245 pediatric patients, 608 (11.6%) experienced deep sedation. In unadjusted analyses, deep sedation occurred more frequently with PO than IV midazolam (13.7% vs. 5.3%, P < 0.001). After IPTW adjustment, this association remained significant (13.3% vs. 6.6%; OR 2.17, 95% CI 1.35-3.48; P = 0.001). The incidence of deep sedation decreased with increasing age and surgical duration. In IPTW-adjusted analyses, route-related differences were significant in patients aged 2-5 years (17.0% vs. 7.3%, P = 0.013) and 6-11 years (12.3% vs. 6.2%, P = 0.018), but not in adolescents (P = 0.632). Deep sedation rates were higher after procedures lasting ≤ 1 h (20.0% vs. 7.6%, P = 0.018), but not for longer procedures. No sedation-related adverse events were observed.
CONCLUSIONS: Oral midazolam is a key driver of postoperative deep sedation in premedicated patients aged 2-11, especially following shorter procedures likely due to limited drug elimination time. Notably, deep sedation was not linked to adverse outcomes.