Research Article
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Effect of premedication on hemodynamics and bispectral index in pediatric dental rehabilitation

Year 2016, Volume: 19 Issue: 1, 1 - 8, 03.01.2016

Elif Sungurtekin Ekci

Abstract

Objectives: The aim of this study was to evaluate the effects of rectal midazolam premedication

on hemodynamic parameters and Bispectral Index Scale (BIS) values in children undergoing

general anesthesia (GA) for dental rehabilitation.

Materials and Methods: Records of 30 children aged 2 to 7 years were retrieved and divided

into 2 groups. Group 1 received midazolam 0.3mg/kg body weight rectally and group 2

involved children who did not receive any presedative (control). Mean arterial blood pressure

(MAP), heart rate (HR), oxygen saturation (SpO2), and BIS were evaluated for six times; before

laryngoscopy(1); 1 min(2); 5 min(3); 10 min after nasotracheal intubation(4); at the time of

extubation (5) and at the time of recovery(6). Paired t-test was performed to analyze all data.

p<0.05 was defined as statistically significant.

Results: MAP and HR did not differ significantly between both groups before laryngoscopy

(p>0.05) but increased significantly in control group 1 min after intubation (p<0.04). SpO2

was in the normal range in both groups, which was statistically insignificant (p>0.05). The BIS

records of the midazolam group were slightly lower than the control group in general but this

difference was insignificant (p>0.05).

Conclusions: Midazolam premedication prior to GA induction resulted with lower MAP and HR

than the control group 1 minute after intubation whereas it did not alter BIS values remarkably

at all time intervals. Therefore, the midazolam sedation did not produce a significant change in

reducing GA awareness in children undergoing GA for dental rehabilitation.

Keywords

Bispectral index General anesthesia Midazolam

References

  • Jensen B, Matsson L. Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia. Acta Paediatr 2002; 9: 920-5.
  • Rayner J, Holt R, Blinkhorn F, Duncan K. British Society of Paediatric Dentistry: a policy document on oral health care in preschool children. Int J Paediatr Dent 2003; 13: 279-85.
  • Sheta SA, AlSarheed M. Oral midazolam premedication for children undergoing general anaesthesia for dental care. Int J Pediatr 2009; 2009: 274-380. doi: 10.1155/2009/274380. Epub 2009 Apr 13.
  • Kain ZN, Hofstadter MB, Mayes LC, Krivutza DM, Alexander G, Wang SM, et al. Midazolam. Effects on amnesia and anxiety in children. Anesthesiology 2000; 93: 676-84.
  • Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam. A review of its pharmacological properties and therapeutic use. Drugs 1984; 28: 519‑43.
  • De Boer AG, De Leede LG, Breimer DD. Drug absorption by sublingual and rectal routes. Br J Anaesth 1984; 56: 69-82.
  • Clausen TG, Wolff J, Hansen PB, Larsen F, Rasmussen SN, Dixon JS, et al. Pharmacokinetics of midazolam and alpha-hydroxy-midazolam following rectal and intravenous administration. Br J Clin Pharmacol 1988; 25: 457-63.
  • Saint-Maurice C, Meistelman C, Rey E, Esteve C, de Lauture D, Olive G. The pharmacokinetics of rectal midazolam for premedication in children. Anesthesiology 1986; 65: 536-8.
  • Sigl JC, Chamoun NG. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit 1994; 10: 392-404.
  • Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol 2006; 20: 81-99.
  • Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836-47.
  • Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K, et al. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg 2005; 100: 653-61.
  • Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48: 20-6.
  • Ganesh A, Watcha MF. Bispectral index monitoring in pediatric anesthesia. Curr Opin Anaesthesiol 2004; 17: 229-34.
  • Messieha ZS, Guirguis S, Hanna S. Bispectral index monitoring (BIS) as a guide for intubation without neuromuscular blockade in officebased pediatric general anesthesia: a retrospective evaluation. Anesth Prog 2011; 58: 3-7.
  • Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. AMA Am J Dis Child 1953; 86: 587-91.
  • Finley GA, Stewart SH, Buffett-Jerrott S, Wright KD, Millington D. High levels of impulsivity may contraindicate midazolam premedication in children. Can J Anaesth 2006; 53: 73-8.
  • Ko YP, Huang CJ, Hung YC, Su NY, Tsai PS, Chen CC, et al. Premedication with low-dose oral midazolam reduces the incidence and severity of emergence agitation in pediatric patients following sevoflurane anesthesia. Acta Anaesthesiol Sin 2001; 39: 169-77.
  • Tolksdorf W, Eick C. Rectal, oral and nasal premedication using midazolam in children aged 1-6 years. A comparative clinical study. Anaesthesist 1991; 40: 661-7.
  • Houi N, Boishardy N, Chapotte C, Granry JC, Delhumeau A. Premedication with midazolam in infants. A comparison of different modes of administration. Cah Anesthesiol 1992; 40: 167-70.
  • Spear RM, Yaster M, Berkowitz ID, Maxwell LG, Bender KS, Naclerio R, et al. Preinduction of anesthesia in children with rectally administered midazolam. Anesthesiology 1991; 74: 670-4.
  • Jensen B, Schröder U, Månsson U. Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective, randomized, doubleblind trial in Swedish children aged 1.5-3.5 years. Acta Odontol Scand 1999; 57: 190-4.
  • Messieha ZS, Ananda RC, Hoffman WE, Punwani IC, Koenig HM. Bispectral Index System (BIS) monitoring reduces time to discharge in children requiring intramuscular sedation and general anesthesia for outpatient dental rehabilitation. Pediatr Dent 2004; 26: 256-60.
  • Messieha ZS, Ananda RC, Hoffman WE, Punwani IC, Koenig HM. Bispectral index system (BIS) monitoring reduces time to extubation and discharge in children requiring oral presedation and general anesthesia for outpatient dental rehabilitation. Pediatr Dent 2005; 27: 500-4.
  • Errando CL, Sigl JC, Robles M, Calabuig E, García J, Arocas F, et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth 2008; 101: 178-85.
  • Miller DR, Blew PG, Martineau RJ, Hull KA. Midazolam and awareness with recall during total intravenous anaesthesia. Can J Anaesth 1996; 43: 946-53.
  • Barr G, Anderson RE, Samuelsson S, Owall A, Jakobsson JG. Fentanyl and midazolam anaesthesia for coronary bypass surgery: a clinical study of bispectral electroencephalogram analysis, drug concentrations and recall. Br J Anaesth 2000; 84: 749-52.
  • Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO. Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients. Anesthesiology 2005; 103: 1142-8.
  • Miyake W, Oda Y, Ikeda Y, Tanaka K, Hagihira S, Iwaki H, et al. Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation. J Anesth 2010; 24: 161‑7.

Year 2016, Volume: 19 Issue: 1, 1 - 8, 03.01.2016

Elif Sungurtekin Ekci

Abstract

References

  • Jensen B, Matsson L. Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia. Acta Paediatr 2002; 9: 920-5.
  • Rayner J, Holt R, Blinkhorn F, Duncan K. British Society of Paediatric Dentistry: a policy document on oral health care in preschool children. Int J Paediatr Dent 2003; 13: 279-85.
  • Sheta SA, AlSarheed M. Oral midazolam premedication for children undergoing general anaesthesia for dental care. Int J Pediatr 2009; 2009: 274-380. doi: 10.1155/2009/274380. Epub 2009 Apr 13.
  • Kain ZN, Hofstadter MB, Mayes LC, Krivutza DM, Alexander G, Wang SM, et al. Midazolam. Effects on amnesia and anxiety in children. Anesthesiology 2000; 93: 676-84.
  • Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam. A review of its pharmacological properties and therapeutic use. Drugs 1984; 28: 519‑43.
  • De Boer AG, De Leede LG, Breimer DD. Drug absorption by sublingual and rectal routes. Br J Anaesth 1984; 56: 69-82.
  • Clausen TG, Wolff J, Hansen PB, Larsen F, Rasmussen SN, Dixon JS, et al. Pharmacokinetics of midazolam and alpha-hydroxy-midazolam following rectal and intravenous administration. Br J Clin Pharmacol 1988; 25: 457-63.
  • Saint-Maurice C, Meistelman C, Rey E, Esteve C, de Lauture D, Olive G. The pharmacokinetics of rectal midazolam for premedication in children. Anesthesiology 1986; 65: 536-8.
  • Sigl JC, Chamoun NG. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit 1994; 10: 392-404.
  • Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol 2006; 20: 81-99.
  • Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836-47.
  • Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K, et al. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg 2005; 100: 653-61.
  • Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48: 20-6.
  • Ganesh A, Watcha MF. Bispectral index monitoring in pediatric anesthesia. Curr Opin Anaesthesiol 2004; 17: 229-34.
  • Messieha ZS, Guirguis S, Hanna S. Bispectral index monitoring (BIS) as a guide for intubation without neuromuscular blockade in officebased pediatric general anesthesia: a retrospective evaluation. Anesth Prog 2011; 58: 3-7.
  • Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. AMA Am J Dis Child 1953; 86: 587-91.
  • Finley GA, Stewart SH, Buffett-Jerrott S, Wright KD, Millington D. High levels of impulsivity may contraindicate midazolam premedication in children. Can J Anaesth 2006; 53: 73-8.
  • Ko YP, Huang CJ, Hung YC, Su NY, Tsai PS, Chen CC, et al. Premedication with low-dose oral midazolam reduces the incidence and severity of emergence agitation in pediatric patients following sevoflurane anesthesia. Acta Anaesthesiol Sin 2001; 39: 169-77.
  • Tolksdorf W, Eick C. Rectal, oral and nasal premedication using midazolam in children aged 1-6 years. A comparative clinical study. Anaesthesist 1991; 40: 661-7.
  • Houi N, Boishardy N, Chapotte C, Granry JC, Delhumeau A. Premedication with midazolam in infants. A comparison of different modes of administration. Cah Anesthesiol 1992; 40: 167-70.
  • Spear RM, Yaster M, Berkowitz ID, Maxwell LG, Bender KS, Naclerio R, et al. Preinduction of anesthesia in children with rectally administered midazolam. Anesthesiology 1991; 74: 670-4.
  • Jensen B, Schröder U, Månsson U. Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective, randomized, doubleblind trial in Swedish children aged 1.5-3.5 years. Acta Odontol Scand 1999; 57: 190-4.
  • Messieha ZS, Ananda RC, Hoffman WE, Punwani IC, Koenig HM. Bispectral Index System (BIS) monitoring reduces time to discharge in children requiring intramuscular sedation and general anesthesia for outpatient dental rehabilitation. Pediatr Dent 2004; 26: 256-60.
  • Messieha ZS, Ananda RC, Hoffman WE, Punwani IC, Koenig HM. Bispectral index system (BIS) monitoring reduces time to extubation and discharge in children requiring oral presedation and general anesthesia for outpatient dental rehabilitation. Pediatr Dent 2005; 27: 500-4.
  • Errando CL, Sigl JC, Robles M, Calabuig E, García J, Arocas F, et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth 2008; 101: 178-85.
  • Miller DR, Blew PG, Martineau RJ, Hull KA. Midazolam and awareness with recall during total intravenous anaesthesia. Can J Anaesth 1996; 43: 946-53.
  • Barr G, Anderson RE, Samuelsson S, Owall A, Jakobsson JG. Fentanyl and midazolam anaesthesia for coronary bypass surgery: a clinical study of bispectral electroencephalogram analysis, drug concentrations and recall. Br J Anaesth 2000; 84: 749-52.
  • Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO. Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients. Anesthesiology 2005; 103: 1142-8.
  • Miyake W, Oda Y, Ikeda Y, Tanaka K, Hagihira S, Iwaki H, et al. Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation. J Anesth 2010; 24: 161‑7.
There are 29 citations in total.

Details

Subjects Health Care Administration
Journal Section Original Research Articles
Authors

Elif Sungurtekin Ekci

Publication Date January 3, 2016
Submission Date December 6, 2016
Published in Issue Year 2016Volume: 19 Issue: 1

Cite

EndNote Sungurtekin Ekci E (January 1, 2016) Effect of premedication on hemodynamics and bispectral index in pediatric dental rehabilitation. Cumhuriyet Dental Journal 19 1 1–8.

Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.


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