Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy

Andrew Garcia; Elizabeth A Clark; Sohel Rana; Diego Preciado; George M Jeha; Omar Viswanath; Ivan Urits; Alan D Kaye; Claude Abdallah

doi:10.7759/cureus.13101

Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy

Cureus. 2021 Feb 3;13(2):e13101. doi: 10.7759/cureus.13101.

Authors

Andrew Garcia¹, Elizabeth A Clark¹, Sohel Rana², Diego Preciado³, George M Jeha⁴, Omar Viswanath⁵, Ivan Urits⁶, Alan D Kaye⁷, Claude Abdallah²

Affiliations

¹ Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
² Anesthesiology, Children's National Medical Center, Washington, D.C., USA.
³ Otolaryngology - Head and Neck Surgery, Children's National Medical Center, Washington, D.C., USA.
⁴ Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, USA.
⁵ Pain Management, Valley Pain Consultants Envision Physician Services, Phoenix, USA.
⁶ Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
⁷ Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA.

Abstract

Background Midazolam is commonly used preoperatively for anxiety. Adverse effects data in pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy (T&A) is limited. Aims We hypothesized that preoperative midazolam increases the time to emergence from anesthesia and postoperative discharge. Secondary objectives assessed if patients receiving midazolam experienced increased side effects or complications from treatment. Methods This study was a retrospective chart review of patients undergoing T&A from July 2014 to December 2015. Midazolam receiving patients (midazolam group: MG) were compared to patients who did not (non-midazolam group: NMG). Multivariable analyses were performed and adjusted for predefined potential cofounder variables. Results Emergence and discharge times were 5.2 minutes (95% CI [-7.1, 17.4]; p=0.41) and 10.1 minutes (95% CI [-6.7, 26.8]; p=0.24) longer in MG. These results were not statistically significant. Comparing by OSA status, there was no statistical difference in emergence and discharge times between mild, moderate and severe OSA groups or between MG and NMG within each OSA group. Emergence and discharge times in moderate OSA was 6.1 minutes (95% CI [-17.6, 29.8]; p=0.61) and 18.8 minutes (95% CI [-16.4, 53.9]; p=0.29) longer than mild OSA, and in the severe OSA group, 2.6 minutes (95% CI [-19.9, 25.1]; p=0.82) shorter and 2.8 minutes (95% CI [-30.3, 35.9]; p=0.87) longer. The incidence of postoperative complications was comparable between MG and NMG groups. Conclusions Premedication with midazolam was not associated with prolonged emergence or discharge time or higher incidence of complications after anesthesia for T&A in patients with OSA.

Keywords: adenoidectomy; anesthesia; apnea; midazolam; tonsillectomy.