Ebru KELSAKA, Binnur SARIHASAN, Sibel BARIŞ, Deniz KARAKAYA, Ayla TÜR

Pediyatrik hastalarda rektal premedikasyonda kullanılan diazepam ve midazolamin karşılaştırılması

Bu çalışma; ürogenital cerrahi geçirecek çocuklarda rektal midazolam ve diazepam premedikasyonunun hemodinami, sedasyon, aileden ayrılma ve intravenöz kanülasyona etkilerini karşılaştırmak amacıyla yapıldı. 1-8 yaş arası toplam 40 çocuk 2 gruba ayrıldı. Midazolam grubuna (Grup M) 0.5 mg $kg^{-1}$ midazolam + 0.02 mg kg-1 atropin, Diazepam grubuna (Grup D) 0.5 mg $kg^{-1}$ diazepam + 0.02 mg $kg^{-1}$ atropin rektal olarak cerrahiden 20 dk önce aplikatör ile uygulandı. Sistolik arter basınçları (SAB), kalp atım hızları (KAH) ve periferik oksijen saturasyonları (SpO2) premedikasyondan önce ve sonra, intraoperatif ve postoperatif dönemlerde takip edildi. Aileden ayrılma ve intravenöz kanülasyon skorları kaydedildi. Sedasyon düzeyleri premedikasyondan önce, sonra ve postoperatif 20 dk boyunca değerlendirildi. Çocukların postoperatif ağrıları CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) ile izlendi. Grup M'de 19 olgu ve Grup D'de 10 olgu ailelerinden ayrılırken sakin ve uyuyordu (p0.05). Grup M'deki olguların sedasyon skorları Grup D'dekilere göre daha yüksekti (p

Anahtar Kelimeler:

Kaygı, Midazolam, Premedikasyon, Ürogenital cerrahi prosedürler, Diazepam

Comparison of rectal midazolam and diazepam premedication in pediatric patients

This study was performed to compare rectal midazolam and diazepam premedication on hemodynamics and sedation effects, separation from parents and intravenous cannulation scores in children undergoing urogenital surgery. Forty children, aged between 1 and 8 years, were divided into two groups. 0.5 mg $kg^{-1}$ midazolam + 0.02 mg $kg^{-1}$ atropine in the Midazolam Group (Group M), 0.5 mg $kg^{-1}$ diazepam + 0.02 mg $kg^{-1}$ atropine in the Diazepam Group (Group D) were administered rectally via an applicator 20 minutes before the onset of surgery. Systolic arterial pressure (SAP), heart rate (HR), arterial oxygen saturation (SpO2) were recorded before and after premedication and in the intraoperative and postoperative periods. The seperation and intravenous cannulation scores were noted. Sedation scores were evaluated before and after premedication and 20 minutes postoperatively. Postoperative pain was assessed by CHEOPS (Children's Hospital of Eastern Ontario Pain Scale). Nineteen patients in Group M, 10 patients in Group D were asleep and calm during parental separation (p<0.05). Intravenous cannulation scores were similar between the groups (p>0.05). Sedation scores were higher in Group M than Group D (p<0.05). The number of the patients with CHEOPS score of 5 and above in the first postoperative 15 minutes was lower in the Group M when compared to Group D (p<0.05). We found that rectal midazolam premedication was more effective than rectal diazepam for anxiety and parental seperation in children.

Keywords:

Anxiety, Midazolam, Premedication, Urogenital Surgical Procedures, Diazepam,

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1. Beeby DG, Hughes Jom. Behaviour of unsedated children in the anaesthetic room. Br J Anaesth 1980; 52: 279.
2. Kayhan Z. Pediatrik Anestezi. Hacettepe-Taş Kitapçılık Ltd. Şti, Ankara 1995, 67-71.
3. Kuvaki B, Küçükgüçlü S, Şentürk Z, Türköz A, Arkan A. Çocuk hastalarda rektal premedikasyonda klonidin ile midazolamm karşılaştırılması. Türk Anest Rean Cem Mecmuasıl998;26:30-3.
4. Sonander H, Arnold E, Nilsson K. Effects of the rectal administered of diazepam. Br J Anaesth 1985; 57:578-80.
5. Saint- Maurice C, Meistelman MD, Rey E. The pharmacokinetics of rectal midazolam in children. Anesthesiology 1986; 65: 536-9.
6. Esener Z. Klinik Anestezi. Logos Yayıncılık, Istanbul 1997, 98-101.
7. Mc Groth PJ, Johnson G, Goodman ST, et al. The CHEOPS: a behavioval scale to measure postoperative pain in children. In: Fields HL, Dubner R, Ververo F, eds. Advances in Pain Research and Therapy. New York; Raven Press, 1985: 395.
8. Sigurdsson GH, Lindhal S, Norden N. Influence of premedication on the sympathetic and endocrine responses and cardiac arrhythmias during halothane anaesthesia in children undergoing adenoidectomy. Br J Anaesth 1983; 55: 961-8.
9. Spielberger CD, Gorsuch R. Emotional reactions to surgery. J Consult Clin Psychol 1973; 40: 33.
10. Andersen G, Pedersen NA, Johansson G, Stjernholm P, Reinstrup P. Rectal midazolam as premedicant in children: a dose response study. Paed Anaesth 1994; 4: 365-70.
11. Aydın ON, Gürsoy F, Uğur B. Çocuklarda diazepam, ketamin ve midazolam ile rektal premedikasyonun değerlendirilmesi. Türk Anest Rean Mecmuası 2001; 29: 210-4.
12. Beebe DS, Belani KG, Chang Pi-N, et al. Effectiveness of preoperative sedation with rectal midazolam, ketamin or their combination in young children. Anesth Analg 1992;75:880-4.
13. Roelofse JA, Bijl PVD. Comparison of rectal midazolam and diazepam for premedication in pediatric dental patients. J Oral MaxillofacSurg 1991; 51: 525-9.
14. Çakmak SA, Hancı A, Sivrikaya GU, Ekşioğlu B, Başgül A. Çocuklarda premedikasyonda rektal ketamin, alfentanil ve diazepam etkinliğinin karşılaştırılması. Anestezi Dergisi 2002; 10(3): 198-202.
15. Van der Bijl P, Roelofse JA, Stander IA. Rectal ketamine and midazolam for premedication in pediatric dendistry. J Oral Maxillofac Surg 1991;49(10): 1050-4 (abstract).
16. Conventry DM, Marthin CS, Burke AM. Sedation for pediatric computerized tomography-a double-blind assessment of rectal midazolam. Eur J Anaesthesiol 1991;8(1):29-32.
17. Roelofse JA, Bijl PVD, Stegmann DH. Preanesthetic medication with rectal midazolam in children undergoing dental extraction. J Oral Maxillofac Surg 1990; 48: 791-5.
18. Tanaka M, Sato M, Saito A, Nishikawa T. Reevaluation of rectal ketamine premedication in children: comparison with rectal midazolam. Anesthesiology 2000; 93: 1217-24.
19. Malinovsky JM, Populaire C, Cozian A, et al. Premedication with midazolam in children. Effect of intranasal, rectal and oral routes on plasma midazolam concentrations. Anaesthesia 1995; 50: 351-4.
20. Sjövall S, Kanto J, Hsalo E, Himberg JJ, Kangas L. Midazolam versus atropine plus pethidine as premedication in children. Anaesthesia 1984; 39: 224.
21. Süer AH, Dağlı G, Erk K, Coşar A, Kurt E, Acar V. Pediyatrik olgularda rektal midazolam+atropin ve midazolam+ketamin+atropin premedikasyon uygulaması. Türk Anest Rean Cem Mecmuası 1995; 23: 415-20.
22. Matilla MAK, Ruoppi MK, Ahlstrom-Bengs E, Lorny HM, Pekkola PO. Diazepam in rectal solution as premedican in children with special reference to serum concentration. Br J Anaesth 1981;53:1269-72.
23. Erinçler T, Lüleci N, Tutan A. Çocuklarda rektal premedikasyonda farklı midazolam dozlarının etkileri. Türk Anest Rean Mecmuası 1998; 26: 193-6.
24. Spear RM, Yaster M, Berkowitz ID, Maxwell LG, Bender KS. Preinduction of anesthesia in children with rectally administered midazolam. Anesthesiology 1991;74:670-4.