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Shin YH, Kim MH, Lee JJ, et al. The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients. Korean J Anesthesiol. 2013;65(1):9-13doi: 10.4097/kjae.2013.65.1.9.
Shin, Y. H., Kim, M. H., Lee, J. J., Choi, S. J., Gwak, M. S., Lee, A. R., Park, M. N., Joo, H. S., & Choi, J. H. (2013). The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients. Korean journal of anesthesiology, 65(1), 9-13. https://doi.org/10.4097/kjae.2013.65.1.9
Shin, Young Hee, et al. "The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients." Korean journal of anesthesiology vol. 65,1 (2013): 9-13. doi: https://doi.org/10.4097/kjae.2013.65.1.9
Shin YH, Kim MH, Lee JJ, Choi SJ, Gwak MS, Lee AR, Park MN, Joo HS, Choi JH. The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients. Korean J Anesthesiol. 2013 Jul;65(1):9-13. doi: 10.4097/kjae.2013.65.1.9. Epub 2013 Jul 19. PMID: 23904933; PMCID: PMC3726857.
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Korean J Anesthesiol. 2013 Jul;65(1):9-13. doi: 10.4097/kjae.2013.65.1.9. Epub 2013 Jul 19.

The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients.

Korean journal of anesthesiology

Young Hee Shin, Myung Hee Kim, Jung Jin Lee, Soo Joo Choi, Mi Sook Gwak, Ae Ryoung Lee, Mi Na Park, Hyo Sung Joo, Jung Hee Choi

Affiliations

  1. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

PMID: 23904933 PMCID: PMC3726857 DOI: 10.4097/kjae.2013.65.1.9

Abstract

BACKGROUND: Although midazolam administration may occasionally induce a paradoxical episode, such as threatened crying and violent behavior in children, systematic studies on the causes of paradoxical reaction are limited. We investigated the effect of children's age and a dose of midazolam on the paradoxical reaction.

METHODS: A total of one hundred sixty four children of 1-3 years and 3-5 years, were enrolled in this study. Each age group randomly received 0.05 mg/kg or 0.1 mg/kg of intravenous midazolam (41 patients/group).

RESULTS: The incidence of paradoxical midazolam reaction in the study groups, 1-3 years with 0.1 mg/kg of intravenous midazolam, 1-3 years with 0.05 mg/kg, 3-5 years with 0.1 mg/kg, and 3-5 years with 0.05 mg/kg were as follows: 29.3%, 12.2%, 7.3% and 2.4%, respectively. The incidence among the 4 groups was significantly different (P = 0.002), highest in the 1-3 years receiving 0.1 mg/kg of midazolam (29.3%). Both age (P = 0.004, OR [95%CI] = 5.3 [1.7-16.8]) and dose of midazolam (P = 0.036, OR [95%CI] = 3.0 [1.1-8.4]) were risk factors. Perioperative clinical data including anxiety scales of children were not associated with the paradoxical midazolam reaction.

CONCLUSIONS: In conclusion, we suggest that children less than 3 years old receiving higher dose of intravenous midazolam are at risk for the paradoxical midazolam reaction.

Keywords: Child; Midazolam; Paradoxical reaction

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