Abstract
Objective: Causes of postoperative delirium of children are probably multifactorial. The aim of our study was to assess if using tramadol instead of midazolam in premedication will decrease incidence of postoperative delirium without worsening conditions for induction to anaesthesia.
Design: randomised double blinded Setting: University hospital Methods: After ethic committee approval and parents' consent 63 children scheduled for adenotomy or tympanostomy were included. Oral premedication 30 min. before induction to anaesthesia was atropine gtt. 0.02 mg/kg + ibuprofen syrup 5 mg/kg and either midazolam 0.4 - 0.5 mg/kg (group Midazolam), or tramadol 1.0 - 1.5 mg/kg (group Tramadol).
Induction and maintenance of anaesthesia were standard. Level of anxiety after arrival to operation theatre (OS) (1-5), quality of induction to anaesthesia, postoperative delirium at OS and ward (during postanaesthetic ward round), incidence of PONV and interval to the first analgesic request were noticed.
Statistical analysis was performed by Mann-Whitney and Pearson xi-square tests with Yates correction, P value<0.05 was considered significant. Results: There were 35 patients in Midazolam and 28 patients in Tramadol.
There were no differences in demography, anxiety on arrival on OT, induction to anaesthesia need of perioperative analgesic and incidence of PONV. Main difference was in incidence of postoperative delirium both at OT (24 vs. 8 patients p=0.0016) and ward (26 vs. 3 patients p=0.0000).
Conclusion: Premedication of children with tramadol instead of midazolam results in significantly reduced incidence of postoperative delirium with unchanged conditions for induction to anaesthesia. Tramadol does not increase incidence of PONV.