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Emergence delirium varied even when children shared oral midazolam premedication
A prospective cohort identified predictors of emergence delirium among children who all received oral midazolam before tonsil and adenoid surgery.
A prospective cohort identified predictors of emergence delirium among children who all received oral midazolam before tonsil and adenoid surgery.
What a uniform regimen allows researchers to ask
The investigators followed 143 children undergoing elective tonsillectomy and adenoidectomy at one hospital. The children shared an oral midazolam premedication protocol. Forty-seven children, or 32.9%, met the study definition of emergence delirium based on the Pediatric Anesthesia Emergence Delirium scale. That proportion describes the cohort and its overall anesthesia and surgical context.
Which factors helped distinguish cases
The model identified younger age, male sex, lower opioid dosing, and absence of a remifentanil infusion as associated factors. The area under the receiver operating characteristic curve was 0.818 in the derivation cohort. At the reported threshold, sensitivity was 87.2% and specificity was 63.5%. These figures describe how the model separated cases from noncases in the study population. They do not establish that changing any one associated factor would prevent delirium.
What the comparison cannot answer
Because there was no alternative or unmedicated premedication group, the study cannot estimate the effect of giving midazolam versus withholding it. The observational design also leaves room for treatment selection and unmeasured differences. The authors called for external validation before applying the prediction model more broadly. When reviewing a case, use the timing of emergence symptoms, pain assessments, surgical context, and full anesthesia record. A shared exposure can be an important part of the clinical history without explaining why one child experienced delirium and another did not.
Source paper
Original analysis of the supplied journal article, identified as PMC13081614.