The Effects of the Loading Dose and Addition of Midazolam on the Involuntary Movement during Induction of Anesthesia with Propofol in Children

Cho, Mee Sun; Han, Jong In; Kim, Dong Yeon; Chung, Rack Kyung; Kim, Jong Hak; Kim, Chi Hyo; Lee, Guie Yong; Lee, Choon Hi

Abstract

BACKGROUND
Spontaneous involuntary movements are a relatively common side effect during induction of anesthesia with propofol and related with the loading dose, especially in children. Midazolam has GABAergic effects that may modify propofol-induced involuntary movements. So the aims of this study was to determine the dose of propofol for induction without involuntary movements in unpremedicated children and to confirm that midazolam may interact with propofol to modify neuroexcitatory movements.
METHODS
Seventy two ASA physical status I, II children, between 4~13 yrs of age were included. The children were randomly assigned to group I (propofol 3 mg/kg), II (propofol 4 mg/kg), III (midazolam 0.1 mg/kg+propofol 3 mg/kg), or IV (midazolam 0.1 mg/kg+propofol 4 mg/kg). After the injection of propofol loading dose, an independent anesthesiologist graded the incidence, severity (grade 1~4), and duration of involuntary movements.
RESULTS
Spontaneous movements were described as excitatory, dystonic, and choreiform, with twisting, flexion, and extension of the arms and legs. The incidence of involuntary movements did not differ between groups. But the incidence of moderate to severe movements was higher in group II than any other group.
CONCLUSIONS
Intravenous midazolam 0.1 mg/kg failed to modify propofol-induced involuntary movements during induction of anesthesia with propofol loading dose 3 mg/kg and 4 mg/kg.