Melatonin versus midazolam premedication in children undergoing surgery: A pilot study.
Reviewer: Dr. Alan Gaby
Author: Gitto E, et al
Reference: Melatonin versus midazolam premedication in children undergoing surgery: A pilot study. J Paediatr Child Health 2016;52:291-295.
Design: Randomized double-blind placebo-controlled trial.
Participants: Ninety-two children (aged 5-14 years) scheduled for elective surgery.
Study Medication and Dosage: Premedication with oral melatonin (0.5 mg per kg of body weight) or oral midazolam (0.5 mg per kg) 40 minutes before induction of anesthesia with propofol.
Primary Outcome Measures: Dosage of propofol needed to induce anesthesia, and the degree of pre- and post-anesthesia sedation.
Key Findings: Compared with midazolam, melatonin significantly decreased the dose of propofol required to induce anesthesia. No significant difference was found between groups with respect to pre- and post-anesthesia sedation, which suggests that melatonin is as effective as midazolam.
Practice Implications: Midazolam is widely used prior to induction of anesthesia in both adults and children. Midazolam has a number of side effects including paradoxical reactions, interactions with opioids, variable bioavailability and elimination half-life, excessive sedation, disorientation, impaired psychomotor performance, and amnesia. Melatonin is recognized as an effective alternative to midazolam in adults, but data regarding tis use in children are conflicting. The results of the present study demonstrate that premedication with melatonin can increase the potency of propofol, and that melatonin is an effective alternative to midazolam in children undergoing elective surgery. Use of melatonin as premedication instead of midazolam could decrease the number of adverse reactions in patients undergoing anesthesia.