ArticlePerioperative medicine (London, England)2022
Effect of sedative premedication with oral midazolam on postanesthesia care unit delirium in older adults: a secondary analysis following an uncontrolled before-after design.
Article in Perioperative medicine (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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7 citing papers in PubMed, 11 citations in OpenAlex.
- Effect of electroacupuncture on postoperative delirium in elderly patients undergoing laparoscopic radical prostatectomy: study protocol for a double-center randomized controlled trial.Frontiers in medicine · 2026Article
- The omission of routine preoperative midazolam prescription is associated with increased preoperative sympathetic activation but not mortality: a propensity score matched, before-and-after study.Perioperative medicine (London, England) · 2025Article
- Evaluating Midazolam's Influence on Bispectral Index and Propofol Concentrations Using Schnider and Eleveld Models in Target-Controlled Infusion General Anesthesia: A Prospective Observational Study.Life (Basel, Switzerland) · 2025Article
- Nomogram-based prediction of emergence delirium in elderly patients undergoing laparoscopic surgery.Journal of anesthesia and translational medicine · 2024Article
- Preoperative Midazolam and Patient-Centered Outcomes of Older Patients: The I-PROMOTE Randomized Clinical Trial.JAMA surgery · 2024Article
- Predisposing and precipitating factors for the development of postoperative delirium in critically ill patients in a university intensive care unit.Revista latino-americana de enfermagem · 2024Article
- Prevalence of Emergence Delirium and Associated Factors among Older Patients Who Underwent Elective Surgery: A Multicenter Observational Study.Anesthesiology research and practice · 2022Article
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Authors and funding
10 authors at 1 institution in 1 country.
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Abstract
backgroundSedative premedication with benzodiazepines has been linked with prolonged recovery and inadequate emergence during the immediate postoperative period. We aimed to analyze the association between postanesthesia care unit (PACU) delirium and sedative premedication with oral midazolam.
methodsWe performed a secondary analysis of prospectively collected data before (midazolam cohort) and after (non-midazolam cohort) implementation of a restrictive strategy for oral premedication with midazolam. From March 2015 until July 2018, we included patients 60 years and older, who underwent elective radical prostatectomy for prostate cancer. Exclusion criteria were contraindications to premedication with midazolam, preoperative anxiety, and a history of neurological disorders. Patients, who were scheduled for postoperative admission to the intensive care unit, were excluded. Between 2015 and 2016, patients received 7.5 mg oral midazolam preoperatively (midazolam cohort). Patients included between 2017 and 2018 did not receive any sedative medication preoperatively (non-midazolam cohort). The primary endpoint was the incidence of PACU delirium.
resultsPACU delirium rates were 49% in the midazolam cohort (n = 214) and 33% in the non-midazolam cohort (n = 218). This difference was not statistically significant on multivariable logistic regression analysis (OR 0.847 [95% CI 0.164; 4.367]; P = 0.842). Age (OR 1.102 [95% CI 1.050; 1.156]; P < 0.001), the cumulative dose of sufentanil (OR 1.014 [95% CI 1.005; 1.024]; P = 0.005), and propofol-sufentanil for anesthesia maintenance (OR 2.805 [95% CI 1.497; 5.256]; P = 0.001) were significantly associated with PACU delirium.
conclusionMidazolam for sedative premedication was not significantly associated with PACU delirium. The reduction in the incidence of PACU delirium throughout the study period may be attributable to improvements in perioperative management other than a more restrictive preoperative benzodiazepine administration.
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