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Comparison between Midazolam and Hydroxyzine Premedication in Pediatric Day Care Surgery - Abstract

Awadh Almugadam, Aaref Al Kaabi, Kamran Malik



Midazolam is a commonly used premedication in children. It was shown to be more accepted and effective than the Hydroxyzine syrup in reducing anxiety and improving compliance at induction of anesthesia. The aim of this study was to compare the effectiveness of midazolam and hydroxyzine as premedication in children scheduled for day care surgery.

Material and methods

Fifty children, ages 2-8 years participated in the study. Twenty five children randomly received 0.4 mg/kg of oral Midazolam (group M) and other 25 received Hydroxyzine syrup 1 mg/kg (group H) 30-40 minutes before being taken into preoperative area in the operating theater. Level of sedation, separation from family, response to mask induction, pulse, oxygen saturation, pre and post-operative behavior and sleep patterns were noted every 5 minutes by an experienced recovery nurse.


There were significant differences in Ramsay Sedation Score (RSS), response to parental separation and mask induction, or wake-up behavior score. When compared with group H, patients in group M were significantly more cooperative, easy to separate from parents, with less anxiety and they accepted the mask in the operation room within 30 minutes after premedication (P value < 0.05 ). Postoperative agitation was considered significantly lower in group M due to anterograde amnesia in comparison with group H. Though blood pressure and pulse were on lower side in group M than in group H, due to the effect of midazolam which could reduce pain perception by producing sedation and amnesia, oxygen saturation remained the same in both groups with no statistical significance.


Midazolam is more effective compared to Hydroxyzine as premedication in pediatric patients having more intense sedation, excellent parent separation response and lower incidence of postoperative agitation. Vital signs were acceptable and remained the same in both groups. Mean satisfaction of patients and surgeons were significantly better in the Midazolam group. 


Key words: midazolam, hydroxyzine, premedication, anesthesia

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