Postsurgery Distress in Children Eased by Hormone Treatment

Oral treatment with melatonin in children before undergoing surgery can significantly reduce the occurrence of emergence delirium, according to a new study.

Researchers at the University of California Irvine (USC; USA) examined a study group that consisted of 148 subjects between the ages of two and eight undergoing outpatient surgery under general anesthesia. The children were randomly assigned to receive either midazolam (the recommended premedication for anxiety reduction in children scheduled for surgery) or melatonin orally before surgery. The children were followed throughout their surgical experience as researchers measured anxiety and secondary study outcomes of anesthesia administration compliance and emergence behavior. Behaviors were measured using the Yale preoperative anxiety scale (mYPass), the Induction Compliance Checklist, and the Keegan scale.

The researchers found that preoperative melatonin administration did not effectively reduce anxiety levels; however, it was found that melatonin did demonstrate a direct dose dependent effect on emergence delirium. Children in the melatonin premedication group received any of three doses of melatonin: 0.05 mg/kg, 0.2 mg/kg and 0.4 mg/kg, while the incidence of delirium at each dose was 25%, 8.3%, and 5.4%, respectively. The study was published in the July 2009 issue of Anesthesiology.

"Studies conducted in adults have revealed that oral administration of melatonin before surgery beneficially reduced anxiety levels, but relevant similar treatment data for children undergoing anesthesia and surgery are limited,” said lead author Zeev Kain, M.D., MBA, of the department of anesthesiology. "It was found that melatonin significantly reduced the incidence of emergence delirium in these children. As 3 million children undergo surgery in the U.S. each year, these findings reveal noteworthy health care and treatment implications.”

Emergence delirium is a distressing incidence of acute behavioral changes experienced when emerging from general anesthesia, and affects up to 20% of children who undergo surgery. Acute behavioral changes in the postanesthesia care unit (PACU) include crying, thrashing, and need for restraint. The condition can also lead to the development of behavioral changes outside the recovery suite, with the onset of nightmares, bed wetting, and separation anxiety.

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