Indian Journal of Anaesthesia

: 2009  |  Volume : 53  |  Issue : 4  |  Page : 504--505

Melatonin for Anxiolysis in Children

Pramila Bajaj 
 Senior Prof. & Head, Department ofAnaesthesiology, R.N.T Medical College, Udaipur (Raj.), India

Correspondence Address:
Pramila Bajaj
25, Polo Ground, Udaipur (Raj.)

How to cite this article:
Bajaj P. Melatonin for Anxiolysis in Children.Indian J Anaesth 2009;53:504-505

How to cite this URL:
Bajaj P. Melatonin for Anxiolysis in Children. Indian J Anaesth [serial online] 2009 [cited 2020 Nov 29 ];53:504-505
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Up to 65% of children experience intense anxiety throughout the perioperative period, especially in the preoperative holding area and during induction of an­esthesia [1] . Intensity of perioperative anxiety is a predic­tor of both emergence delirium in the postanaesthesia care unit and new-onset maladaptive behavioral changes (e.g., nightmares, enuresis, separation anxiety) [2],[3],[4] . To reducepreoperative anxiety, midazolam is widely used forpremedication in children. Midazolam, which was first introduced as an oral premedication for children in the 1980s, rapidly achieved widespread acceptance as the preferred premedication before induction of an a esthesia. Currently, it is the preferred pre-medication more than 90% of the tune. [5],[6] Midazolam acquired widespread acceptance because of its rapid absorp­tion after oral ingestion; it can also be administered via multiple routes and confers areduced incidence ofnau­sea compared with other benzodiazepines. [7] However, midazolam has several drawbacks, including paradoxi­cal reactions, interactions with opioids, variable bio availability and elimination half-life, and delayed dis­charge from the post- anaesthesia care unit after brief procedures. [7] Moreover, the effects ofmidazolam have been shown to vary with the age and temperament of the child. [8] In light of these drawbacks, an alternative to midazo lam might have widespread appeal.

Consideration of these findings has generated a great deal of interest inthe potentialuses of melatonin in the perioperative setting. This nocturnal neurohorm one is secreted bythe pinealgland, retina, and gastrointesti­naltract. It has several diverse functions, including antioxi­dant, onco static, antiinflammatory, and anticonvulsant activities, as well as regulation of circadian thythms and the reproductive axis. [9],[10] Melatonin has numerous uses: treatment of sleep disorders and jet lag, [9],[10] reduction of oxidative stress in neonates in the perioperative period [11] , protection of the skin from ultraviolet damage, and treatment of psychosis inthe intensive care unit. [12] Most impor­tantly, its hypnotic effects [l3] may be exploited fonts use as a preoperative sedative.

Several studies reported that melatonin is as ef­fective as midazolam in reducing preoperative anxiety in adults, [14] akhough evidence does not support such a role in the elderly. [15] Two recent trials involving children reported that melatonin was as effective in reducing preoperative anxiety as midazolam. [16],[17] Moreover, mel­atonin was associated with a more rapid recovery, a reduced incidence of emergence delirium, and reduced incidence of sleep disturbances 2 weeks after surgery when compared with midazolam. However, both trials suffered from methodological deficiencies such as small sample sizes (with resultant low power) and failure to control for the time of day (important, given variability in endogenous melatonin levels throughoutthe day)

Currently there is no consensus on the appropri­ate dose ofmelatonin for sedation in children. Melato­nin dosing for children is reported to be between 0.3mg and 20 mg [18],[19] Doses as great as 20 mg have been administered to children without adverse side effects apart from sedation [20] . Nonetheless, what remains un­clear is the most appropriate dose to induce sedation. On the basis of these results the possibility can not be excluded, doses of melatonin in excess of 20 mg may be necessary to reduce anxiety.


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