Research ArticleResearchMedication SafetyWorkflow

Clonidine and midazolam did not reduce pediatric emergence delirium in the primary analysis

Paediatric Anaesthesia (PubMed)Aug 1, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A post hoc analysis of prospectively collected data from 4,796 pediatric anesthetics found no significant association between clonidine or midazolam premedication and emergence delirium in the primary propensity-matched analyses.

What NurseJet pulled from the source

Emergence delirium occurred after 6% of anesthetics in the pooled single-hospital cohort. Among 331 children who received clonidine and 731 who received midazolam, neither drug was associated with lower odds in the primary analysis; a secondary adjusted model linked midazolam to higher odds, which the authors described cautiously.

Why this matters for nurses

Pediatric and post-anesthesia nurses assess agitation, pain, orientation, airway safety, and medication effects during emergence. The findings do not support assuming that either premedication prevents delirium and reinforce structured assessment of a distressed child.

Bedside takeaway

Neither premedication reduced emergence delirium in the primary analysis, so structured postoperative assessment remains essential.

How This Applies in Practice

Use this when: Receiving a child after general anesthesia when clonidine or midazolam was used as premedication.

On your shift

Review the anesthesia and medication record and establish the child's expected recovery and pain-management plan.
Use the approved emergence-delirium, pain, sedation, airway, and safety assessments during recovery.
Protect the child and attached devices during agitation and escalate persistent, severe, or atypical findings.

Keep in mind: The primary findings were observational and the secondary midazolam signal may reflect residual confounding. Follow the pediatric recovery protocol, facility policy, and provider orders.

Key takeaways

The analysis pooled 4,796 anesthetics from 10 studies at one tertiary pediatric hospital.
The primary propensity-matched analyses found no significant association for clonidine or midazolam.
A secondary regression model suggested higher emergence-delirium odds with midazolam.
The overall emergence-delirium incidence was 6% in this cohort.

Practice implications

Verify the premedication and anesthesia record, use the unit-approved emergence-delirium and pain assessments, and protect the airway and lines during agitation. Escalate persistent or severe symptoms and avoid attributing all agitation to a single medication without clinical review.

Limitations & cautions

This was a post hoc observational analysis of 10 pooled studies at one hospital, not a randomized comparison of the two drugs. Medication selection and other anesthesia factors may confound the findings, and the midazolam signal appeared only in a secondary model.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Paediatric Anaesthesia (PubMed)

Paediatric Anaesthesia (PubMed). Evaluating the Impact of Clonidine and Midazolam Premedication on Emergence Delirium in Pediatric Patients.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42538855/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

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In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

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Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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AI-summarized from the linked source. Review the original article before applying to practice.

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Adjusted neonatal-mortality odds for freestanding birth centers fluctuated around 1.0 across the 10-year study period. No individual year showed a statistically significant difference from hospital births, including 2020 and 2021 when birth-center volume increased.

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The analysis was restricted to births meeting selected low-risk criteria.
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The observational design cannot establish that birth setting itself caused the mortality pattern.

Why this matters on shift

The findings add national outcome data for counseling and systems planning around freestanding birth-center care for appropriately selected low-risk pregnancies.

Bedside takeaway

Apply local eligibility, surveillance, escalation, and transfer protocols when caring for planned low-risk birth-center patients.

Nursing implications

Keep eligibility, surveillance, escalation, and transfer decisions anchored to local birth-center criteria and maternal-newborn protocols.

Limitations & cautions

Abstract-only summary. The study used retrospective vital-record data, was limited to selected low-risk births, and cannot exclude residual differences between people who delivered in birth centers and hospitals.
AI-summarized from the linked source. Review the original article before applying to practice.

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Journal of midwifery & women's health (PubMed). Neonatal Mortality Risk Among Births in Freestanding Birth Centers, 2015 to 2024.

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Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

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AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

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AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

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