Emergence Delirium in Children: Many Questions, Few Answers
This is a very interesting study which shows a correlation between Sevoflurane and emergence delirium. This is a study of children, but apparently it also applies to people like me and others.
Here is a quote from the article;
"On the other hand, there are studies in which midazolam premedication did not show any benefit on the quality of recovery from anesthesia (70–72). This finding may possibly be the result of applying a nonspecific measuring tool or a provision of inadequate pain control (70,72). The combination of midazolam and a small dose of diazepam may extend the beneficial effects of premedication until the recovery phase, which decreases the incidence of EA/ED (73). Paradoxically, Cole et al. (16) reported an almost ninefold higher risk of the development of EA in children who were premedicated with midazolam over those who were not premedicated before outpatient surgery under either isoflurane or halothane anesthesia. Benzodiazepines themselves are associated with paradoxical reactions and agitation that are reversed with flumazenil (13,74). Furthermore, the antianalgesic effects of midazolam might worsen pain and increase the incidence of nonspecific agitation that resembles ED (75). However, the results of this study may be disputed because of a lack of randomization in the selection process.
Premedication with melatonin has proven to be a good alternative to midazolam in reducing postoperative excitement (76)."
Pretty good stuff. Some of it is unfortunately pro Versed, but at least they have stated that the opposite can be true in the above statements.