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PubMed1985

Course work and grades of premedical students at two liberal arts colleges.

Choices of courses and academic performances of premedical students were investigated at two liberal arts colleges. Four hypotheses tested related to the areas of science concentration in the students' overall academic programs, breadth of the programs, depth of study in subjects outside science, and the grades achieved in all areas. Altogether, 345 students from the classes of 1982 and 1983 were studied. Premedical students were compared with nonpremedical students studying biology and chemistry and with all other students. Premedical students and other students majoring in biology, chemistry, or other health-related subjects had similar distributions of course credits by academic division and studied a greater breadth of subject matter than did other students. In contrast, the other students tended to study one subject outside their major in greater depth than the premedical students and other students majoring in biology and chemistry, and these subjects were usually in an academic division that did not include their major departments. The students from the two colleges who were admitted to medical schools achieved higher grades than either rejected applicants or nonapplicants from the colleges.

Education, Premedical↗
PubMed1991

A two-year experience with premedical postbaccalaureate students admitted to medical school.

To determine how well premedical postbaccalaureate students performed in and adjusted to medical school, the author examined the records for all 123 matriculants to the Brown University Program in Medicine in 1987-88 and 1988-89 and sent each student a questionnaire. More than one-third of the first-year students admitted to Brown were from premedical postbaccalaureate programs (that is, they had taken the traditional premedical course requirements after graduating from college). The postbaccalaureate students were older than the rest of their classmates, on average, and were more likely to have been non-science majors in college. Academic performances over the first two years were comparable in the two groups, and there was no significant difference between the groups in their self-reports of adequacy of preparation or involvement in extracurricular activities. The author concludes that, faced with a smaller applicant pool, medical schools may wish to consider premedical postbaccalaureate students as a valuable resource.

Adaptation, Psychological↗
PubMed1998

Premedication with Xylocaine spray does not lead to a false positive rapid urease test.

Rapid urease tests are used for quick identification of Helicobacter pylori during upper gastrointestinal endoscopy. Rapid urease test solutions contain urea, which in the presence of H. pylori urease, generates ammonia, which changes the test medium color to indicate a positive result. Theoretically, Xylocaine spray (ASTRA, Södertalje, Sweden), which has a basic pH value, could cause a similar positive reaction in the test medium. To determine whether patients premedicated with Xylocaine spray have a higher rate of false positive urease tests, we compared the results of a rapid urease test and histologic stains in 107 patients, 54 premedicated with Xylocaine spray and 53 premedicated with intravenous midazolam but not Xylocaine spray. There were no significant differences in test sensitivity, specificity, or predictive values between the study groups. We conclude that patients can be premedicated with Xylocaine spray without concern that the false positive rate of rapid urease tests will increase.

Anesthetics, Local↗
PubMed1996

Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty?

Evidence of pre-emptive analgetic effect of opioid would offer great potential benefit to patients with postoperative pain, a better pain relief with less opioid. The aim of this double blind randomised trial was to study the effect of intramuscular morphine premedication on postoperative pain. Forty-one patients undergoing total knee arthroplasty were randomly allocated to four groups. Two groups received epidural morphine, 4 mg immediately after operation and 3 mg ten hours later, and two groups the same volume of saline. All patients had access to intravenous PCA-fentanyl. One epidural morphine and one epidural saline group (PreEpiMo and PreMo, respectively) received morphine, 0.14 mg/kg i.m. as premedication. Pain was measured with a visual analogue scale (VAS). Respiration was monitored by means of pulseoximetry, arterial blood gas analysis and rate of breathing. Morphine premedication reduced postoperative pain in the immediate postoperative period in patients with epidural placebo (PreMo), but the effect was absent in patients with PreEpiMo. Epidural morphine (EpiMo) provided stable analgesia with reduced need of PCA-fentanyl. Two patients (10%) (one in EpiMo and one in PreEpiMo) developed respiratory depression requiring naloxone treatment. The dosage of epidural morphine used in this study was a likely explanation of this depression. Nausea, vomiting, itching and urinary retention were the most frequent side effects without significant differences between the groups. In conclusion, morphine premedication had a temporary rest effect on the postoperative pain. Epidural morphine provides a better analgesia than intravenous PCA-fentanyl.

Aged↗
PubMed1993

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.

Administration, Oral↗
PubMed2006

Effects of premedication medicines on the formation of the CYP3A4-dependent metabolite of ropivacaine, 2', 6'-Pipecoloxylidide, on human liver microsomes in vitro.

Ropivacaine is a relatively new amide-type local anaesthetic, mainly used for surgery and postoperative pain relief. In this study we have investigated the interaction between the CYP3A4 metabolite of ropivacaine, 2',6'-pipecoloxylidide (PPX), and premedication with, i.e., psychotropic and antianxiety agents (diazepam, midazolam), hypnotics (thiamylal), local anaesthetics (lidocaine), depolarizing muscular relaxants (vecuronium), antihypertensive (clonidine) and H(2)-receptor antagonist (cimetidine) using human liver microsomes in vitro. The effects of the interaction between PPX and premedications were examined using a human liver microsomal preparation in vitro. The concentrations of ropivacaine and PPX were determined by HPLC with UV detection. The apparent Michaelis-Menten constant (Km) and the maximal velocity of total metabolic formation (V(max)) of PPX, the main metabolite of ropivacaine in human liver microsomes, were 17.7 (microM, mean) and 711 (nmol/min./mg protein, mean), respectively. Five premedications (diazepam, lidocaine, cimetidine, vecuronium and clonidine) did not inhibit ropivacaine metabolism in human liver microsomes at concentrations within the therapeutic range. However, midazolam and thiamylal weakly inhibited ropivacaine metabolism in competitive manner (IC(50) 7.8 microM and 250 microM, respectively). The results show lack of interaction between ropivacaine and seven premedication medicines within the therapeutic range of ropivacaine using human liver microsomes in vitro.

Amides↗
PubMed1982

Response of patients to upper gastrointestinal endoscopy: effect of inherent personality traits and premedication with diazepam.

The influence of personality traits on the reaction of patients to upper gastrointestinal endoscopy was studied prospectively in 86 patients. High N (neuroticism) scores on the Eysenck personality inventory were associated with poor tolerance to and future compliance with the procedure. Although premedication with diazepam did not affect the degree of discomfort and distress during the procedure, it guaranteed acceptance of repeat endoscopy by virtue of its strong amnesic effect. By contrast, not giving premedication to patients who were anxious and had high N scores jeopardized future compliance. These findings suggest that a version of the Eysenck personality inventory should be used to assess patients' neurotic phenotype and their need for premedication before endoscopy. Alternatively, all patients might be given premedication.

Adolescent↗
PubMed2006

The effects of melatonin premedication on propofol and thiopental induction dose-response curves: a prospective, randomized, double-blind study.

BACKGROUND: The effect of melatonin on the intraoperative requirements for i.v.anesthetics has not been documented. We studied the effect of melatonin premedication on the propofol and thiopental dose-response curves for abolition of responses to verbal commands and eyelash stimulation. METHODS: This prospective, randomized, double-blind study included 200 adults with ASA physical status I. Patients received either 0.2 mg/kg melatonin or a placebo orally for premedication (n = 100 per group). Approximately 50 min later, subgroups of 10 melatonin and 10 placebo patients were administered various doses of propofol (0.5, 1.0, 1.5, 2.0, or 2.4 mg/kg) or thiopental (2.0, 3.0, 4.0, 5.0, or 6.0 mg/kg) for anesthetic induction. The ability of each patient to respond to the command, "open your eyes," and the disappearance of the eyelash reflex were assessed 60 s after the end of the injection of propofol or thiopental. Dose-response curves were determined by probit analysis. RESULTS: Melatonin premedication decreased thiopental ED50 values for loss of response to verbal command and eyelash reflex from 3.4 mg/kg (95% confidence interval, 3.2-3.5 mg/kg) and 3.7 mg/kg (3.5-3.9 mg/kg) to 2.7 mg/kg (2.6-2.9 mg/kg) and 2.6 mg/kg (2.5-2.7 mg/kg), respectively (P < 0.05). Corresponding propofol ED50 values decreased from 1.5 mg/kg (1.4-1.6 mg/kg) and 1.6 mg/kg (1.5-1.7 mg/kg) to 0.9 mg/kg (0.8-0.96 mg/kg) and 0.9 mg/kg (0.8-0.95 mg/kg), respectively (P < 0.05). CONCLUSIONS: Melatonin premedication significantly decreased the doses of both propofol and thiopental required to induce anesthesia.

Adolescent↗
PubMed2007

Premedication with pronase or N-acetylcysteine improves visibility during gastroendoscopy: an endoscopist-blinded, prospective, randomized study.

AIM: To assess the efficacy of premedicaton with pronase or N-acetylcysteine (NAC) at 20 min before upper gastrointestinal (UGI) endoscopy and to determine whether pronase or NAC pretreatment influences the reliability of the rapid urease test. METHODS: A total of 146 patients were prospectively and randomly assigned into the study groups according to different premedications before endoscopy. One endoscopist assessed mucosal visibility (MV) with scores ranged from 1 to 4 at four sites in the stomach. The sum of the MV scores from these four locations was defined as the total mucosal visibility (TMV) score. Identification of H pylori was performed using CLO test, histology, and serology. RESULTS: The Group with pronase premedication had a significantly lower TMV score than did the groups with gascon and gascon water (P < 0.001 and P < 0.01, respectively). The group with NAC had a significantly lower TMV score than the group with gascon (P < 0.01) and a trend of a lower MV score than the group with gascon water (P = 0.06). The TMV score did not significantly differ between the group with pronase and the group with NAC (P = 0.39 and P = 0.14, respectively). The sensitivity and specificity of the CLO test were 92.5% and 93.9%, respectively, in groups premedicated with pronase and NAC together. CONCLUSION: Premedication with pronase or NAC at 20 min before UGI endoscopy improves the mucosal visibility of the stomach. Neither pronase nor NAC produces any obvious interference with the CLO test for the identification of H pylori infection.

Acetylcysteine↗
PubMed2001

Biological correlates of acute hypersensitivity events with DAB(389)IL-2 (denileukin diftitox, ONTAK) in cutaneous T-cell lymphoma: decreased frequency and severity with steroid premedication.

DAB(389)IL-2 (denileukin diftitox, ONTAK) is a cytokine-targeted fusion protein that delivers the catalytic domain of diphtheria toxin to lymphoma cells expressing the interleukin-2 receptor (IL-2R). In phase I and phase III studies of DAB(389)IL-2 in patients with cutaneous T-cell lymphoma (CTCL), non-Hodgkin's lymphoma, and Hodgkin's disease in which premedications were limited to diphenhydramine and acetaminophen, acute infusion-related hypersensitivity reactions occurred in 70% of patients and vascular leak syndrome (VLS) in 27%, resulting in discontinuation of therapy in 29% of patients. There was no correlation between the dose or half-life of DAB(389)IL-2 and the occurrence of hypersensitivity events or VLS. To explore whether steroid premedication would improve the tolerability of DAB(389)IL-2, we treated 15 patients with CTCL with either dexamethasone or prednisone prior to each dose of DAB(389)IL-2. The incidence of acute infusion events was significantly decreased, with only three patients experiencing acute infusion events (one grade 4) and only two patients developing clinically apparent VLS. Grade 3 skin rash occurred in two patients and moderately severe asthenia in nine patients. A significantly improved response rate of 60% was noted with the use of steroid premedication compared to prior studies in which steroids were prohibited. We conclude that steroid premedication significantly improves the tolerability of DAB(389)IL-2 without compromising the clinical response.

Adult↗
PubMed2002

[Comparison of zopiclone and midazolam premedication for preoperative anxiolysis].

To compare the anxiolysis property of zopiclone (ZPC) and midazolam (MDZ), 117 patients were given zopiclone 7.5 mg p.o. or midazolam 0.05 mg.kg-1 i.m. as premedication. In the study 1, patients were randomly allocated to 4 groups: ZZ group (n = 16) received ZPC in the night before operation and 2 h before operation, ZM group (n = 18) received ZPC in the night before operation and MDZ 1 h before operation, Z group (n = 18) received ZPC 2 h before operation, and M group (n = 24) received MDZ 1 h before operation. The degree of anxiety was evaluated using the state-trait anxiety inventory (STAI) on the day before operation and after receiving premedication. ZPC showed a significant reduction in the STAI score in the ZZ and Z group, but premedication with MDZ showed no changes in the STAI score. In the study 2, patients were randomly allocated to 2 groups: ZPC group (n = 22) received ZPC 2 h before operation, and M group (n = 19) received MDZ 1 h before operation. The degree of anxiety was evaluated using the visual analog scale (VAS) on the day before operation and after receiving premedication. ZPC showed a significant reduction in the VAS score, but MDZ showed no changes in the VAS. It is concluded that ZPC (7.5 mg p.o.) is suitable to reduce the preoperative anxiety in patients who are to undergo surgery as compared to MDZ (0.05 mg.kg-1 i.m.).

Adult↗
PubMedDate not supplied

A simplified premedication schedule for 1-hour paclitaxel administration.

Many investigations have focused on an optimal dosing schedule for paclitaxel since its regulatory approval. Paclitaxel is generally administered at a dose of 175 mg/m2 IV over 3 hours or 135-175 mg/m2 IV over 24 hours, every 3 weeks. The purpose of this study was to simplify the administration of paclitaxel to make it suitable and practical in the outpatient setting. Using this rationale, the duration of administration was decreased to 1 hour, with a minimized premedication regimen. Fifty-two patients scheduled to receive paclitaxel-based chemotherapy were entered into the study. Tumor types included non-small cell lung cancer, small cell lung cancer, breast cancer, head and neck cancer, and ovarian cancer. Twelve patients received paclitaxel 175 mg/m2 IV, and the remaining 40 patients received paclitaxel 225 mg/m2 IV. Premedication consisted of IV dexamethasone 20 mg over 5-10 minutes, given 30-60 minutes before infusion of paclitaxel,followed by IV dimethindene maleate 4 mg and IV ranitidine 50 mg over 30 minutes. Paclitaxel always was administered before other chemotherapeutic agents. Hypersensitivity reactions were recorded in 4 patients (7.7%) and were not influenced by age, gender, disease, dose schedule, or number of cycles of therapy; no serious hypersensitivity reactions were observed. The present study supports the efficacy and safety of a short premedication schedule; with further study, this schedule might become a standard premedication protocol prior to paclitaxel administration.

Adult↗
PubMed1992

[Is premedication in gastroscopy hazardous?].

Premedication for gastroscopies is still controversial. Most gastroenterologists use premedication routinely, often without control of vital signs. However, even if rarely, serious (mainly cardiorespiratory) complications still occur. In 101 patients in whom a gastroscopy had been performed, oxygen saturation before, during and after the endoscopy was investigated. A fall in saturation was seen in most of the patients but was usually minor. However, severe hypoxemia occurred in some patients, especially if premedication was used. Older patients and patients with severe anemia were particularly at risk. These results emphasize that premedication should not be used without precaution and special surveillance, especially in high risk patients. Prophylactic oxygen administration significantly diminishes the risk.

Age Factors↗
PubMedDate not supplied

[Preoperatory anxiety in children: psychological evaluation of premedication and parental presence efficacy].

OBJECTIVES: The induction of anaesthesia for surgery is a stressful event for child. To treat pre-operative anxiety in children pharmalogical methods (premedication) and behavioural methods (the presence of parents during the induction of anesthesia) are used in combination with each other. The purpose of this investigation was to study the effect of two interventions to alleviate preoperative anxiety of 39 children who are undergoing minor surgery. We studied the influence of some psichological and social characteristics of child and parents on operative period. METHODS: We studied 39 italian speaking children aged 2-14 years ASA 1. We used STAI, a semi structured interview, with questions in the social-demographical area, a valuation scale of the behaviour of the child completed by the anesthesist, a questionaire after surgery for the parent. The descriptive analysis has been performed taking into account the nature of variables (frequency distributions for nominal and ordinal variables; means and standard deviations for cardinal variables). RESULTS: The results show that the age of the child is strongly conditional to the level of stress: negative reactions are more usual in children of pre-school age. The sedative premedication is not an important factor in relieving anxiety, and this result contrasts with published studies, stating the premedication is more effective than presence of a parent. We obtained interesting results by relating the level of stress in the child with other variables: which parent, the level of stress according to the STAI, level of education, type of residence of parents. CONCLUSIONS: Mother's presence during induction resulted of paramount importance. This study shows that the premedication alone is not effective. Some social-demographical factors of the parents have influence.

Adolescent↗
PubMedDate not supplied

Anticholinergic premedication for prevention of oculocardiac reflex during squint surgery.

BACKGROUND: Profound bradycardia during eye surgery is potentially serious event. In clinical practice this Oculocardiac Reflex (OCR) is most often encountered during squint surgery. The objective of this study was to assess the occurrence of OCR and prove the effect of anticholinergic premedication (atropine) to prevent OCR. METHODS: This study comprises of sixty patients (age 2-30 years) operated for squint surgery under general anaesthesia. Cases were divided into two groups of thirty each. Group 1 was premedicated with intravenous injection of atropine and Group 2 did not receive any premedication. Patients were monitored during operation for any bradycardia or dysrhythmias. RESULTS: The observed data showed occurrence of 70% OCR in Group 2 as compared to only 10% in Group 1. Severe bradycardia in 40% cases of Group 2 needed intervention by IV injection of atropine. CONCLUSION: Our study showed that atropine premedication in the patients of squint surgery under general anaesthesia definitely obtunds OCR and prevents any untoward effects of dysrhythmias during eye surgery.

Adolescent↗
PubMed1988

[Is there a risk of global respiratory insufficiency with the use of intramuscular midazolam as premedication for bronchoscopy?].

To determine whether midazolam i.m. as premedication for bronchoscopy involves a risk of overall respiratory failure, we compared hydrocodonum (15 mg i.m.) with midazolam (5-7.5 mg i.m., weight related) as premedication in flexible bronchoscopy in two groups of 30 patients. The two groups were comparable. Arterial blood gases were measured before premedication, before bronchoscopy, and 10 and 60 minutes after the procedure. Significant respiratory depression did not occur in either group. Side effects were rare and similar. Confusional states, as reported with midazolam given orally, were not noted. Midazolam administered as reported above is of value as premedication in flexible bronchoscopy.

Blood Gas Analysis↗
PubMed1979

The interface between premedicine and medicine: expectations of premedical advisors.

Premedical advisors can carry out many varied activities, but all require commitment, resources, and personal interest. Premedical and health career advising appear to be most successful when the task is not assigned to one individual, but is assumed as a university responsibility. Also, premedical advisors seem to be valued more and to have fewer conflicts when they are known by health professional schools and work together with them. Medical schools have a responsibility to assist and support premedical advisors more than is done at present. This need will become increasingly important if the high quality of applicants to medical school is to be maintained in an apparently shrinking applicant pool.(1)

Counseling↗
PubMed1979

[The influence of a beta-adrenolytic premedication on cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)].

Three groups of patients with different premedications were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acid levels during esophago-gastro-duodenoscopy: Group A was premedicated with Bunitrolol, group B was premedicated with Hyoscin-N-butyl-bromide and diazepam, group C was endoscopied without premedication. The pulse rate rose significantly less in group A than in groups A and C; the same phenomenon was observed with regard to the systolic blood pressure. Premature beats occurred in all 3 groups: 32 per cent of the patients in group A, 43 per cent in group B and 60 per cent in group C had at least occasional premature beats; an accumulation of premature beats however occurred significantly less frequently in group A than in groups B or C. A drop of the ST-part of the ECG occurred with about the same frequency in each group. An increase of the plasma free fatty acids, which was noted in groups B and C, could be observed in Group A. A pre-endoscopic medication of beta blocking agents could be a useful measure in patients with labile arterial hypertension, vegatative dysregulation and a hyperkinetic heart syndrome.

Adrenergic beta-Antagonists↗