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PubMedDate not supplied

[Correlation between the effectiveness of premedication and neuroanatomic protection during surgery with NLA and the initial state of the autonomic nervous system].

The study was performed on 94 urological patients, aged 15 to 78 years, subjected to planned operations. The initial autonomic tone, autonomic reactivity, autonomic maintenance of the activity, ACTH and cortisol content have been investigated in the ward and in the operation room with concomitant premedication with pipolphen in combination with promedol and diazepam in combination with promedol. Tactile and pain thresholds were studied in patients on premedication in the ward and the operation room. It has been noted that positive effect of premedication, an increase in the pain threshold and adequate neuroautonomic protection do not only depend on the presence or absence of diazepam in premedication, but also on the initial autonomic tone, autonomic reactivity, and autonomic maintenance of the activity. The above parameters in their turn depend on the functional state of the autonomic nervous system, the patient's age, concomitant diseases, and other factors determining general physical status of the patient.

Adolescent↗
PubMedDate not supplied

Increasing the pool of qualified minority medical school applicants: premedical training at historically black colleges and universities.

Historically black colleges and universities have educated significant numbers of black students preparing for careers in medicine. These institutions have the potential to make even greater contributions to the pool of black medical school applicants and ultimately to the supply of black physicians. The Division of Disadvantaged Assistance, Bureau of Health Professions, Health Resources and Services Administration within the Public Health Service, commissioned a study of the curriculums and other factors related to premedical education. The study was conducted at the historically black colleges and universities that graduate a large number of students who gain admission to medical school, and the historically black colleges and universities whose students are less successful in gaining admission to medical school. Nine historically black colleges and universities participated in a self-assessment of their undergraduate premedical curriculums. The findings from schools with higher acceptance rates were compared with those of schools with lower acceptance rates to identify factors contributing to the production of significant numbers of successful medical school applicants. Comparisons of data on these schools revealed several important factors that may be related to differences in acceptance rates: Those schools that devoted greater effort to premedical training (for example, advising students about how to prepare for medical school, curriculum development, maintaining premedical or pre-health professions offices and clubs--the staff of these offices provide students with information on medical or other health professions schools--to identify and recruit students) tended to have higher acceptance rates. * Schools with higher acceptance rates had larger proportions of biology and chemistry majors aspiring to medical and dental careers and stronger affiliations with medical schools than schools with lower acceptance rates.* Institutions with higher acceptance rates offered a broader range of externally sponsored enrichment programs; the highest medical school acceptance rates were found among those schools with continuing Health Careers Opportunity Program projects that served significant percentages of students interested in careers in medicine.* Mean Medical College Admission Test scores were somewhat lower for applicants from schools with lower acceptance rates, but the great variation in acceptance rates for these schools is not reflected in a comparable variation in the Medical College Admission Test scores.

Black or African American↗
PubMedDate not supplied

[The influence of premedication with diclofenac or pethidine on pain and postop treatment in lumbar discopathy].

206 patients scheduled for spinal surgery (lumbar discopathy) were randomly premedicated with diclofenac, pethidine, diazepam or hydroxizine. The frequency of persisted postoperative pain was evaluated from the 3-ed. postoperative day to the end of hospitalisation--as the need for additional concomitant treatment with dexamethasone and intravenous analgesics. The frequency of persisted pain was significantly decreased in patients premedicated with diclofenac (together with diazepam) before spinal surgery (limited to fenestration) in comparison to patients premedicated with pethidine. The pre-emptive analgesic effect of diclofenac was even more evident in patients treated with non-steroidal anti-inflammatory drugs (NSAID) before surgery, but was not observed in patients after more traumatic surgery (laminectomy) premedicated with diazepam. The results are supporting the important role of NSAID given before surgery to decrease the frequency of persisted pain after spinal surgery (limited to fenestration), in patients treated with NSAID.

Adult↗
PubMed1980

Premedication for outpatient adenoidectomy: comparison between ketamine and pethidine.

A comparison of intramuscular ketamine and pethidine as premedicants was carried out in a series of 32 children under two years of age who were given thiopentone-N2O-O2-succinyl choline anesthesia for elective outpatient adenoidectomy. Fourteen (87.5%) of the 16 children premedicated with ketamine (3 mg./kg.) were calm or asleep when brought into the operating room as compared to 4 (25.0%) of the 16 children (p less than 0.001) premedicated with pethidine (1 mg/kg.). Immediate recovery was similar in the groups premedicated with ketamine and pethidine. These two small groups of children did not differ significantly in their emotional state during recovery room observation, nor during the 48 postoperative hours at home, either. It is suggested that ketamine administered intramuscularly is a suitable agent for outpatient premedication of small children because of its rapid action, excellent sedative and analgesic properties and low incidence of side-effects.

Adenoidectomy↗
PubMed1980

Comparison of the calming and sedative effects of nalbuphine and pentazocine for paediatric premedication.

Nalbuphine (EN2234A) is an agonist-antagonist analgesic. It is structurally related to the narcotic analgesic oxymorphone and to the narcotic antagonist naloxone. A double blind study was carried out in 400 children in ASA classification I, ranging from 10 months to 14 years of age, to compare nalbuphine, pentazocine and placebo for paediatric premedication. Our results showed that nalbuphine is comparable to pentazocine as a premedicating agent and superior to placebo, in the doses used, and that premedication is an important adjunct to anaesthesia in children. Following premedication with nalbuphine or pentazocine, there were fewer apprehensive children at the time of induction of anaesthesia and in the recovery room when compared to those receiving placebo injections.

Adolescent↗
PubMed1993

Oral midazolam premedication for children with congenital cyanotic heart disease undergoing cardiac surgery: a comparative study.

To determine whether oral midazolam is a safe and effective alternative to our current standard premedication for children with cyanotic congenital heart disease (CCHD), 30 children aged 1-6 yr, scheduled for elective cardiac surgery, were studied. The children were randomly assigned to one of two groups: Group I received oral midazolam 0.75 mg.kg-1 30 min before separation from their parents in the surgical waiting area, and Group II received oral or rectal pentobarbitone 2 mg.kg-1 at 90 min, and morphine 0.2 mg.kg-1 and atropine 0.02 mg.kg-1 im at 60 min before separation. Heart rate, haemoglobin oxygen saturation (SpO2) and anxiolysis and sedation scores were recorded at four times during the study: at baseline (immediately before premedication), immediately after administration of the premedication, at separation of children from parents in the waiting area and at the time of application of the face mask in the operating room. We found that in Group I, anxiolysis improved at separation from parents compared with baseline (P < 0.05) and sedation increased both at separation and on mask application (P < 0.05), whereas in Group II anxiolysis did not change at any time and sedation increased only at separation (P < 0.05). Intramuscular injection of morphine produced a transient decrease in mean SpO2 (from 84% to 76%) (P < 0.05) that did not occur after ingestion of oral midazolam. The results of this study indicate that oral midazolam is a safe and effective replacement for the standard premedication for children with CCHD undergoing cardiac surgery and avoids the decrease in SpO2 associated with im injections.

Administration, Oral↗
PubMed1999

Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr.

PURPOSE: To study the effect of midazolam premedication on the recovery characteristics of sevoflurane anesthesia induced with propofol in pediatric outpatients. METHODS: Sixty children, one to three years, presenting for ambulatory adenoidectomy were randomly assigned , in a double-blind fashion, to receive either 0.5 mg x kg(-1) midazolam (Group M) or placebo (Group P) p.o. 30 min before anesthesia. Anesthesia was induced with 10 microg x kg(-1) atropine, 10 microg x kg(-1) alfentanil, and 3-4 mg x kg(-1) propofol i.v.. Tracheal intubation was facilitated with 0.2 mg x kg(-1) mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane with controlled ventilation. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery end-points (emergence, full Aldrete score, discharge). A postoperative questionnaire was used to evaluate the children's well-being at home until 24 hr after discharge. RESULTS: Emergence from anesthesia (22 +/- 9 vs 16 +/- 6 min (mean +/- SD), P = 0.005) and achieving full Aldrete scores (30 +/- 11 vs 24 +/- 16 min, P = 0.006) were delayed in patients receiving midazolam. Children in the placebo group were given postoperative analgesia sooner than those in the midazolam group (18 +/- 11 vs 23 +/- 8 min, P = 0.009). More children premedicated with midazolam suffered from arousal distress (20% vs 3%, P = 0.04) and scored higher on the Pain/Discomfort scale (P = 0.004) at 20 min after arrival in the recovery room. Discharge was not affected by premedication and well-being at home was similar in the groups. CONCLUSIONS: Oral premedication with midazolam delays early recovery but not discharge after ambulatory sevoflurane anesthesia induced with propofol in children one to three years. Midazolam did not improve the quality of recovery.

Adenoidectomy↗
PubMed2002

Benzodiazepine premedication may attenuate the stress response in daycase anesthesia: a pilot study.

PURPOSE: Patients undergoing daycase surgery suffer from varying degrees of fear and anxiety. There is conflicting evidence in the literature regarding the benefit of benzodiazepine premedication in daycase surgery. We carried out a prospective, double-blind, randomized pilot study investigating the effect of benzodiazepine premedication on the stress response in patients undergoing daycase anesthesia and surgery. METHODS: Group I (n = 16) received diazepam 0.1 mg*kg(-1) orally 60 min preoperatively; Group II (n = 15) received diazepam 0.1 mg*kg(-1) orally 90 min preoperatively; Group III (n = 30) received a placebo. The stress response was measured by analyzing urinary catecholamine and cortisol levels and by scoring anxiety levels using state-trait anxiety inventory (STAI) scores and visual analogue scores (VAS). RESULTS: Anxiety scores (VAS and STAI scores) were not different between groups. We found a statistically significant reduction in urinary cortisol and noradrenaline levels in the groups receiving diazepam vs placebo. DISCUSSION: The reduction in stress hormones following diazepam premedication, in patients undergoing daycase surgery may support the role for benzodiazepine premedication in this setting. However, further studies are warranted to determine the clinical significance of these findings.

Adolescent↗
PubMed2001

IM droperidol as premedication attenuates intraoperative hypothermia.

PURPOSE: Perioperative hypothermia results largely from core-to-peripheral heat redistribution. Droperidol, which is often used for premedication, promotes vasodilation, and thus may affect redistribution of heat. Accordingly, we tested the hypothesis that preanesthetic droperidol would affect perioperative hypothermia. METHODS: Twenty-three ASA physical status I patients scheduled for arthroscopic ligament reconstruction were randomly assigned to two groups to receive no premedication or im droperidol 0.1 mg x kg(-1) 30 min before anesthesia. Anesthesia was induced and maintained with propofol and fentanyl. We monitored core (tympanic) and peripheral (palm) temperatures, and skin (fingertip) blood flow for two hours after the induction of anesthesia during surgery. RESULTS: Before the induction of anesthesia, patients given droperidol were more deeply sedated than those given no premedication. Core temperature, which was similar in both groups before induction, decreased significantly more in the control than in the droperidol patients (0.75 +/- 0.34 degrees C and 0.37 +/- 0.20 degrees C, respectively, at 75 min after induction; P <0.01). Preinduction peripheral temperature and skin blood flow were lower in the control group than in the droperidol group, but the two variables became similar in both groups after induction. CONCLUSION: The results of the present study confirm our hypothesis that premedication with droperidol affects perioperative hypothermia. Droperidol may prevent core-to-peripheral heat redistribution after the induction of anesthesia.

Adjuvants, Anesthesia↗
PubMed2003

Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children.

PURPOSE: To evaluate the efficacy and safety of intranasally administered s-ketamine and midazolam for premedication in pediatric patients. METHODS: Ninety children were randomly allocated to receive intranasally administered s-ketamine 1 mg.kg(-1) and midazolam 0.2 mg.kg(-1) (Group K1, n = 30), s-ketamine 2 mg.kg(-1) and midazolam 0.2 mg.kg(-1) (Group K2, n = 30), or midazolam 0.2 mg.kg(-1) (Group M, n = 30) as premedicants, using a double-blind study design. Sedation and anxiolysis were evaluated using a sedation and cooperation scale and recorded at several time points. RESULTS: Acceptable conditions (K1: 23; K2: 26, M: 19) for parental separation were not different between groups. Induction conditions were acceptable in 26 patients in K2 (P < 0.05 vs M) (K1: 23; M: 19). Compared to baseline values individual conditions significantly improved in groups K1 and K2 from 2.5 min after premedication until induction of anesthesia (P < 0.003), in group M conditions improved only five minutes after premedication (P < 0.05). Adverse effects observed in this series were within an acceptable range and similar for the three groups. CONCLUSION: Intranasal administration of s-ketamine and midazolam is an appropriate premedication in preschool children.

Adjuvants, Anesthesia↗
PubMed2006

Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children?

PURPOSE: The purpose of this evidence-based clinical update was to identify the best evidence to determine if behavioural outcomes are improved in children after oral midazolam premedication. METHODS: A literature search was conducted using both PubMed and OVID programs, utilizing the terms "midazolam", and either "premedication" or "preoperative treatment". Search limits that were employed included randomized controlled trials (RCTs), English language, human studies, children aged 0-18 yr, and publication dates 1990 - present (January 2006). A review of the 171 abstracts obtained was undertaken and, of these, 30 papers were identified that concerned oral midazolam in children prior to general anesthesia, and that involved a RCT with a placebo or control arm. These studies were assigned levels of evidence, and grades of recommendation were made according to Centre for Evidence-Based Medicine criteria. RESULTS: Oral midazolam premedication in children was found to reduce the anxiety associated with separation from parents/guardians, and with induction of anesthesia. Recovery times are not significantly delayed. There is no consistent evidence to suggest a reduction in the phenomenon of emergence agitation. Evidence suggesting an improvement in behavioural outcomes at home is also inconsistent. CONCLUSION: Premedication with midazolam 0.5 mg x kg(-1) po administered 20-30 min preoperatively, is effective in reducing both separation and induction anxiety in children (grade A recommendation), with minimal effect on recovery times. However improved postoperative behavioural outcomes in the postanesthesia care unit, or at home cannot be predicted on a consistent basis.

Administration, Oral↗
PubMed1996

[Anxiolysis, sedation, and stress reduction following oral premedication with midazolam in adults. A comparison with dipotassium clorazepate and placebo].

Benzodiazepines are the most commonly used anxiolytic agents. Among the benzodiazepines, midazolam has the advantage of a short elimination half-life, which is especially useful in outpatient surgery. However, in contrast to other commonly prescribed benzodiazepines, such as chlorazepate dipotassium, oral premedication with midazolam has not been thoroughly investigated. Therefore, the present study was performed to compare anxiolysis, sedation and stress reduction with midazolam and clorazepate dipotassium in adults. METHODS. After IRB approval and informed consent had been obtained, 85 patients scheduled for breast biopsy were studied. The patients were chosen at random to receive either 7.5 mg midazolam (n = 29), 20 mg clorazepate dipotassium (n = 28) or placebo (n = 28) preoperatively. Before premedication, immediately prior to surgery and postoperatively in the recovery room, the following parameters were determined with visual analogue scales (VAS): "asthenia," "depression," oral salivation, muscle tension, motoric restlessness and sweating of the palms. In addition, anxiety (STAI-G-X-1, Spielberger), heart rate and arterial blood pressure were measured. Before patients underwent surgery, the degree of sedation was evaluated by the anaesthesiologist. RESULTS. Clorazepate dipotassium and midazolam both caused a reduction in anxiety as compared with the placebo (P < 0.05). Only clorazepate dipotassium reduced anxiety postoperatively (P < 0.05). Neither midazolam nor clorazepate dipotassium caused a reduction in "asthenia" and "depression." Midazolam was more effective in preventing increased blood pressure than clorazepate dipotassium and the placebo (P < 0.05). Furthermore, after premedication with midazolam, salivation, muscle tension, motoric restlessness and sweating of the palms remained stable, in contrast to the results after premedication using clorazepate dipotassium or placebo (P < 0.05). CONCLUSIONS. The anxiolytic effects of 7.5 mg midazolam and 20 mg clorazepate dipotassium were similar after oral application. However, the anxiolytic effect of midazolam is shorter-lived than that of clorazepate dipotassium. In contrast to clorazepate dipotassium, midazolam produced no increase in arterial blood pressure and stabilized oral salivation, production in the palms, muscle tension and motoric restlessness.

Adult↗
PubMed2004

Premedication medicines do not cause drug metabolic interaction with propofol using human liver microsomes in vitro.

OBJECTIVE: Propofol (2,6-diisopropylphenol) is widely used for anesthetic induction as well as for chronic sedation in intensive care units. In this study, we investigated the interaction between propofol and premedications, i.e., psychotropic and antianxiety agents (diazepam, midazolam), hypnotics (thiamylal), local anesthetics (lidocaine), depolarizing muscular relaxants (vecuronium), an antihypertensive (clonidine) and an H2-receptor antagonist (cimetidine) using human liver microsomes in vitro. METHODS: The interaction effects between propofol and premedications were examined using human liver microsomal preparation in vitro. The concentration of propofol was determined by HPLC with UV detection. RESULTS: The apparent Michaelis-Menten constant (Km) and the maximal velocity of total metabolic formation (Vmax) of propofol in human liver microsomes were 123 microM and 26.1 micromol/min per milligram of mg protein, respectively. Seven premedications (diazepam, midazolam, thiamylal, lidocaine, cimetidine, vecuronium, and clonidine) did not inhibit propofol metabolism in human liver microsomes at concentrations within the therapeutic range. CONCLUSIONS: These results showed no interactions between propofol and seven premedication drugs within the therapeutic range of propofol using human liver microsomes in vitro.

Anesthetics, Intravenous↗
PubMed1992

Premedication with metoclopramide decreases the frequency of methohexital induced hiccup.

Metoclopramide is one of many drugs that have been recommended for the treatment of intractable hiccup. Methohexital may produce hiccup during induction of general anesthesia. 211 women received methohexital for induction and maintenance of general anesthesia for short gynaecological procedures. All the patients were premedicated with fentanyl, diazepam and atropine. 109 patients were randomly selected to receive metoclopramide before induction of anesthesia; the remaining 102 patients served as a control group, and were anesthetized without metoclopramide premedication. The frequency of hiccup was compared between the two groups. 7 patients had hiccup in the metoclopramide premedicated group, as compared to 17 patients in the control group. This difference was statistically significant. We conclude that metoclopramide reduces the frequency of methohexital induced hiccup, and recommend that metoclopramide be routinely used for the premedication of methohexital injection.

Clinical Trial↗
PubMed2005

Assessment of psychological tension after premedication by measurement of salivary chromogranin A.

STUDY OBJECTIVE: Although some sedatives or analgesics are commonly used for premedication to reduce psychological tension before surgery or anesthesia, it remains unclear which drug is more suitable. Because salivary chromogranin A is a reliable index for estimating psychological tension, this variable was measured during the perioperative period after premedication. DESIGN: Prospective, randomized control study. SETTING: Operating room at a general hospital. PATIENTS: Thirty adult female patients undergoing abdominal total hysterectomy were randomly assigned to 3 groups of 10 patients each. INTERVENTIONS: On the day before surgery, saliva was collected, and 0.1 mg/kg of midazolam (midazolam group) or 0.02 mg/kg of butorphanol (butorphanol group) was injected intramuscularly 30 minutes before entering the operating rooms. For the control group, no premedication was performed. Saliva was collected as the patient entered the operating room and then the patient received an epidural catheter insertion followed 5 minutes later by collection of the saliva. MEASUREMENTS AND MAIN RESULTS: Salivary chromogranin A was assayed using a radioimmunoassay, and revised values calculated from the protein concentration of the saliva were regarded as data. Revised salivary chromogranin A levels increased in the control and butorphanol groups at the time of entrance to the operating room and after epidural treatment compared with the value of the day before surgery, whereas it did not change statistically in the midazolam group. CONCLUSIONS: From the standpoint of reducing psychological tension before surgery or anesthesia, midazolam as a sedative may be more suitable for premedication.

Adult↗
PubMed1986

[Oral premedication with diazepam].

A double blind study has been carried out on patients scheduled for appendicectomy. They were divided into two groups who were given diazepam as premedication either orally or intramuscularly. The clinical effects were measured with regard to anxiolysis, gastric contents volume and acidity. Orally premedicated patients were not significantly less anxious. No significant differences between both groups concerning gastric contents (volume and pH) were found. Therefore, oral premedication did not increase the risk of inhalation. Taking into account the previous findings in the literature, the pharmacological advantages of the oral route and the lack of complications, a wider use of oral premedication for elective operations in adults is recommended.

Administration, Oral↗
PubMed1987

[Midazolam used for premedication reinforces sleep induced by flunitrazepam].

This single blind study aimed to discover possible effects of intramuscular premedication with midazolam on the sleep induced by intravenous flunitrazepam. 24 male patients, aged 17 to 71 years, who were to undergo surgery to the distal parts of an upper limb under regional anaesthesia, were randomly assigned to two equal groups: in the midazolam group, an intramuscular premedication of 0.12 mg.kg-1 midazolam with 0.5 mg atropine was given, whereas in the control group atropine only was used. In all patients, 1 mg flunitrazepam was given intravenously 45 min after the premedication, before carrying out regional anaesthesia. No other drug was given. In the midazolam group, the time of loss of spontaneous conversation was reduced (p less than 0.05), as well as the time of eye closure (p less than 0.001), and the time for recovery of the capacity to count backwards was increased (p less than 0.001). So, premedication with 0.12 mg.kg-1 midazolam intravenously 45 min before giving 1 mg flunitrazepam reinforced the sleep induced by the latter.

Adult↗
PubMed2000

Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA.

BACKGROUND: Because of its pain-attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations. METHODS: One hundred children between 10 and 15 kg of body weight scheduled for day-case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 microg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1-9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well-being at home. RESULTS: The children of the K-groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D-groups; stridor scores > or = 6 were seen in one child of the D-groups (DS) and in six children of the K-groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home. CONCLUSION: Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.

Adenoidectomy↗