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At least 217 records · Page 12Linked to original sources
PubMed2003

Oral clonidine premedication preserves heart rate variability for patients undergoing larparoscopic cholecystectomy.

BACKGROUND: Clonidine has been shown to reduce perioperative circulatory instability. This postoperative analgesic effect of clonidine was also known in previous studies. The aim of the study was to investigate the clinical efficiency of oral clonidine premedication in anesthesia and analgesia in patients undergoing laparoscopic cholecystectomy. METHODS: Thirty-two patients scheduled for elective laparoscopic cholecystectomy were recruited for a prospective, randomized, double-blinded comparative study. They were allotted randomly to two groups: placebo or clonidine. Patients in the placebo group (n = 16) were premedicated with oral antacid (alugel hydroxide 300 mg), while those in the clonidine group (n = 16) were premedicated with oral clonidine 150 micro g before anesthesia. Analysis of heart rate variability was used to quantify the control of heart rate at baseline, and during the pneumoperitoneum and recovery periods. Time of the first request for postoperative analgesic and cumulative analgesic requirements in 24 h were recorded. Data are expressed as mean +/- SD. RESULTS: Heart rate variability was reduced in the pneumoperitoneum and postoperative period in the placebo group. Clonidine resulted in a greater perioperative (pneumoperitoneum period) power at all frequency ranges compared with placebo (671.5 +/- 470.5 vs. 55.1 +/- 51.6 ms2/Hz for total power variability, 170.1 +/- 94.4 vs. 16.9 +/- 21.1 ms2/Hz for low-frequency variability and 206.1 +/- 95.7 vs. 16.4 +/- 15.1 ms2/Hz for high-frequency variability, P < 0.05). The postoperative analgesic requirement was less (2.3 +/- 0.8 vs. 3.2 +/- 1.2 dose, P < 0.05) in comparison with the placebo group. CONCLUSION: Clonidine preserves heart rate control in pneumoperitoneum and recovery periods. Oral clonidine premedication also reduces the requirement for postoperative analgesia.

Adrenergic alpha-Agonists↗
PubMed2002

Safety and efficacy of glucagon as a premedication for upper gastrointestinal endoscopy--a comparative study with butyl scopolamine bromide.

BACKGROUND: Glucagon inhibits digestive motility and is used for endoscopic premedication; however, its effect on cardiopulmonary function during endoscopy has not yet been fully investigated. AIM: To clarify the efficacy and safety of glucagon compared with butyl scopolamine bromide as upper gastrointestinal endoscopy premedication. METHODS: Two hundred and forty consecutive patients over 40 years of age, referred for upper gastrointestinal endoscopy, without any complications, were studied. These patients were randomly premedicated with butyl scopolamine bromide (SC group) or glucagon (G group). Time course changes in blood pressure, arterial oxygen saturation, heart rate and the number of retching episodes during endoscopy were examined. The efficacy of glucose tablets after upper gastrointestinal endoscopy to prevent hypoglycaemia caused by glucagon was evaluated. Cardiopulmonary parameters were also examined in 77 complicated patients with glucagon premedication (GC group). RESULTS: A continuous increase in heart rate during upper gastrointestinal endoscopy was observed in the SC group, but not in the G and GC groups. Blood pressure, arterial oxygen saturation and number of retching episodes were not different between the groups. Hypoglycaemia-related symptoms were frequent in the G group without glucose tablets, but were prevented by the administration of glucose. CONCLUSIONS: Glucagon has a weaker effect on cardiopulmonary function during upper gastrointestinal endoscopy than butyl scopolamine bromide. Glucose administration prevents hypoglycaemia-related symptoms caused by glucagon.

Aged↗
PubMed1997

Midazolam for premedication in children: nasal vs. rectal administration.

The authors compared the acceptance and efficacy of rectal and nasal administration of midazolam (MDZ) for premedication. Ninety-five ASA I and II paediatric patients (8 months to 12 years) scheduled for elective surgery were randomly allocated to two groups. Group R received 0.3 mg kg-1 of rectal midazolam (in 5 mL saline). Group N received 0.2 mg kg-1 of nasal midazolam (5 mg ml-1). Both groups were divided in two subgroups according to age (group RA (< or = 6 years, n = 33), group RB (> 6 years, n = 18), group NA (< or = 6 years, n = 28), group NB (> 6 years, n = 16)). At the time of premedication, tolerance to the administration was confirmed. Twenty min after rectal or 10 min after nasal administration the quality of sedation was recorded. The nasal midazolam, in commonly used dosages, induced a sedation similar to that following rectal administration with a shorter delay of onset. Nasal administration was more often painful than rectal administration. Swallowing (nasal midazolam) and concerns about modesty (rectal midazolam) were more frequent in older children. Because of its poor tolerance, nasal premedication should be reversed for cases where there is no alternative. Rectal premedication should be avoided in older children.

Administration, Intranasal↗
PubMed1984

Oral benzodiazepine premedication in minor gynaecological surgery.

Clobazam 20 mg, diazepam 10 mg, lorazepam 2 mg and oxazepam 30 mg were compared in a randomized, double-blind, placebo-controlled trial as oral premedication for 150 patients undergoing minor gynaecological surgery. All drugs and placebo significantly decreased anxiety when assessed by the patient on a 10-cm linear analogue rating scale 60 min after premedication. Diazepam 10 mg induced significantly more drowsiness when assessed by a trained observer 60 min after premedication than clobazam 20 mg, oxazepam 30 mg and placebo (P less than 0.01). Lorazepam 2 mg caused significantly more drowsiness 2 h (P less than 0.001) and 4 h (P less than 0.01) after operation, and significantly impaired psychomotor function after operation compared with the other four agents. The data suggest that clobazam 20 mg, diazepam 10 mg, oxazepam 30 mg or placebo offer advantages over lorazepam 2 mg for oral premedication in minor gynaecological surgery where early discharge after operation is preferred.

Adolescent↗
PubMed1984

Atropine increases inspiratory flow during enflurane anaesthesia after pethidine premedication.

The effects of atropine i.v. on inspired volume and occlusion pressure were measured in three groups of patients. Group PE received premedication with pethidine 50 mg and promethazine 12.5 mg i.m., and anaesthesia was provided by 2% enflurane in 67% nitrous oxide. Group TE received temazepam 20 mg orally for premedication and similar anaesthesia. Group TH received temazepam premedication and 1% halothane in 67% nitrous oxide. Atropine 0.02 mg kg-1 i.v. increased significantly the inspiratory flow in the first 1 s of inspiration, and this effect was greater in the group that received pethidine (9% increase in flow). However, occlusion pressure did not change, and minute volume was not altered. The results suggest that atropine increases inspiratory flow after pethidine premedication without increasing the force developed during inspiration, possibly by bronchodilatation.

Adult↗
PubMed1985

Premedication before day surgery. A double-blind comparison of diazepam and placebo.

Premedication with diazepam 0.25 mg kg-1 by mouth was compared with placebo in a double-blind trial in patients undergoing day-case surgery under general anaesthesia. Diazepam decreased significantly preoperative discomfort and apprehension. The patients were discharged on time regardless of the type of premedication, and complaints at the time of discharge and on the following day could be related only to the length of anaesthesia and not to the type of premedication. Premedication given early in the morning remained effective for up to 6 h.

Adolescent↗
PubMed1990

Arterial oxygen saturation following premedication for cardiac surgery.

We studied patients scheduled for coronary artery bypass surgery following premedication with lorazepam, morphine and droperidol, using pulse oximetry and serial electrocardiographic (ECG) recordings. Arterial oxygen saturation (SaO2) values were compared with those obtained during two control periods when the patients were awake and asleep. All patients demonstrated progressive arterial oxygen desaturation during the premedication period, statistically significant from both controls (P less than 0.001). Twelve of the 15 patients developed hypoxaemia or severe hypoxaemia which was corrected immediately by administration of oxygen. New ECG changes developed during the premedication period in 33% of patients. It is concluded that additional oxygen should be administered to patients receiving this and similar premedication regimens.

Adult↗
PubMed1998

Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability.

Midazolam is often used for paediatric premedication. We have compared two methods of administering midazolam intranasally in 44 surgical day-case children allocated randomly to receive midazolam 0.2 mg kg-1 as drops or midazolam 0.1 mg kg-1 from an intranasal spray device. Behaviour was recorded on a four-point scale by the parent, nurse and anaesthetist. Coefficients were obtained representing the change in behaviour score. There was no significant difference in method of administration (coefficient 0.13, P = 0.39). Children were significantly more distressed at the time of premedication and at the time of venous cannulation (coefficients 1.31 and 0.70) than at baseline. There was no significant difference in the assessments between observers. Midazolam by either method was equally effective but acceptability of the premedication was poor in both groups. Intranasal midazolam cannot be recommended as a method for routine premedication of young children.

Administration, Intranasal↗
PubMed1999

Premedication with melatonin: a double-blind, placebo-controlled comparison with midazolam.

We have evaluated the perioperative effects of melatonin with those of midazolam in 75 women in a prospective, randomized, double-blind, placebo-controlled study. Patients were given sublingual midazolam 15 mg, melatonin 5 mg or placebo, approximately 100 min before a standard anaesthetic. Sedation, anxiety and orientation were quantified before, and 10, 30, 60 and 90 min after premedication, and 15, 30, 60 and 90 min after admission to the recovery room. Psychomotor performance was evaluated at these times also, using the digit-symbol substitution test (DSST) and the Trieger dot test (TDT). Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation before operation compared with controls. Midazolam produced the highest scores for sedation at 30 and 60 min after administration and significant psychomotor impairment in the preoperative period compared with melatonin or placebo. After operation, patients who received midazolam or melatonin premedication had increased levels of sedation at 30 min and impairment in performance on the DSST at 15, 30 and 90 min compared with controls. There were no significant differences between the three groups for anxiety levels or TDT performance after operation. Amnesia was notable only in the midazolam group for one preoperative event (entry into the operating room). Patient satisfaction was noted in the midazolam and melatonin groups only. We have demonstrated that melatonin can be used effectively for premedication of adult patients.

Administration, Sublingual↗
PubMed1999

Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points.

We have studied the effects of midazolam premedication on multiple anaesthetic end-points (hypnotic, loss of verbal contact (LVC); motor, dropping an infusion flex or bag (DF); analgesic, loss of reaction to painful stimulation (LRP); and EEG, attainment of burst suppression (BUR)) during induction by slow thiopental infusion at a rate of 55 mg kg-1 h-1. Patients received midazolam 0.05 mg kg-1 i.v. (group TM, n = 12) or no midazolam (group T0, n = 13). ED50 and ED95 values and group medians for times and doses at the end-points were measured. Midazolam premedication reduced significantly thiopental ED50 and ED95 values at all end-points (exception for ED95 for BUR). Potentiation was greatest for the motor end-point (dropping the infusion bag (DF)) (ED95 +52%, ED50 +23%, median +39%), and smallest for painful stimulation (LRP) (median +18%; ED50 +13%). For LRP and DF, premedication was associated with significant, non-parallel increases in the slope of the thiopental dose-response curves, resulting in marked potency ratio changes from ED50 to ED95 (LRP +31%, DF +29%). There were no such increases for LVC or BUR. The interaction between midazolam and thiopental varied with the anaesthetic end-point and may also depend on the dose of thiopental. Our data suggest that the mechanism of interaction between midazolam premedication and thiopental was different for motor effects or analgesia (DF, LRP) compared with hypnotic effects or cortical depression (LVC, BUR), in agreement with the different central nervous system substrates underlying these distinct anaesthetic end-points.

Adult↗
PubMed1995

Cardiorespiratory effects of premedication for children.

Cardiovascular and respiratory effects of pediatric preanesthetic premedication have received only minimal attention, probably because most children tolerate such drugs without apparent ill effect. In children with congenital heart disease or other serious illness, there is often reluctance to use premedication. We sought to determine whether different premedication regimens produced significant cardiorespiratory effect. A randomized prospective study of the cardiovascular and respiratory effects of different oral, nasal, and rectal premedication regimens was conducted. Fifty-eight young children (average age 2.7 yr) were studied. Oral meperidine (3 mg/kg) with pentobarbital (4 mg/kg) decreased heart rate, mean arterial pressure, cardiac index, respiratory rate, and oxygen saturation. Stroke volume was maintained. Nasal ketamine (5 mg/kg) with midazolam (0.2 mg/kg) produced no significant cardiovascular or respiratory effects. Rectal methohexital (30 mg/kg) increased heart rate with a coincident decrease in stroke volume but had no other positive or negative cardiac or respiratory effect. This information documents disparate cardiorespiratory effects of different preanesthetic medications in normal children.

Administration, Intranasal↗
PubMed1996

Oral transmucosal fentanyl citrate for premedication in adults.

This study was designed to assess the efficacy of oral transmucosal fentanyl citrate (OTFC) for premedication in an adult population and to determine its effects on anxiety, sedation, gastric volume, and gastric fluid acidity. The fentanyl citrate is incorporated in a lozenge mounted on a handle (oralet). The effects of OTFC, placebo oralet, and no premedication were compared in a prospective, double-blind study on 90 adult ASA physical status I and II patients undergoing same-day admission surgery. Patients were randomly assigned to one of three groups: OTFC group (n = 30), placebo group (n = 30), and control group (n = 30). Arterial blood pressure, heart rate, respiratory frequency, and oxygen saturation determined by pulse oximetry were recorded before any premedication was given, and then every 10 min until the patient was taken to the operating room. Baseline anxiety and sedation levels were assessed to ensure group similarity immediately before premedication was given and at the more anxiety-provoking phase upon entering the operating room. Anxiety levels were rated using the Spielberger State-Trait Anxiety Inventory short form and sedation levels were assessed with the Ramsay scale. Side effects, as reported by the patients, were also recorded. Gastric contents were aspirated via an orogastric tube after induction of anesthesia and were measured for volume and pH. No significant differences were found among the three groups in mean arterial pressure, heart rate, or respiratory frequency. Initial oxygen saturation levels in all groups decreased after 30 min but not less than 96% except for one patient in the OTFC group, who decreased to 88%. On entering the operating room, the OTFC group demonstrated significantly higher levels of anxiolysis than the control group, but no significant differences were seen between the OTFC and the placebo groups or the placebo and control groups. Mean gastric volumes (OTFC, 29 mL; placebo, 26 mL; control, 24 mL) and pH (OTFC, 2.0; placebo, 1.8; control, 2.1) were similar in all groups. There were no significant differences among the groups in levels of sedation achieved. Mild dizziness or light-headedness was the most commonly reported side effect in 23% of the OTFC group. In the OTFC group, 71.4% like the premedicant effect as compared to 46.4% of the placebo group. Most of the groups found the oralet method of premedicant delivery very acceptable. This study demonstrates that the OTFC oralet is an effective anxiolytic in adults. It has minimal side effects and is prepared in an acceptable format. There was no measurable increase in gastric contents or acidity in the oralet groups, compared to those patients who were given nothing by mouth.

Administration, Oral↗
PubMed1997

Midazolam premedication increases sedation but does not prolong discharge times after brief outpatient general anesthesia for laparoscopic tubal sterilization.

Preoperatively administered midazolam may contribute to postoperative sedation and delayed recovery from brief outpatient general anesthesia, particularly in patients who receive significant postoperative opioid analgesics. We evaluated the effects of midazolam premedication (0.04 mg/kg) on postoperative sedation and recovery times after laparoscopic tubal sterilization (Falope rings) in 30 healthy women in a randomized, double-blind, placebo-controlled study. Patients received midazolam or saline-placebo intravenously 10 min before anesthesia. General anesthesia was induced with fentanyl, propofol, and mivacurium and was maintained with N2O and isoflurane. Sedation was quantified before and after premedication and 15, 30, and 60 min after emergence from anesthesia, using the digit-symbol substitution (DSST) and Trieger dot (TDT) tests. Management of postoperative pain and nausea and discharge criteria were standardized. Groups were similar with respect to age, weight, and duration of surgery and anesthesia. Midazolam was associated with impairment of performance on the TDT and DSST after premedication administration and 15 (TDT and DSST) and 30 (DSST) min after postanesthesia care unit (PACU) arrival. There were no differences in PACU time and time to discharge-readiness. In conclusion, midazolam premedication augments postoperative sedation in this population but does not prolong recovery times.

Adult↗
PubMed2000

Nimodipine premedication and induction dose of propofol.

UNLABELLED: Antagonists at the L-type voltage sensitive calcium channel (L-VSCC) potentiate anesthetic potency in experimental models, suggesting that it may be a target site for IV anesthetics. Nimodipine is a 1, 4-dihydro- pyridine antagonist of L-VSCC which crosses the blood-brain barrier. We tested the hypothesis that premedication with oral nimodipine in healthy patients would reduce the induction dose of propofol, independently of its effects on the cerebral circulation. Sixty ASA physical status I or II patients (18-60 yr), undergoing knee arthroscopy or minor urological surgery, were randomized to receive either nimodipine 60 mg or placebo, orally 1-2 h before induction. Noninvasive mean blood pressure, heart rate, and time-averaged mean velocity in the middle cerebral artery by using transcranial Doppler ultrasonography were obtained before and 5 min after the induction of anesthesia. Propofol 1% was administered by an infusion pump at a rate of 10 mL/min. Both groups of patients had a reduction in mean blood pressure after the induction (P < 0.01), but there were no significant differences between the groups. The induction dose of propofol was 2.19 mg/kg (95% confidence interval [CI]: 1.97-2.42) in the nimodipine group, compared with 2.16 mg/kg (95% CI 1.98-2.34) in the control group, P = 0.8. Time-averaged mean velocity remained unchanged after the induction of anesthesia in both patients receiving nimodipine premedication (51% CI 43-59 cm/s to 52% CI 46-58 cm/s, P = 0.6) and those receiving placebo (50% CI 43-58 cm/s to 53% CI 45-59 cm/s, P = 0.3). Premedication with oral nimodipine 60 mg does not reduce the induction dose of propofol compared with placebo, casting doubt on the hypothesis that propofol has an anesthetic action at L-VSCC. IMPLICATIONS: Premedication with oral nimodipine 60 mg does not reduce the induction dose of propofol compared with placebo, casting doubt on the hypothesis that propofol has an anesthetic action at L-type voltage sensitive calcium channels.

Adolescent↗
PubMed2003

The effects of clonidine premedication on the blood pressure and tachycardiac responses to ephedrine in elderly and young patients during propofol anesthesia.

UNLABELLED: We studied the pressor and tachycardiac responses to ephedrine in elderly and young patients given either clonidine or midazolam during propofol anesthesia. In the first experiment, elderly (>60 yr) and young (20-45 yr) patients were randomly allocated to one of four groups according to age and premedicated regimens (n = 16 each; elderly-clonidine [EC], elderly-midazolam [EM], young-clonidine [YC], and young-midazolam [YM]). Under propofol anesthesia, ephedrine was injected, and hemodynamic measurements were made. In the second experiment, with clonidine premedication, elderly patients (n = 16) were given a reduced dose of propofol (EC-LP) and young patients (n = 16) were given an increased dose of propofol (YC-HP). Ephedrine was injected, and he- modynamic measurements were performed. The in-creases in mean blood pressure and heart rate were larger in the EC group than in the EM, YM, and EC-LP groups (P < 0.05). In the YC-HP group, the pressor response to ephedrine tended to be augmented as compared with the YC group but was not statistically significant. These results suggest that clonidine premedication augmented the pressor and tachycardiac responses to ephedrine, especially in elderly patients during a standard dose of propofol anesthesia, and that clonidine, age, and propofol could be involved in the augmentation of the blood pressure and tachycardiac responses to ephedrine. IMPLICATIONS: Clonidine premedication augments the pressor and tachycardiac responses to ephedrine in elderly patients during standard or large doses of propofol anesthesia but does not augment during small doses of propofol anesthesia. Clonidine, age, and propofol could be involved in the augmentation of the pressor and tachycardiac responses to ephedrine.

Adjuvants, Anesthesia↗
PubMed1995

Premedication with famotidine augments core hypothermia during general anesthesia.

BACKGROUND: Animal studies have provided considerable evidence to support a role of histamine in the central nervous system in thermoregulation, and premedication with a histamine H2 receptor antagonist before general anesthesia is used to reduce the risk of acid aspiration. The authors investigated whether premedication with famotidine had an effect on thermoregulation during general anesthesia. METHODS: In a randomized, placebo-controlled study, 30 ASA physical status 1 or 2 patients, scheduled for open abdominal surgery, were given either placebo or 40 mg oral famotidine 3 h before induction of anesthesia. Epidural buprenorphine (4 micrograms/kg) was injected, and anesthesia was maintained with 0.4-0.6% isoflurane and 66% nitrous oxide in oxygen. The tympanic membrane temperature was measured to assess core temperature, and forearm-fingertip and calf-toe skin-surface temperature gradients were used to assess peripheral vasoconstriction. Tympanic membrane temperature triggering initial vasoconstriction (a skin temperature gradient of 0 degree C) identified the vasoconstriction threshold. RESULTS: Tympanic membrane temperature during surgery in the patients premedicated with famotidine was significantly less than those in the patients without famotidine. Famotidine significantly reduced the thermoregulatory threshold for vasoconstriction in the leg (35.0 +/- 0.5 degree C, P < 0.05), compared to that in the placebo group (36.4 +/- 0.6 degree C) Once triggered, thermoregulatory vasoconstriction produced a core-temperature plateau and no further hypothermia was observed for the duration of the study. Neither mean arterial pressure nor heart rate were significantly different between the two groups. CONCLUSIONS: Premedication with famotidine augments intraoperative hypothermia. The mechanism appears to be inhibition of centrally mediated thermoregulatory control.

Abdomen↗
PubMed1994

Oral premedication for local anesthesia in plastic surgery: prospective, randomized, blind comparison of lorazepam and temazepam.

Patients undergoing plastic surgical procedures under local anesthesia as inpatients were entered into a phase III randomized, blind trial designed to compare two commonly used oral premedications, lorazepam and temazepam. The effects of the drugs on each patient's memory, pain, sedation, and anxiety were assessed by questions asked of the patient, the nurse, and the surgeon. Analysis was based on 100 randomized patients. Lorazepam had a significantly greater amnesic effect (p < 0.0001), resulted in less pain with the local anesthetic injection (p = 0.006), and had a greater sedative effect than temazepam (p < 0.0001, patient's assessment; p = 0.005, observers' assessments). There was no significant difference in anxiolysis between the two premedications (p = 0.20). If premedication is indicated, we advocate the use of lorazepam rather than temazepam as premedication for plastic surgical procedures to be performed under local anesthesia, provided there is adequate postoperative supervision.

Administration, Oral↗
PubMed1975

The premedication of cardiac surgical patients. A clinical comparison of four regimes.

One of four groups of patients was not premedicated; the others received diazepam 10 mg by mouth, diazepam 20 mg by mouth or a combination of pentobarbitone orally and morphine and hyoscine intramuscularly. The cardiovascular and respiratory parameters were studied before and after the premedication and any changes in sedation, apprehension and reaction to pain were noted. The ease of induction of anaesthesia in the four groups was compared. Most of the patients who received the pentobarbitone, morphine and hyoscine combination came to theatre calm, sedated and often asleep. They showed no significant cardiovascular or respiratory depression and the induction of anaesthesia was more satisfactory than in the other groups. Two of the patients who were not premedicated became very agitated in the ward and the remainder of the patients in this group were apprehensive in the anaesthetic room and during induction. The effects of diazepam in the two doses studied were intermediate between those who received the pentobarbitone, morphine and hyoscine and those who were not premedicated.

Administration, Oral↗