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PubMed1986

[Rectal administration of midazolam as an adjuvant in the premedication of infants].

In a randomized, double-blind study of premedication in 69 infants aged between 13 and 48 months the effects of 0.82 mg/kg midazolam or diazepam rectally plus 2.0 mg/kg ketamine i.m., or the administration of 2.4 mg/kg ketamine i.m. alone was studied. A satisfying result of 94.1% following the premedication with midazolam/ketamine, of 82.9% with diazepam/ketamine and of 81.3% with ketamine alone was observed. Premedication with midazolam/ketamine was the best one in the review of vigilance, agitation, and behaviour of defence against the mask at the beginning of anaesthesia. The amnestic action of midazolam extinguished the infants' memory of the i.m.-injection. The dose of midazolam/ketamine is suitable as an effective and positive method for premedication of infants within 20 min.

Anesthesia↗
PubMed1985

Endocrine response to surgery in children after premedication with midazolam or papaveretum.

The effect of two premedications on the sympatho-adrenal and endocrine stress-response to minor surgery under halothane anaesthesia was investigated in 16 children. One group (n = 9) was premedicated with midazolam, 0.1 mg kg-1, and atropine 0.2-0.4 mg i.m. The other group (n = 7) received papaveretum 0.4 mg kg-1 and hyoscine 0.008 mg kg-1 i.m. Plasma concentrations of catecholamines, ACTH and cortisol were measured during undisturbed anaesthesia, during surgery and 15 min post-operatively. There were no differences in catecholamine concentrations between the groups. Prior to surgery, plasma ACTH was significantly lower (P less than 0.05) in the papaveretum group. During surgery, plasma cortisol and plasma ACTH were significantly lower after papaveretum premedication. Post-operatively there were no differences. End-tidal CO2 concentrations were similar in the two groups. It was concluded that the endocrine stress-response immediately after induction of anaesthesia and during surgery was lower after papaveretum than after midazolam premedication.

Adrenocorticotropic Hormone↗
PubMed1985

The effects of premedication on anaesthesia with propofol ('Diprivan').

The effects of premedication on anaesthesia with propofol (2,6-diisopropylphenol) in a dose of 2.5 mg/kg were assessed. One hundred and twenty female patients were randomized into one of three groups of 40 who received either no premedication, diazepam 10 mg orally, or pethidine 50-75 mg intramuscularly (i.m.) and atropine 0.6 mg i.m. Propofol 2.5 mg/kg was found to be a reliable induction dose. Premedication did not affect the induction time nor the incidence of side effects which occurred in 19% of patients. Apnoea occurred in 44% of patients but was not related to premedication, nor was arterial hypotension. Pain on injection was rare in the antecubital fossa but was a frequent occurrence (30%) in the dorsum of the hand. Recovery was rapid and characterized by lack of emetic sequelae; only one patient had nausea and there was no vomiting. The site of injection was examined postoperatively and venous sequelae were rare.

Adolescent↗
PubMed1981

[Night-time premedication with Di-potassium-clorazepate, diazepam or a placebo before anaesthesia; a double-blind trial (author' transl)].

The efficacy of dipotassium clorazepate (DPCA) and of diazepam (DP) as night-time premedication was tested against a placebo in a double-blind trial in 300 patients of all ages. Examination of the patients in the morning before anaesthesia showed that tachycardia, nausea and anxiety were considerably less in patients who had been premedicated with DPCA or DP. Relief from anxiety and restlessness according to standardized self-evaluation scale was most marked in the DPCA group. There were statistically significant differences between the groups with respect to the sleep pattern: 66 per cent of patients in the DPCA group fell asleep within the normal time of 2-15 minutes compared with 53 per cent in the DP group and 48 per cent in the placebo group. Uninterrupted sleep until the morning was experienced by about 70 per cent of patients who had been premedicated with DPCA as against 47 per cent and 31 per cent who had been given DP or a placebo respectively. The total sleeping period was normal or slightly prolonged in 73 and 74 per cent of patients who had received one or the other drug but in only 38 per cent of patients in the placebo group. As regarded the quality of sleep (quiet, uninterrupted sleep and feeling rested) the DPCA group considered it to have been much sounder than did the other groups. On account of its marked ataractic and sleep-protecting properties DPCA is considered to be the most suitable agent for night-time premedication.

Adult↗
PubMed1983

The efficacy and plasma concentrations of flunitrazepam after oral or intramuscular premedication.

Flunitrazepam premedication administered orally or intramuscularly was compared in 41 surgical patients. The effect of the premedication was assessed both subjectively and objectively. The plasma concentrations were determined just before induction. The mean (+/-SD) plasma concentration in the oral premedication group was 8.2 +/- 2.2 ng/ml and 7.9 +/- 4.6 ng/ml in the intramuscular premedication group. There was a highly significant correlation (p less than 0.001) between the sedative effect and plasma concentration of flunitrazepam in all patients. Oral flunitrazepam was equal to i. m. flunitrazepam as an anxiolytic and sedative with a rapid onset of action. However, the oral route of administration of flunitrazepam is preferable because it is painless and easy to administer.

Administration, Oral↗
PubMed1983

[The anxiety process under various high doses of thalamonal for premedication].

In this study special attention was paid to the individual anxiety--and coping process. 101 patients in a general hospital were premedicated with Innovar in different high dosages with and without Atropine. The four Innovar-groups were referred to a Dolantin/Atosilgroup. The results show that during the preoperative period the intensity of anxiety did not depend on premedication alone. Premedication was effective in reducing anxiety only in those patients who were aware of their somatic excitation at least to a certain degree. The preoperative anxiety process was also influenced by factors, like negative experience with anaesthesia and premedication, a negative attitude towards any kind of sedative and specific intrapsychic coping styles.

Anxiety↗
PubMed1995

[Plasma catecholamine level and clinical parameters--quality criteria for premedication in childhood].

Stress hormones noradrenaline and adrenaline were measured in plasma before and after premedication to objectivate the anxiolytic potency of different premedication methods in children. In addition indirect signs of sympathoadrenergic activity (heart rate and blood pressure) as well as children's behavior and reaction to face mask were documented. Each group consisted of 16 children (aged 3 to 15 years). One group was prepared only psychologically, the second group received 0.1 mg/kg midazolam intravenously and the third group was given 1 mg/kg promethazine orally. Blood pressure and heart rate decreased after premedication, mainly in the midazolam group. After mask exposition in all groups noradrenaline and adrenaline levels increased with the exception of adrenaline in the midazolam-group, where the levels remained low. Mask acceptance and anxiolysis were better in the midazolam-group than in other groups. Reduction in heart rate and blood pressure, catecholamines in plasma, anxiolysis and a high mask acceptance indicate that intravenous administration of midazolam is very effective in premedicating children.

Adjuvants, Anesthesia↗
PubMedDate not supplied

[Comparative analysis of different premedication methods in minor surgery in children].

Oxygen regimen, hemodynamics, hemocoagulation, vegetative status, and immune status of patients subjected to multiple surgical interventions under anesthesia are analyzed. Three premedication schemes are considered. Routine fluothane anesthesia with nitrogen oxide + oxygen or calypsol after standard premedication is inadequate in children when used repeatedly. Tramal, a new analgesic, used in premedication, is highly effective, causes no side effects, and ensures sufficiently deep and prolonged analgesia. Use of neurovegetative blocking for premedication is a new and most physiological method of analgesia to be used in multiple minor surgical interventions in patients with burns.

Adolescent↗
PubMedDate not supplied

[Effects of premedication in children with congenital cardiopathy].

OBJECTIVES: To evaluate the effects of premedication in children with congenital heart disease. MATERIAL AND METHODS: Twenty-five children scheduled for surgical repair of congenital heart defects were studied. Two groups were formed based on whether cardiopathy was noncyanotic (group CNC) or cyanotic (group CC). Patients were premedicated rectally with 4 mg/kg pentobarbital and, 15 minutes later, with 0.15 mg/kg of morphine chloride by subcutaneous perfusion. SpO2 was monitored, as was the degree of sedation and airway obstruction prior to premedication (T1), 15 minutes after administration of pentobarbital (T2) and 30 minutes after morphine (T3). RESULTS: In the children with cyanotic cardiopathy, SpO2 increased over T1 (75.5 +/- 8.7%) at times T2 (76.2 +/- 7.7%) and T3 (78.1 +/- 8%), although the change was not statistically significant. In group CNC, average SpO2 did not change, although one case of clinically significant desaturation due to hypoventilation was observed at T3. Adequate sedation was attained in 36% of patients at T2 and in 80% at T3 (p < 0.002). There were no cases of airway obstruction. CONCLUSION: Premedication with 4 mg/kg pentobarbital rectally does not provide adequate sedation. Addition of 0.15 mg/kg subcutaneous morphine chloride increased the effect considerably, providing stability in SpO2 and even improving it in group CC.

Administration, Rectal↗
PubMed1995

Comparison of rectal to intranasal administration of midazolam for premedication of children.

Sixty children aged 3 to 9, undergoing minor surgical procedures, were studied to compare 0.5 mg/kg intranasal with 0.5 mg/kg rectal midazolam as a premedication. The children were evaluated for their ability to tolerate the medication, preanesthetic sedation, and alertness after anesthesia. Both premedication routes were equally effective in sedating the children. In both groups, a significant loss of effectiveness was noted if induction of the anesthesia began more than 30 minutes after administration of the medication (p < 0.0003). Rectal midazolam was much better tolerated by the children than the intranasal route (30 versus 3, p < 0.0001). We advocate the rectal over the intranasal route for premedication with midazolam in children, and anesthetic induction should occur no more than 30 minutes after administration of premedication.

Administration, Intranasal↗
PubMed1996

[Perioperative follow-up of physiologic and cognitive functions after oral premedication with midazolam 3.75 mg in women for retrobulbar anesthesia].

Recent changes in the medical system have resulted in a significant increase in the number of surgical procedures performed as day surgery. Therefore, a safe and short postoperative recovery period has become increasingly important. In the present study we investigated perioperative cognitive and physiological functions after oral premedication with low-dose midazolam (3.75 mg). The study was carried out on at total of 55 women (age > 60 years, weight 50-90 kg) scheduled for elective cataract surgery under retrobulbar anaesthesia (RBA), who were randomly assigned to either group 1 (n = 35) receiving 3.75 mg midazolam p.o. or group 2 (n = 20) receiving placebo p.o. 30 min prior to RBA. We measured the following parameters: sedation (modified Glasgow Coma Scale); anxiety (visual analogue scale); numerical and verbal memory (digit span and reproduction of previously presented words); concentration (revision test of Stender/Marschner). To identify depression of ventilation, pulse oximetric oxygenation and end-tidal PCO2 (nasal) were monitored intraoperatively. In the midazolam group anxiety was significantly lower and patients were significantly more sedated than in group 2. At a check 30 min after premedication with midazolam the scores for concentration and numerical memory were significantly (P < 0.05) lower. No differences between the groups could be found 2 h after the operations (2.92 +/- 35 min after premedication). Intraoperatively there was no significant difference in end-tital PCO2 and oxygenation between the groups. Oral administration of low-dose midazolam (3.75 mg) seems to be an appropriate form of premedication for ambulatory surgical procedures in elderly patients.

Aged↗
PubMed1982

Curriculum choices of premedical students.

The authors examined the curricular choices of premedical students to discover the differences from the choices of other students in the sciences and liberal arts. Premedical students took more science courses and took conscience courses in which they were more likely to get a higher grade than would other students. The authors have confirmed that premedical students' preparation for medical school is not broad-based and that course selection appears to be made on the basis of competition for entry into medical school.

Curriculum↗
PubMed2002

Acetaminophen and diphenhydramine as premedication for platelet transfusions: a prospective randomized double-blind placebo-controlled trial.

Non-hemolytic transfusion reactions (NHTR) occur in up to 30% of patients receiving platelet transfusions. Premedication with acetaminophen and diphenhydramine is a common strategy to prevent NHTR, but its efficacy has not been studied. In this prospective trial, transfusions in patients receiving pre-storage leukocyte-reduced single-donor apheresis platelets (SDP) were randomized to premedication with either acetaminophen 650 mg PO and diphenhydramine 25 mg IV, or placebo. Fifty-one patients received 98 transfusions. Thirteen patients had 15 NHTR: 15.4% (8/52) in the treatment arm and 15.2% (7/46) in the placebo arm. Premedication prior to transfusion of pre-storage leukocyte reduced SDP does not significantly lower the incidence of NHTR as compared to placebo.

Acetaminophen↗
PubMed1994

Yohimbine premedication and 35% CO2 vulnerability in healthy volunteers.

A group of 20 healthy volunteers underwent a 35% carbon dioxide/65% oxygen air-placebo controlled challenge test twice, premedicated 1 h before with either 20 mg yohimbine or placebo, following a double-blind randomized crossover design. Contrary to expectation the anxiety response to carbon dioxide was not higher when premedicated with yohimbine compared to premedication with placebo. Possible implications of this finding are discussed, with reference to general chemical models of panic.

Adolescent↗
PubMed2006

Effect of clonidine premedication on postoperative sore throat and hoarseness after total intravenous anesthesia.

To determine the effect of oral clonidine premedication on postoperative sore throat and hoarseness, we evaluated the incidence and severity of each of these complications in patients who underwent elective surgery in the supine position. The subjects were 82 patients, American Society of Anesthiologists (ASA) status I-III, aged 15-82 years. They were premedicated with either 150 microg oral clonidine and 20 mg raftidine (clonidine group; n = 41) or with 20 mg raftidine only (control group; n = 41) 2 h before anesthesia induction. General anesthesia was maintained with propofol, ketamine, fentanyl, and vecuronium, with or without epidural anesthesia. Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery. The incidences of sore throat and hoarseness tended to be higher in the clonidine group than in the control group; however, the difference did not reach statistical significance. There were no significant differences in the severity of these symptoms between the two groups. In conclusion, oral premedication with 150 microg clonidine did not prevent postoperative sore throat or hoarseness, and may have exacerbated these symptoms.

Adjuvants, Anesthesia↗
PubMed2006

Steroid premedication markedly reduces liver and bone marrow toxicity of trabectedin in advanced sarcoma.

Trabectedin is a marine-derived cytoxic alkaloid which has shown promising antitumour activity in a variety of human malignancies including sarcoma. Fifty-four patients with advanced sarcoma (age 43 yrs, range 18-70), all pretreated with prior chemotherapy, were enrolled on a named individual basis for treatment with trabectedin. Diagnosis was adult soft tissue sarcoma (STS) in 46 patients, Ewing's family tumour (EFT) in 4, and osteosarcoma (OS) in 4. The initial 23 patients (total number of courses administered: 68) did not receive premedication prior to trabectedin, while the other 31 patients (total number of courses administered: 134) received premedication with dexamethasone 4 mg po bid 24 hours before therapy. Incidence of toxicity (grade 3-4), expressed as percentage of courses, was as follows: in patients without dexamethasone, elevation of transaminases 34%, neutropenia 24% and thrombocytopenia 25%; in patients with prior dexamethasone, elevation of transaminases 2%, neutropenia 2% and no thrombocytopenia. The median received dose intensity of trabectedin was superimposable in the two groups (404 microg and 400 microg per week, respectively), as well as progression-free survival (19% at 6 months). Among STS patients, 9% had objective responses. In this unselected patient series, premedication with dexamethasone strongly reduced drug-induced hepatotoxicity and myelosuppression.

Adolescent↗
PubMed2006

Dextromethorphan premedication reduced postoperative analgesic consumption in patients after oral surgery.

OBJECTIVE: N-methyl-D-aspartate (NMDA) receptor antagonist premedication reduces postoperative pain. In this study, we examined if NMDA antagonist premedication might reduce postoperative pain after oral surgery, testing dextromethorphen. STUDY DESIGN: One hundred eleven patients undergoing mandibular third molar extraction under local anesthesia were included. Patients were randomly allocated into 3 groups. Group A (n = 37), B (n = 38), and C (n = 36) patients were emphasis-placed on dextromethorphan 30 mg, diclofenac 25 mg, or placebo orally before surgery, respectively. Postoperatively, patients were allowed to use oral diclofenac, 25 mg, for postoperative pain relief. Postoperative pain was evaluated the 1st, 7th, and 14th day after surgery, respectively, by using a visual analog scale (VAS) and the number of diclofenac consumed. VAS score and the number of diclofenac consumption were compared among the groups. RESULTS: VAS score was similar among the 3 groups during the study period. Total postoperative diclofenac consumption was significantly less in group A than in group C (P < 0.05). CONCLUSION: Dextromethorphan premedication reduced postoperative analgesic consumption after oral surgery.

Administration, Oral↗
PubMed2005

Premedication with orally administered midazolam in adults undergoing diagnostic upper endoscopy: a double-blind placebo-controlled randomized trial.

BACKGROUND: A double-blind placebo-controlled randomized trial was conducted to investigate the safety and the efficacy of orally administered midazolam as premedication for patients undergoing elective EGD. METHODS: A total of 130 patients were randomized to receive either 7.5 mg of midazolam orally (n = 65) or a placebo (n = 65) as premedication. Outcomes measures included the anxiety score (visual analog scale) during EGD, overall tolerance, extent of amnesia, overall satisfaction, patient willingness to repeat the procedure, recovery time, and hemodynamic changes after medication. RESULTS: The median (interquartile range) anxiety score during the procedure in the midazolam group was significantly lower than that in the control group (2.0 [0-4.9] vs. 3.8 [2.1-7.95], p < 0.001). A significantly greater number of patients in the midazolam group graded overall tolerance as "excellent or good" (70.8% vs. 49.2%, p = 0.012) and reported a partial to complete amnesia response (52.3% vs. 32.3%, p = 0.02) when compared with the control group. Patients in the midazolam group were more willing to repeat the procedure if necessary (89.2% vs. 69.2%, p = 0.005). The median (interquartile range) recovery time was significantly longer in the midazolam group than in the control group (5 [5-15] minutes vs. 5 [5-10] minutes, p = 0.014). There were no statistically significant differences in satisfaction score and hemodynamic changes between groups. CONCLUSIONS: Premedication by oral administration of midazolam is a safe and an effective method of sedation that significantly reduces anxiety and improves overall tolerance for patients undergoing EGD.

Administration, Oral↗