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PubMed1993

Inhaled induction and emergence from desflurane anesthesia in the ambulatory surgical patient: the effect of premedication.

We studied the effect of premedication (1 microgram/kg fentanyl and 0.04 mg/kg midazolam 5 min before induction of anesthesia) on airway reactivity and hemodynamic stability during inhaled induction using desflurane in 10 ambulatory surgical patients. Eight patients who were anesthetized without premedication served as the controls. Induction and emergence were rapid and unaffected by premedication. End-tidal and inspired concentrations of desflurane at loss of consciousness were significantly reduced by premedication (10.1% end-tidal/14.1% inspired, no premedication, vs. 5.3% end-tidal/8.9% inspired, premedication). Airway irritability was markedly attenuated by premedication (100% no premedication versus 30% premedicated), as was apnea (37.5% no premedication versus 0% premedicated). We observed an increase in mean arterial blood pressure and heart rate after loss of consciousness (mean arterial pressure 103 vs 121 mm Hg, heart rate 73 vs 100 bpm) in the unpremedicated patients, whereas both groups demonstrated a decrease in mean arterial blood pressure with no change in heart rate when baseline values were compared to those at incision (103 vs 74 mm Hg, no premedication, 99 vs 81 mm Hg premedicated). Patient acceptability was satisfactory and unchanged by premedication. We recommend the use of such premedication when desflurane is used during the induction of anesthesia.

Adult↗
PubMed2004

Premedications and peribulbar analgesia--a prospective audit.

PURPOSE: After peribulbar block analgesia (PBA) instituted in the preoperative anesthetic room, patients are often anxious, developing increased heart rate (HR) and blood pressure (BP) upon their arrival to the operating room and during subsequent surgery. The efficacy of premedication in attenuating these stress responses has not been examined. A prospective audit was undertaken to examine the relationship between the premedication schedules most commonly prescribed at the King Khaled Eye Specialist Hospital and increases in HR and BP during surgery in response to the stress of surgery, and the requirements for intravenous (IV) benzodiazepine, opioid or NSAID medication to treat these increases, or any complaint of pain or positional discomfort on the operating table, respectively. METHODS: The preoperative and intraoperative anesthesia course of 1,064 patients > or = 50 years of age who underwent ocular surgery under PBA was prospectively examined. The following data were recorded: (i) patient characteristics, state of health or disease, medications and premedications; (ii) heart rate (HR), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) at 0600 hrs before surgery (baseline), on admission to the operating room, maximum and minimum values of HR, SAP and DAP recorded at the start of, and during, surgery; and (iii) all instances of benzodiazepine, opioid or NSAID drug administration during surgery, according to standard protocols. RESULTS: Five premedication schedules were identified: Group 1 hydroxyzine po alone (n = 302); Group 2 hydroxyzine, paracetamol with codeine (Revacod), diclofenac po (N = 173); Group 3 hydroxyzine, diclofenac, ranitidine po (N = 94); Group 4 hydroxyzine, cimetidine or ranitidine po, morphine or pethidine IM (N = 340); and Group 5 lorazepam (nocte), hydroxyzine, diclofenac, ranitidinepo, morphine or meperidine IM (N = 155). The five groups of patients were comparable for age, sex, weight and health. Healthy, diseased (with concurrent hypertension, diabetes, ischemic heart disease) and all patients in each premedication group had similar baseline HR, SAP and DAP. In the operating room, the maximum and minimum mean HR in each group was similar, except that more patients in Group 1 developed SAP exceeding 160 mmHg and DAP exceeding 90 mmHg than in Group 5 (p<0.002 and <0.0005, respectively). The requirements for medication at the commencement of, and during, surgery in the five groups to treat increases in HR/BP, eye pain and positional discomfort on the operating table were similar. CONCLUSION: Each of the five premedication schedules described appear to confer similar effects on cardiovascular changes in anticipation of, and during, surgery, except that those given the lightest premedication, Group 1, showed greater increases in BP at the start of surgery than did those given the heaviest premedication, Group 5. The requirements in the operating room for IV medication were similar in the five premedication groups, and no greater benefit was discernible for any one of the five premedication schedules on the objective features assessed. These data suggest that simple oral premedication of hydroxyzine, with or without an H2 receptor antagonist and NSAID, may suffice as premedication in middle-aged to elderly patients undergoing anterior segment surgery.

Analgesia↗
PubMed2002

The relationship between premedical coursework in gross anatomy and histology and medical school performance in gross anatomy and histology.

Many premedical students enroll in courses whose content will be encountered again during their medical education. Presumably, students believe this practice will lead to improved academic performance in corresponding medical school courses. Therefore, this study was undertaken to determine whether a premedical gross anatomy and/or histology course resulted in increased performance in corresponding medical school courses. A second aim of the study was to examine whether the type of premedical gross anatomy and/or histology course differentially affected medical school performance. A survey that assessed premedical gross anatomy and histology coursework was administered to 440 first-year medical students. The results from this survey showed that students with premedical gross anatomy (n = 236) and/or histology (n = 109) earned significantly more points in the corresponding medical school course than students without the premedical coursework (P < 0.05). Analysis of premedical course types revealed that students who took a gross anatomy course with prosected specimens (n = 35) earned significantly more points that those students without premedical gross anatomy coursework (P < 0.05). The results from this study suggest: 1) premedical gross anatomy and/or histology coursework improves academic performance in corresponding medical school courses, and 2) a premedical gross anatomy course with prosected specimens, a specific type of undergraduate course, significantly improves academic performance in medical gross anatomy.

Adult↗
PubMed2001

Oral premedication for operations on the face under local anesthesia: a placebo-controlled double-blind trial.

Modern strategies for preventing or controlling pain and anxiety demand a premedication for operations using local anesthesia and for those using sedation or general anesthesia. For optimal patient care, the premedication should be given orally and, with respect to the outpatient basis of the operations, should have a short recovery period. Midazolam, one of the most favored premedications for general anesthesia, has been recommended as a premedication for operations using local anesthesia as well. However, midazolam has only sedative-anxiolytic effects and does not reduce pain sensation, which should be mandatory for operations using local anesthesia. A further requirement is the maintenance of stable hemodynamics for the prevention of postoperative hematomas, especially in the face. For these reasons, another premedication meeting all requirements (anxiolysis, analgesia, and stable hemodynamics) was researched. A randomized, double-blind prospective study was performed from March of 1997 to June of 1998. Five groups totalling 150 patients were included in the study; each group contained 30 patients who had operations performed solely on the face. In the first four groups, the effect of midazolam (0.15 mg/kg(-1)), morphine (0.3 mg/kg(-1)), and clonidine (1.5 microg/kg(-1)) administered orally was compared with a placebo. The fifth group was the control group and received no premedication. To evaluate the effects of the premedications, a corresponding questionnaire was completed independently by the patient and surgeon. With regard to the anxiolytic or analgesic properties of the premedication, 61 percent of the patients preferred pain reduction to anxiety control, and 24 percent of patients preferred reduction of anxiety. The remainder insisted on a reduction of both properties (8 percent) or had no preference (7 percent). Reduction of anxiety was largest in the midazolam and the clonidine groups, but the difference was not significant. The least pain during the application of local anesthesia was experienced by the morphine group (37 percent) and the clonidine group (33 percent), in contrast to the midazolam group (60 percent) (p = 0.04). Morphine and clonidine met the requirements of pain reduction equally well. Nevertheless, considering the rate and intensity of adverse effects with respect to hemodynamic compromises, nausea, and emesis, clonidine is even better suited as an oral premedication for operations on the face using local anesthesia.

Administration, Oral↗
PubMed2005

Premedication and infusion reactions with infliximab: results from a pediatric inflammatory bowel disease consortium.

BACKGROUND: Infusion reactions (IRs) are the most common adverse events associated with the use of infliximab for inflammatory bowel disease (IBD). Antipyretics, antihistamines, and corticosteroids have been used to prevent the development of IRs, but their efficacy is not known. We studied the proportion of pediatric patients receiving infliximab for IBD that developed IRs and the potential effects of premedication on IR. METHODS: Uniformly collected data from a cohort of pediatric patients with IBD enrolled between January 2000 and May 2003 at 6 pediatric centers were analyzed. Data were retrospectively reviewed and analyzed. RESULTS: A total of 1652 infusions given to 243 patients in 6 centers was analyzed. Overall, 60 IRs were recorded in 40 patients (3.6% of infusions, 16.5% of patients). Thirty-three of 243 patients received premedication before the first IR (group 1). Two hundred ten patients did not receive premedication until the development of IRs, if at all (group 2). IRs were more common among patients in group 1 than in group 2 (12/33 versus 28/210, P < 0.01). Of the 28 patients in group 2 with IRs, 10 began receiving premedication with each subsequent infusion, 12 continued without premedications, and 6 had no further infusions recorded. Two of 10 who began receiving premedication had a subsequent IR versus 6 of 12 who did not receive premedication (P = 0.15). CONCLUSIONS: IRs occur in a small proportion of infusions among pediatric patients receiving infliximab for IBD. Premedication does not seem to prevent the development of IRs; however, once an IR has occurred, premedication may be indicated to prevent subsequent IRs.

Adolescent↗
PubMed1986

[Premedication in fiber optic bronchoscopy from the patient's and the physician's viewpoint--a randomized study for the comparison of midazolam and hydrocodone].

To evaluate side effects and patients' assessment of fiberoptic bronchoscopy under local anesthesia, 122 consecutive patients answered questions from an outside interviewer (an experienced psychiatrist) and not from the endoscopists themselves. The effect of premedication with midazolam (5 mg i.m.) and hydrocodonum (15 mg i.m.) was compared in a randomized study. In a multiple choice questionnaire 68% of all patients indicated considerable fear in the days before bronchoscopy. They were more afraid of the possible diagnosis of cancer (23%) than of dyspnea or asphyxiation (14%). Coughing is considered the worst side effect of bronchoscopy by 25% of patients (36% of the endoscopists) followed by dyspnea during insertion of the scope (21%) and discomfort during local anesthesia. Although the patients premedicated with midazolam are more sedated (p = 0.025 by physicians' assessment vs. p = 0.11 in patients' view), they cough more (p = 0.001 vs. p = 0.22) and usually tolerate the examination less well (p = 0.009 vs. p = 0.08) than patients premedicated with hydrocodonum. 42% of patients premedicated with midazolam had anterograde amnesia. Although they did not remember all the unpleasant side effects, only 77% said they would repeat the procedure with the same premedication, compared with 90% of patients premedicated with hydrocodonum (p = 0.08). Before and two hours after premedication the reaction times had not changed (optical sign, Wiener reaction device) and were identical in the two patient groups. At that time 37% of the patients premedicated with midazolam and 27% of those premedicated with hydrocodonum were still sleepy and could not be regarded as fit for any form of travel.

Adult↗
PubMed1996

Patient-controlled premedication by i.v. midazolam for ambulatory surgery.

Applying the principle and equipment of patient-controlled analgesia, this double-blind randomised study was designed to determine the premedication dose of midazolam and to provide information about the need for preoperative anxiety control. The effects of patient-controlled premedication by i.v. midazolam were compared to those of a 1-hour i.v. infusion of a fixed dose of 4 mg. Two groups of 25 patients were studied prior to ambulatory surgery. Using a visual analogue scale graded from 0 (no anxiety) to 100, anxiety and short-term memory as well as vital signs, vigilance, cognition and orientation were assessed before premedication and then every 20 min until admission to the operating room. In both groups, 40% of the patients were free of anxiety before premedication. Sixty-four percent of patients in the self-pre-medicated group never used the pump. The dose of midazolam was only 0.7 0.2 mg (mean SD) in this group taken as a whole, 0.7, 1.1 mg (mean SD) in the 8 patients who had an anxiety score at least equal to 50 before premedication, and 1.7 0.3 mg (mean SD) in the 9 patients who chose to push the button of the patient-controlled device. Anxiety and short-term memory scores decreased significantly and similarly in the self-premedicated group and in the fixed-dose group. For similar intraoperative anaesthetic requirements, time from the end of anaesthesia for determining whether a patient was ready for admission to the postrecovery lounge was shorter in the self-premedicated group (26 +/- 8 min vs 32 +/- 8 min; mean +/- SD. Reduced doses of midazolam self-administered via a patient-controlled device can result in a relaxed preoperative period and amnesia in ambulatory surgery patients. However, the level of anxiety before premedication was low, which calls into question the legitimacy of the patient-controlled premedication in this kind of population. The expense of the pump was not justified by the small number of patients using it, probably because they were worried by the technical nature and the invasiveness of this technique.

Adult↗
PubMed2006

Preferences for shared decision making in chronic pain patients compared with patients during a premedication visit.

BACKGROUND: There is some evidence that patients' outcomes improve if they are involved in shared decision making (SDM). A chronic pain clinic or premedication visit could be adequate settings for the implementation of SDM. So far, the patients' preference for involvement in decision making and their desire for information have not been tested in anesthesiological settings. METHODS: A group of chronic pain patients was compared with a group of patients in the premedication visit with respect to SDM, the desire for information and perceived involvement in care. The autonomy preference index (API, measuring preference for involvement and desire for information) and the perceived involvement in care scale (PICS, measuring patients' perception of easier involvement by doctors and information exchange) were administered. RESULTS: In total, 190 chronic pain patients and 151 patients of premedication were included in this study. Patient of the premedication visit had significantly higher SDM scores. Desire for information was high, but there were no differences between groups. Younger patients [B (estimate) =- 0.3; 95% CI (-0.4) - (-0.1)], women (B = 10.9; 95% CI 6.3-15.4) and patients with higher educational level (B = 10.1; 95% CI 5.6-14.6) had more desire for SDM. PICS scores were basically influenced by groups: chronic pain patients felt more facilitated by doctors [B =- 0.185; 95% CI (-0.4) - (-0.1)] and had more information exchange [B =- 19.5; 95% CI (-15.8) - (-2.4)] than patients in the premedication visit. CONCLUSION: In both anesthesiological settings, the desire for information was high, but patients in the premedication visit had higher SDM scores, especially young female patients with higher educational level. Real patient-physician interaction showed that premedication patients felt less involved by doctors and had less information exchange compared with the chronic pain patients. Therefore, premedication visits should be focussed more on adequate information exchange and involvement of the patient in the shared decision making process.

Adult↗
PubMed1995

Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone.

Seventy five ASA 1 and 2 children, aged between six months and five years were randomized to receive oral midazolam 0.5 mg.kg-1, rectal thiopentone 35 mg.kg-1 or no premedication to compare the safety and efficacy of, and parental attitudes to, both premedicants. Cardio-respiratory variables were from the time of premedication to awakening from anaesthesia. In addition, anxiety and sedation scores and patients' acceptance of both premedicant and mask at induction, were all recorded using four-point rating scales. Times to recovery and discharge, and parental satisfaction with the premedication their child had received were also recorded. Children receiving rectal thiopentone had higher sedation scores and were more accepting of the mask than were the other two groups (P < 0.001). Their acceptance of the premedication was similar to that of the midazolam group. Times to spontaneous eye opening and discharge were longer in the thiopentone group (P < 0.005). Parental preoperative satisfaction rating was higher for thiopentone, but not midazolam, than no premedication (P < 0.05). When asked their premedication preferences for subsequent general anaesthetics, a higher proportion of parents whose children were not premedicated requested an alternative regimen (P < 0.01). In conclusion the study found that premedication with rectal thiopentone provided superior induction characteristics to oral midazolam, but with a longer recovery period.

Administration, Oral↗
PubMed1989

The effect of a standardized premedication on oxygen saturation in the cardiac patient before transfer to the operating room.

The effect of premedication with morphine and scopolamine on arterial hemoglobin oxygen saturation (SaO2) was measured continuously in 26 undisturbed patients in their hospital rooms before coronary artery bypass surgery. Two hours preoperatively each patient received morphine, 0.1 mg/kg, and scopolamine, 0.2 or 0.4 mg. SaO2 was continuously recorded using pulse oximetry from one-half hour before premedication until 1 1/2 hours after premedication. The lowest SaO2 measured both the evening before surgery and one-half hour before premedication was 95% +/- 0.5% (mean +/- SEM). After administration of premedication, the lowest SaO2 for the patient population decreased to 93% +/- 0.4% (P less than 0.001 compared with that before premedication), and occurred 52 +/- 2 minutes after premedication was given. Two patients (8%) had an SaO2 less than 90% (lowest SaO2 for both was 88%). It is concluded that the dose of morphine/scopolamine premedication used was associated with a low risk of clinically important hypoxemia in the patient population studied.

Adult↗
PubMed2002

Premedication strategy for weekly paclitaxel.

PURPOSE: Dexamethasone and histamine antagonists have been employed commonly as premedications for prophylaxis of hypersensitivity reactions (HSRs) to paclitaxel. Frequent premedications for weekly administration of paclitaxel are associated with added side-effects and extra cost. We analyzed our experience of HSRs to paclitaxel administered every 3-4 weeks, and designed a treatment algorithm to eliminate premedications in a majority of patients receiving weekly paclitaxel. PATIENTS AND METHODS: The incidence of HSRs was analyzed retrospectively in patients who received 3-hr infusions of paclitaxel (135-225 mg/m2) every 3-4 weeks in our institution over a period of 5 years. On the basis of the results of this analysis, we designed a premedication schema for patients receiving weekly paclitaxel, 50-90 mg/m2/week, as follows: Thirty minutes prior to the first weekly dose of paclitaxel, patients received intravenously (i.v.) dexamethasone (10 mg), diphenhydramine (25 mg), and cimetidine (300 mg). If no HSRs occurred, all premedications were deleted for subsequent weekly paclitaxel doses. For patients who experienced HSRs, 20 mg of dexamethasone was given orally 12 and 6 hr prior to re-challenge with paclitaxel in addition to diphenhydramine and cimetidine. RESULTS: Over a period of 5 years, 358 patients received 1608 3-hr infusions of paclitaxel (135-225 mg/m2). Hypersensitivity reactions, which occurred exclusively during the first cycle of paclitaxel administration, were observed in 14 patients. Of these 14 patients, 11 were successfully retreated with paclitaxel without HSRs, two had recurrent HSRs upon paclitaxel re-challenge, and one refused further treatment. These observations indicate that HSRs to paclitaxel occurred in 4% of patients upon first exposure, that most of these patients can be retreated successfully with paclitaxel without recurrent HSRs, and that if no HSRs occur during the first cycle, HSRs are unlikely to occur with subsequent paclitaxel administration. The premedication schema was applied to 30 patients receiving 205 one-hr infusions of weekly paclitaxel. Using this premedication strategy, no HSRs have been observed during the initial or subsequent administration of paclitaxel. CONCLUSION: We conclude that this premedication strategy is feasible and worthy of further study for patients receiving weekly paclitaxel.

Administration, Oral↗
PubMed2001

S(+)-ketamine for rectal premedication in children.

Our purpose for this prospective, randomized, and double-blinded study was to evaluate the anesthetic efficacy of S(+)-ketamine, an enantiomer of racemic ketamine, compared with a combination of S(+)-ketamine and midazolam, and plain midazolam for rectal premedication in pediatric anesthesia. Sixty-two children, ASA physical status I and II, scheduled for minor surgery, were randomly assigned to be given rectally one of the following: 1.5 mg/kg preservative-free S(+)-ketamine, a combination of 0.75 mg/kg preservative-free S(+)-ketamine and 0.75 mg/kg midazolam, or 0.75 mg/kg midazolam. Preoperative anesthetic efficacy was graded during a period of 20 min by using a five-point scale from 1 = awake to 5 = asleep. Tolerance during anesthesia induction via face mask was graded by using a four-point scale from 1 = very good to 4 = bad. A sufficient anesthetic level (> or = 3) after rectal premedication was reached in 86% in midazolam/S(+)-ketamine premedicated children, in 75% in midazolam premedicated children, but only in 30% in S(+)-ketamine premedicated children (P < 0.05 S(+)-ketamine versus midazolam/S(+)-ketamine and midazolam groups). The incidence of side effects after rectal premedication was rare. Whereas the mask acceptance score was comparable in the three study groups, a 25% rate of complications during anesthesia induction via face was observed in the S(+)-ketamine study group (P < 0.05 versus other study groups). Our conclusions are that S(+)-ketamine for rectal premedication in the dose we chose shows a poor anesthetic effect and a frequent incidence of side effects during induction of anesthesia via face mask compared with the combination of midazolam/S(+)-ketamine and plain midazolam. Dose-response studies of S(+)-ketamine for rectal premedication in pediatric anesthesia may be warranted.

Administration, Rectal↗
PubMed1989

Comparison of oral transmucosal fentanyl citrate and an oral solution of meperidine, diazepam, and atropine for premedication in children.

The safety and efficacy of premedication with oral transmucosal fentanyl citrate (OTFC) was compared with that of an orally administered solution of meperidine, diazepam, and atropine and no premedication in 59 children about to undergo elective operations. The patients were randomly assigned to receive no premedication (n = 19); 0.25 ml/kg of the oral solution (containing meperidine, 1.5 mg/kg, diazepam, 0.2 mg/kg, and atropine, 0.02 mg/kg, n = 20); or OTFC (15-20 micrograms/kg, n = 20). Children had activity (sedation) and anxiety scores, vital signs (including systolic and diastolic arterial blood pressures and heart and respiratory rates) and pulse oximetry determined oxygen saturation measured before and at 10-min intervals after premedication until they were taken to the operating room. Quality of induction and recovery was evaluated using scoring schedules; recovery times were measured and side effects noted. OTFC was readily accepted and provided significant reductions in preoperative activity (sedation) and anxiety starting after 30 min. After OTFC, sedation and anxiolysis were significantly greater than in children having no premedication but similar to children having the oral solution for premedication. Vital signs and oxygen saturations remained unchanged preoperatively in all groups. Induction and recovery evaluations and recovery times were similar in the three groups, although children having OTFC had the lowest requirements for narcotics in the recovery room. OTFC caused an 80% incidence of mild preoperative facial pruritus and a higher overall incidence of postoperative vomiting (37%) than premedication with the oral solution (5%) or no premedication (18%).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1976

The postanesthetic antiemetic effect of premedication with dehydrobenzperidol before ether anesthesia.

A study was performed to evaluate the antiemetic effects after ether anesthesia when dehydrobenzperidol (DHB) and pentobarbital were used for premedication and to compare these effects with halthane anesthesia when pentobarbital was used as premedication. Eighty-four patients undergoing minor surgical operations were randomly divided into three groups. The patients received ether and ether DHB 0.2 mg/kg or pentobarbital 2 mg/kg for premedication, or halothane and pentobarbital 2 mg/kg for premedication. The complaints of nausea and vomiting were recorded 24 h after anesthesia. We found that DHB compared to pentobarbital had a greater antiemetic effect after ether anesthesia, but the difference was not significant (P greater than 0.05). However, if only persistent nausea and vomiting were considered, the difference was significant (P less than 0.05). The incidence of nausea/vomiting after ether anesthesia with DHB as premedication was a little higher compared to halothane anesthesia with pentobarbital as premedication, but the difference was not significant (P greater than 0.05). However, if only persistent nausea/vomiting was considered, the incidence of complaints was equal in the two groups. It is concluded that when used for premedication to ether anesthesia DHB seems to lead to less postanesthetic nausea/vomiting than pentobarbital. Further DHB seems able to reduce the incidence of nausea/vomiting after ether anesthesia roughly to the level of that seen after pentobarbital premedication for halothane anesthesia.

Adolescent↗
PubMed1998

Influence of premedication with diazepam or morphine on the induction dose of eltanolone.

BACKGROUND: This study examined the influence of premedication with morphine or diazepam on the dose of eltanolone, a steroidal intravenous anaesthetic agent, required to induce anaesthesia. METHODS: Two hundred and sixteen patients, aged 18 to 65 years, were randomly assigned to receive premedication with diazepam 10 mg orally, morphine 10 mg intramuscularly, or placebo. The double-dummy technique was used to maintain blinding. Eltanolone 0.16-0.75 mg x kg(-1) was given intravenously over 20 s. At the commencement of injection patients were instructed to begin counting; if the patient ceased counting within 120 s and failed to respond to commands to continue, anaesthesia was considered to have been induced. The dose required to anaesthetise 50% of patients (ED50) was determined by logistic regression. RESULTS: The ED50 (95% confidence interval) of eltanolone in patients who received placebo premedication was 0.31 (0.27-0.34) mg x kg(-1). It was reduced slightly and nonsignificantly by premedication with diazepam, to 0.27 (0.24-0.30) mg x kg(-1), or morphine, to 0.26 (0.23-0.29) mg x kg(-1). Involuntary movement occurred in 65% of placebo premedicated patients. Its incidence was not significantly reduced by diazepam (57%), but was significantly (P<0.001) reduced by morphine (37%). Morphine premedication was, however, associated with a significant (P<0.01) increase in the incidence of apnoea (21%) compared to placebo premedicated patients (4%). CONCLUSION: Premedication with diazepam or morphine had little influence on the dose of eltanolone required to induce anaesthesia.

Adjuvants, Anesthesia↗
PubMed1993

Supplemental oxygen does not reduce myocardial ischemia in premedicated patients with critical coronary artery disease.

This randomized, prospective clinical study investigated the effects of supplemental inspired oxygen on arterial hemoglobin desaturation and myocardial ischemia in premedicated patients who have critical coronary artery stenosis, identified predictors for these adverse events, and examined the temporal relationship between hemoglobin desaturation and myocardial ischemia. Before elective coronary artery bypass surgery, 104 patients were monitored continuously by using a real-time electrocardiogram (V4 and V5 leads) recorder and a digital pulse oximeter. After a 2-h baseline monitoring period (Interval A), patients were given sublingual lorazepam 0.03 mg/kg, and were randomized to receive continuous supplemental inspired oxygen by nasal catheters [4 L/min (Oxygen Group, n = 52)] or to receive no supplemental inspired oxygen (Control Group, n = 52) (Interval B). One hour later, all patients received intramuscular morphine 0.15 mg/kg with perphenazine 0.05 mg/kg (Interval C). Interval C lasted 1 h, and the study was terminated. In the Oxygen Group, the incidence of desaturation was 25% before premedication and 11.5% after premedication (NS). In the Control Group after premedication, the incidence of desaturation increased from 25% to 56.9% (P < 0.001). There was no significant difference in the incidence of myocardial ischemia before or after premedication within or between the two groups. Arterial hemoglobin desaturation was not associated temporally with myocardial ischemia at any time. Predictors of desaturation after premedication included absence of supplemental O2, increased weight, age, and occurrence of desaturation before premedication. There were no identifiable predictors for myocardial ischemia after premedication. During Intervals A and C, episodes of hemoglobin desaturation were associated with small but statistically significant increases in mean heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

[Evaluation of preoperative anxiety in patients with and without premedication].

BACKGROUND: The purpose of this investigation was to determine whether elimination of premedication before general anesthesia affects preoperative anxiety. METHODS: Subjects were assigned to one of two groups: a sedative group (0.5 mg midazolam i.m., n = 111) or a no-premedication group (n = 98). We used patients' responses to a questionnaire to compare the no-premedication group and the sedative group. RESULTS: Eighty-three percent of patients in the no-premedication group entered the operating room ambulatory. The responses concerning preoperative anxiety were not different between the two groups. There was a high rate of recall of the conversation before anesthesia induction in the no-premedication group, and most of these patients replied that making conversation before general anesthesia was beneficial to them. Increases in heart rate and blood pressure at the point of entrance to operating room were observed in the no-premedication group, but the degrees of increase were not considered clinically important. CONCLUSION: We conclude that elimination of premedication does not increase anxiety in comparison with patients receiving sedatives, but makes patients feel comfortable by way of preoperative conversation. Elimination of premedication also makes ambulatory entrance possible, both improving safety with respect to patient identification and reducing the demand on nursing.

Adult↗
PubMed1987

[Midazolam and pethidine/promethazine for intramuscular premedication].

The main reason for premedication is the reduction of preoperative stress. Despite the proven fact that benzodiazepines best reduce preoperative stress, combinations of opioids and neuroleptic drugs are preferred for premedication by many on reviewing the journal Der Anaesthesist. This double-blind study was performed to investigate midazolam and meperidine/promethazine for intramuscular premedication. Method. 60 patients undergoing minor gynecological surgery were randomly assigned to receive either 5-7.5 mg midazolam or 50-75 mg meperidine and 25-50 mg promethazine intramuscularly 30-90 min before surgery. Anxiety, depression, and asthenia were assessed by the patient before and after premedication but before induction of anesthesia using visual analogue scales and a nominal scale. Sedation was assessed by an observer. Heart rate and blood pressure were the physiological stress parameters. Parameters of acceptance and side effects were registered perioperatively. Results. Midazolam had a significantly better anxiolytic and antidepressive effect. There were no differences in the other parameters except for adverse effects. Meperidine/promethazine produced significantly more side-effects than midazolam. The parameters of acceptance assessed the day after surgery were comparable. Conclusions. We conclude from these results that anesthesiologists still premedicate with meperidine/promethazine because the patients accept this premedication very well when asked the day after surgery. Nevertheless, premedication with midazolam provides significantly better anxiolytic and antidepressive effects with significantly less side-effects. Therefore, midazolam should be preferred to meperidine/promethazine for intramuscular premedication.

Adolescent↗