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PubMed2005

Results of 24-hour ambulatory electrocardiography in dogs undergoing ovariohysterectomy following premedication with medetomidine or acepromazine.

OBJECTIVE: To investigate heart rate characteristics in dogs undergoing ovariohysterectomy following premedication with medetomidine or acepromazine. DESIGN: Clinical trial. ANIMALS: 43 client-owned dogs. PROCEDURE: 24-hour ambulatory electrocardiography was performed beginning approximately 1 hour prior to administration of premedications. Dogs were premedicated with medetomidine and butorphanol (n = 21) or acepromazine and butorphanol (22) and, approximately 85 minutes later, were anesthetized with propofol and isoflurane. Electrocardiographic recordings were examined to determine heart rate, cardiac conduction disturbances (ventricular premature complexes and atrioventricular block), and indices of heart rate variability (HRV). RESULTS: Minimum heart rate during the 24-hour recording period was significantly lower among dogs given medetomidine than among dogs given acepromazine, but during the postoperative period, heart rate increased in all dogs as they became physically active. Intraoperative time domain HRV indices were lower and the low frequency-to-high frequency ratio was higher among dogs given acepromazine than among dogs given medetomidine; however, significant differences between groups were no longer seen by 6 hours after surgery. There was no significant difference between groups with regard to the number of ventricular premature complexes or to values of scaling exponent alpha2 (a nonlinear measure of HRV). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that there are greater enhancements in vagally related heart rate indices in medetomidine-treated dogs that may persist until 6 hours after surgery. Despite the low heart rates, dogs given medetomidine showed expected responses to surgery and positional stimuli, and the 2 preanesthetic protocols may not result in different prevalences of ventricular premature complexes.

Acepromazine↗
PubMed2000

[Weekly administration of paclitaxel for advanced or metastatic breast cancer--short-course premedications for outpatients].

A phase II trial has demonstrated that paclitaxel (210 mg/m2/3 hr) showed a 33.3% response rate among anthracycline-resistant breast cancer patients in Japan. Recently, weekly dosing of paclitaxel has been demonstrated to be a well-tolerated, feasible and effective administration schedule. Standard premedication is commonly administered prior to treatment with paclitaxel. However, this regimen requires dexamethasone administration beginning at 12 to 14 hours prior to paclitaxel, which would not be convenient for outpatients. In this study, paclitaxel was administered by 1 hour intravenous infusion at a dose of 80 mg/m2 every week. Administration was continued for 3 weeks with a 1 week rest. A short course premedication schedule consisted of dexamethasone 20 mg i.v. (diluted in 50 ml normal saline, 1 hour prior to paclitaxel), and oral diphenhydramine 50 mg, H2-antagonist and anti-emetic agent i.v. (diluted in 50 ml normal saline, 30 minutes prior to paclitaxel). A total of 14 outpatients were enrolled in the study. There were 10 partial responders and no complete responders, and the overall response rate was 71.4%. No hypersensitivity reactions were observed, and grade 3/4 leukopenia occurred in 43% (6/14). Allopecia was observed in 4 patients, and peripheral neuropathy in 1 patient (both grade 1). Weekly administration of paclitaxel is effective and well-tolerated in patients with advanced or metastatic breast cancer, with a minimum of peripheral neuropathy. In addition to the above, no hypersensitive reaction in the short course premedication schedule suggests that this administration schedule is feasible for outpatients.

Adult↗
PubMed1992

Effect of premedication on the changes of neuropeptide Y (NPY) in anesthesia.

Premedication is one of the popular techniques in anesthesia, not only for the decrease of side effects but also for the increase of actions. Clinically, we found that plasma neuropeptide Y-like immunoreactivity (NPY-IR) was lowered in patients who had received premedication. In rats, plasma NPY-IR was not modified by the intravenous injection of diazepam. Pethidine reduced the plasma NPY-IR level which could be reversed by naloxone. Direct inhibition of plasma NPY-IR through an activation of opioid receptors can thus be considered. To the cold-stress stimulation, plasma NPY-IR was markedly raised. Diazepam reduced this stimulation-induced increase of plasma NPY-IR in a dose-dependent manner. Similar derivative of benzodiazepine produced an inhibition in a way following the potency as that to produce anxiolytic action. Also, this inhibition was reversed by PK11195, an antagonist of peripheral benzodiazepine receptors. Moreover, pain-stimulated increase of plasma NPY-IR in rats was also reduced by pethidine. This action was totally reversed in the presence of naloxone, indicating the participation of opioid receptors in the process. The obtained results suggest that premedication of diazepam and/or pethidine has the ability to decrease plasma NPY-IR in animals.

Animals↗
PubMed1976

Intramuscular premedication with lorazepam.

Lorazepam is recognized as a tranquillizer. It is presented for intramuscular and intravenous injection. In a study of this drug's possible effects in premedication, its action was studied systematically when it was used for preoperative premedication. The drug has no side-effects other than drowsiness, which occurs in almost all cases. It produces very good premedication, sometimes with anterograde amnesia in the doses used. This anterograde amnesia is dependent on the dosage used but it is always accompanied by profound drowsiness, from which the patient can be roused verbally. The dose will be selected in relation to whether amnesia is desired or not. However, whatever the dose administered (over 2.5 mg), the tranquillizing effect is always of high quality.

Adult↗
PubMed2005

[Surgical care rendered to the wounded in the antiterrorist operations on the Northern Caucasus: premedical and initial medical care in the combat zone (Report II)].

The analysis of organization and contents of the first aid, premedical and initial medical care rendered to the wounded in the armed conflicts on the Northern Caucasus (1994-1996, 1999-2002) was conducted. It was established that the first aid was rendered to the most casualties who needed it (65% in the first conflict and 79% in the second conflict). The mean terms of rendering the first aid in the second conflict as compared with the conflict of 1994-1996 were decreased from 29 +/- 2 min to 18 +/- min. The role of premedical care was minimal in both conflicts: it was rendered to 3% casualties only. The premedical care was rendered in those cases when the first aid appeared to be ineffective, had obvious defects or in the delay of further evacuation of the wounded. The initial medical care became the central type or pre-hospital care in the combat zone. It was rendered to 56% casualties in the first conflict and to 59% in the second conflict. The mean terms of initial medical care rendered in the second armed conflict were 1.5 +/- 0.2 h. They have considerably decreased as compare with the first conflict (2.5 +/- 0.4 h). The introduction of the physicians with initial surgery and intensive care training in the staffs of regimental medical companies was resulted in significant improvement of initial medical care quality. It provided the adequate preparedness of the wounded for aeromedical evacuation to multipurpose military hospitals of the first level.

Critical Care↗
PubMed1991

The effect of premedication on the induction dose of propofol in dogs and cats.

The effect of premedication on the induction dose of propofol was determined in 15 cats and 25 dogs undergoing elective surgical procedures. The induction dose of propofol in dogs younger than 8 years old was 6.9 +/- 0.9 mg kg-1 (n = 4) without premedication and 4.3 +/- 1.4 mg kg-1 (n = 12) with premedication with acetylpromazine maleate. The induction dose in cats younger than 3 years old was 7.8 +/- 1.1 mg kg-1 (n = 8) with atropine alone and 7.1 +/- 0.9 mg kg-1 (n = 7) with the inclusion of acetylpromazine maleate. The reduction in the induction dose of propofol was statistically significant in dogs, but not in cats. When atropine was used together with a fentanyl-droperidol combination or pethidine and acetylpromazine maleate in dogs, the mean induction dose of propofol was reduced to 2.1 +/- 0.1 mg kg-1 (n = 4) and 2.4 +/- 0.3 mg kg-1 (n = 5), respectively. Propofol was also evaluated as an induction agent in patients undergoing non-elective surgical procedures.

Acepromazine↗
PubMed1991

[Rectal, oral and nasal premedication using midazolam in children aged 1-6 years. A comparative clinical study].

Midazolam is often used for the premedication of children in the pre-school age group. Different noninvasive routes of administration have been described. In a prospective study we compared the effects of oral, rectal, and nasal midazolam in commonly used dosages. PATIENTS AND METHODS. Ninety children undergoing surgery under general anesthesia were assigned to oral (0.4 mg/kg) (MO), rectal (0.5 mg/kg) (MR), or nasal (0.2 mg/kg) midazolam (MN), according to the child's and/or parent's preferred route of administration, after having obtained the parent's informed consent. It was applied on the ward before transport to the operating room. The following parameters were assessed by the observer and the anesthesiologist at different times: sedation, acceptance (child, anesthesiologist), mood, emotion, resistance, pain, nausea and vomiting, blood pressure, and heart and respiratory rates. The Wilcoxon test (P less than 0.05) was used for statistical analysis. RESULTS. All groups were comparable with respect to age, weight, and surgery experience. There was no difference in the anesthesiologist's acceptance of the premedication or the cooperation of the children. The children accepted MO significantly better compared to MN and MR. The fastest onset of sedation was found after MR. Immediately after MN many children became euphoric, and it turned out that the effect of MN was rather euphoric than sedative. The effect of MO was good in many children, but less predictable. This led to a significant delay in transport to the operating room. MO children experienced more nausea and vomiting (P less than 0.05) in the postoperative period. There were no differences in physiological parameters. DISCUSSION AND CONCLUSIONS. The results can be explained by the different characteristics of absorption and patient acceptance. The route of administration according to the child's or parent's choice can be recommended but does not guarantee success. MR had the fastest onset of sedative action due to faster absorption of the drug. MN had a euphoric effect that resulted almost immediately. Oral premedication was best accepted, nasal administration worst. MO produced more side effects than MR and MN in the postoperative period. If the child accepts the rectal route of administration, this should be preferred because of the high success rate and few side effects.

Administration, Intranasal↗
PubMed1991

Clinical and metabolic responses to different types of premedication.

Clinical and metabolic responses to three types of premedication were studied in ASA physical status I patients given any one of the following: (a) 0.5 mg of atropine and 50 mg of meperidine given intramuscularly plus an oral placebo tablet (n = 14), (b) 10 mg of oral diazepam and an intramuscular placebo (2 mL NaCl, concentration = 0.9) (n = 14), or (c) oral and intramuscular placebo (n = 14). Based both on subjective estimates (tiredness, fear, anxiety, dryness of mouth) and, especially, on metabolic responses (energy expenditure, oxygen consumption), oral diazepam appears to be superior to the combination of an opiate (meperidine) plus an anticholinergic (atropine). Atropine plus meperidine significantly increased energy expenditure above predicted values (2061 +/- 365 vs 1714 +/- 361 kcal/24 h, P = 0.004), calculated using the Harris-Benedict equation, based on sex, weight, height, and age, as well as increased oxygen consumption above levels seen with diazepam premedication (160 +/- 29 vs 137 +/- 17 mL.min-1. m-2). These findings indicate an iatrogenic stress factor induced by premedication with atropine plus meperidine.

Administration, Oral↗
PubMedDate not supplied

[The effect of premedication using promedol and galanthamine on the course of epidural anesthesia with trimecaine].

The course of epidural anesthesia with a 2% trimecaine solution has been studied in 93 patients (mean age 56.5 years) upon premedication with promedol (20 mg) and galanthamine (10 mg). It has been established that promedol promotes mainly to a reduction in the time of anesthesia onset (by 26.5%) and to the enhancement of the antihypertensive reaction (by 15.7%). Premedication with galanthamine is accompanied by a 13% decrease in the initial anesthetic dose, a 34.5% shortening of the time of anesthesia onset and the attenuation of negative hemodynamic shifts. Upon premedication with both drugs, the total trimecaine expenditure decreases by 25% and the time of anesthesia onset shortens more than by half.

Adult↗
PubMedDate not supplied

[The use of clopheline in premedication].

Central and peripheral hemodynamic changes have been studied in 80 patients aged 18 to 67 years after planned gastro-intestinal and biliary surgery. In 40 of them clopheline (clonidine) was used in premedication. The use of clopheline in premedication led to stabilization of central hemodynamic parameters, made it possible to improve considerably microcirculation, avoid the unfavourable effects of psychic tension, induction to anesthesia, laryngoscopy and tracheal intubation. All the above permits the authors to recommend the use of clopheline in premedication.

Adult↗
PubMed1990

[Rectal premedication using ketamine, diazepam and atropine in childhood].

In 70 children aged between 2 and 14 years the effect of rectal application of ketamine, diazepam and atropine was investigated. Administration was effected by suppositories in 38 children (group A) in four weight classes. Thirty-two children (group B) were premedicated by clysters depending on body weight. We found that the combination of drugs applied in group B showed significantly more effective premedication and enabled smooth induction of anaesthesia. Latency between application and induction was 20 minutes. Since a state of deep sleep can occur rapidly, a preoperative monitoring of the children is necessary. In contrast to group A, we found a smaller increase in heart rate in group B. But there were no differences in behaviour during and after operation between the groups. Despite the relatively small doses of ketamine, 12.8% of all children showed increased salivation. Therefore, this method of premedication should not be used without atropine. Since 11% of the patients vomited postoperatively, the use of dehydrobenzperidol instead of diazepam is discussed.

Administration, Rectal↗
PubMed1990

[Midazolam and ketamine for rectal premedication and induction of anesthesia in children].

Fifteen healthy children 2-10 years old and scheduled for elective surgery, received midazolam 0.35 mg/kg body weight and atropine 0.025 mg/kg as rectal premedication about 35 min before the induction of anesthesia. The induction itself was carried out in a separate and quiet room next to the operating theatre by rectal administration of ketamine 10 mg/kg and midazolam 0.2 mg/kg. With the children breathing spontaneously, anesthesia was maintained by repetitive i.v. bolus injections of ketamine. The sedative and anticholinergic effects of the premedication were satisfactory. Induction of anesthesia was smooth. Consciousness was lost after 9-15 (mean 13) min. No significant adverse effects on hemodynamics or respiration were noted. Recovery from anesthesia was uneventful. No cases of rectal irritation or unpleasant dreams were reported. Post-operative analgesia was good. In conclusion, rectal administration of midazolam and atropine for premedication, followed by ketamine and midazolam for the induction of anesthesia, proved to be a pleasant, safe, and reliable method in pediatric anesthesia.

Administration, Rectal↗
PubMedDate not supplied

[Effect of intravenous anesthetic premedication using diazepam and fentanyl on the arterial oxygen saturation. A pulse-oximetric study].

The effects of anesthetic premedication with diazepam and phentanyl on the arterial oxyhemoglobin saturation (SpO2) were monitored with a pulsioximeter (BIOX 3700, Ohmeda) in 83 patients scheduled for traumatologic and orthopedic surgery who had baseline SpO2 higher than 95%. Premedication was carried out with phentanyl (0.1 mg) and diazepam (2.5 mg increments) until a somnolence state (eye closure), reversible with verbal stimuli, was achieved. The patients were breathing room air during the study. Premedication induced a significant reduction of SpO2 (p less than 0.001) from baseline values of 96.6 +/- 1.2% to 92.7 +/- 2.9% after sedation and to minimal values of 85.9 +/- 6.1%. In 60 patients (72.3%), minimal SpO2 was lower than 90%, and it was lower than 85% in 32 (38.8%). However, 34 of them (73.3%) recovered a SpO2 higher than 90% with verbal respiratory stimuli, but 16 (26.7%) only did so with oxygen administration. Cyanosis was not detected in any case. Minimal saturation was significantly correlated with baseline SpO2, age and smoking habit. Pulsioximetric monitoring or, if not available, routine oxygen administration, are recommended in patients undergoing pharmacological sedation.

Adolescent↗
PubMed1989

[Significant CO2 retention in children after premedication with Dormicum and Thalamonal].

Whereas in adults the use of Innovar for premedication has been abolished, the combination of midazolam and Innovar is still recommended for the premedication of children. This combination may lead to an additional depressive effect on respiration. A prospective, randomized study was performed to evaluate the risk of ventilatory depression. In 36 infants capillary blood gas values were measured pre- and postmedication with either rectal midazolam (0.4 mg/kg) and i.m. Innovar (0.04 ml/kg) or after oral chlorprothixene (2.0 mg/kg). After chlorprothixen the blood gas values did not change, whereas after the combination of midazolam and Innovar pCO2 rose significantly from 35.5 to 43.0 mmHg. In 7 of 22 cases pCO2 reached values above 45 mmHg. This difference compared to the chlorprothixene group was significant (p less than 0.05). The pH fell significantly from 7.42 to 7.36 in the combination group. Clinical signs of respiratory depression could not be observed in this group. The combination of midazolam with Innovar is therefore not useful for premedication in infants and young children.

Analgesics↗
PubMed1989

[Premedication in ENT operations under local anesthesia].

Midazolam 15 mg orally, was compared with the combination of pentobarbital, promethazine, opial and scopolamine as premedication for ear surgery under local anaesthesia in the first of a series of three double blind clinical trials. Sedation, pain sensation and appreciation by patient and surgeon alike were in favour of the pentobarbital regime. Anxiolysis was the same for both regimes. The number of actions needed to administer the medication was basically lower for midazolam. Comparing in a similar, second study midazolam 15 mg with higher doses of 20 mg and 25 mg, the results were satisfactory with the highest dose. Pain during the administration of the local anaesthesia was felt in 16% of the patients. Adding 10 mg morphine intramuscularly in a third study did not prove to diminish the percentage of patients with pain complaints. It is concluded that 25 mg midazolam taken orally 45 minutes pre-operatively is a satisfactory premedication for ear surgery and less troublesome than the pentobarbital, promethazine, opial, scopolamine we used before. In day-care surgery this short acting premedication in our opinion is quite useful.

Adolescent↗
PubMed1989

[2 cases of brief asystole following premedication--a possible connection with Thalamonal?].

Two cases of cardiac arrest about 30 min after intramuscular administration of premedication are analyzed. The patients were two young men without serious diseases in the history. The premedication consisted of Thalamonal (Innovar) and atropine. The cardiac arrest responded readily to treatment and there were no further problems. The indication for Thalamonal for premedication is critically analyzed; our conclusion is that it should be used only with caution.

Adult↗
PubMed1988

Anxiety and informed consent. Does anxiety influence consent for inclusion in a study of anxiolytic premedication?

Forty-three consecutive patients were interviewed on the eve of elective gynaecological surgery to determine the effect of anxiety on the granting of informed consent to participate in an hypothetical study. Anxiety was assessed using the Spielberger state-trait anxiety inventory and 10-cm linear analogue scale. A standardised explanation of an hypothetical premedication study was given and the patients' consent requested. Results were grouped for those who granted (n = 33) and those who withheld (n = 10) consent: anxiety scores for the latter were significantly higher (p less than 0.01). It is concluded that patients with high pre-operative anxiety levels are more likely to withhold consent for inclusion in premedication studies than are those who are less anxious. Seeking informed consent would introduce bias into studies of anxiolytic premedication.

Adult↗
PubMed1988

An assessment of a premedical program in terms of its ability to serve black Americans.

If special programs to increase the number of blacks gaining entry into health professional schools can identify whom they best serve, changes in either the selection process or the curriculum can increase their effectiveness. As one part of an evaluation of the effectiveness of the various components of the prehealth professions program at Xavier University of Louisiana (XU), black freshmen entering the university from 1981 to 1983 in the university's premedical program were tracked to determine who gained entry into medical and related mainline health professional schools upon graduation.The analyses indicate that high-ability black freshmen entering Xavier are more than twice as likely to gain admission into medical school than are their black counterparts nationally, and that this difference is statistically significant beyond the 99 percent level. Fifty-seven percent of high-ability black freshmen (those with American College Testing [ACT] composite scores of 24 or above, the top 2 percent of blacks nationally) who entered XU's biology or chemistry programs during the period under study gained entry into medical school upon graduation, whereas a study by the Educational Testing Service indicates that only 24 percent of similar blacks nationally gain entry into any graduate or professional school.The present study suggests that XU's premedical program serves those blacks who are not in the high-ability group (those whose ACT scores are below 24) at least as well (relative to the national average) as it does the top students. It therefore seems reasonable to assume that XU's premedical program is successful because it increases the probability that students gain admission into health professional schools rather than because of any preselection of students. These results are similar to those obtained from a comparable analysis of XU's prepharmacy program, the other component of prehealth at Xavier.

Black or African American↗