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PubMed1987

[Midazolam (Dormicum) as oral premedication for local anesthesia].

Good physician-patient rapport and an anxiolytic, sedative, and amnesic premedication are necessary for comfortable, stress-free surgery under local anesthesia. Sufficient experience exists with the intramuscular and intravenous administration of the new benzodiazepine midazolam (Dormicum), while knowledge relating to its oral administration is still scant. Therefore, in a randomized double-blind study midazolam was investigated for oral premedication prior to local anesthesia: two dosages of midazolam were studied and compared with diazepam and placebo. One hour prior to ophthalmic surgery under local anesthesia, four randomized groups of 30 patients each, received a tablet of 7.5 or 15 mg midazolam, 10 mg diazepam, or a placebo. Following this medication, the anxiolytic, sedative, amnesic, and side-effects were determined at defined points of time during the day of surgery and the 1st postoperative day. Anxiolysis was determined using the "state-trait anxiety inventory (STAI)" of Spielberger et al.; sedation was assessed according to Pandit et al.; amnesia was determined by recall of picture cards which had been presented to the patients 50 min after premedication; and patients were asked about 13 side-effects typical of benzodiazepines in a standardized way. Anxiety increased little following the placebo; it decreased significantly following 10 mg diazepam and more markedly following 7.5 and 15 mg midazolam. Sedation increased little following the placebo; it increased more and similarly 50 min after the benzodiazepines; after 90 min the sedative effect was most marked for 15 mg midazolam. However, sedation was of shorter duration after midazolam than after diazepam.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1987

[Better acceptance of measures for induction of anesthesia after rectal premedication with midazolam in children. Comparison of results of an open and placebo-controlled study].

The rectal administration of midazolam for premedication of children before induction of anesthesia by mask was investigated in two clinical studies. In 62 children aged between 2 and 10 years, midazolam was given by open design at various dosages (0.15 mg.kg-1, 0.25 mg.kg-1, 0.30 mg.kg-1, 0.35 mg.kg-1, 0.40 mg.kg-1) to evaluate the most effective dose for optimal acceptance of the mask and gas mixture. An additional 40 children between 3 and 9 years received 0.2 mg midazolam.kg-1 body weight or placebo in a double-blind design to estimate the lower limit of efficacy of midazolam. All children were classified as ASA I and had to undergo a surgical procedure. Within the two studies the children were not different with respect to their general data, age, weight, and sex. In both studies more boys than girls were included. Parameters of efficacy were the degree of sedation before and at 10, 20, and 30 min after midazolam as well as acceptance of the mask and the gas mixture at induction of anesthesia. In all groups, including placebo, a sedative and tranquilizing effect of the premedication was found. The rectal administration of 0.35-0.4 mg midazolam.kg-1 is most suitable for the preoperative medication of children between 2 and 10 years. Due to the degree of sedation and the relief of anxiety toward the surroundings and the operation, the induction of anesthesia is optimally accepted by the child. In contrast, the effect of a dose around 0.2 mg midazolam.kg-1 body weight is not much different from that of placebo and is not sufficient for effective premedication.

Administration, Rectal↗
PubMed1987

A double-blind comparison of the efficacy of lorazepam FDDF versus placebo for anesthesia premedication in children.

Lorazepam was tried in a new formulation (FDDF) as premedication in twenty children, aged between 5-10 years. The study was performed in a double-blind fashion using lorazepam 1 mg and placebo in identical FDDF preparations. No significant differences were observed between the two treatment groups except for the recall of the venipuncture and awakening. Because of the lack of sedation observed the study was completed with an open trial on ten new subjects receiving 2 mg lorazepam FDDF. The quality of premedication was not found improved while more secretions were observed in the 2 mg lorazepam group. Recall of venipuncture and awakening was significantly less frequent in the 2 mg lorazepam group as compared to placebo. In both lorazepam groups awakening from anesthesia was prolonged. Side effects were reported in several patients receiving lorazepam. As lorazepam FDDF performed not better than a placebo as premedication for children its use is not recommended in pediatric anesthesia.

Child↗
PubMed1986

Midazolam premedication in paediatric anaesthesia.

To investigate the efficacy of midazolam (Dormicum; Roche) as a paediatric premedication, 150 children, aged 6 months-5 years, were divided into three groups. All three groups spent time with the anaesthetist to allow rapport to be established. Group A received midazolam premedication, group B received oral trimeprazine, droperidol and methadone (TDM) and group C received no sedative medication. Midazolam gave the best behaviour patterns in the holding room. Behaviour at induction was the same in all three groups. The recovery times were similar in the midazolam and unsedated groups, but in the TDM group recovery was significantly delayed. Temperatures remained stable in the unsedated and midazolam groups, but decreased in the TDM group. It is concluded that midazolam is a satisfactory paediatric premedication agent.

Anesthesia Recovery Period↗
PubMed1981

[Psychosomatic effects of intramuscular premedication wtih flunitrazepam, innovar and a placebo in combination with atropine (author's transl)].

A double-blind technique was used for studying the psychic and somatic effects of premedication with flunitrazepam, innovar and a placebo in 116 patients. Innovar and the placebo produced the same results. Flunitrazepam reduced anxiety and apprehension and had a significantly higher amnesic effect. Premedication with Innovar increased not only a feeling of fatigue and heaviness but also anxiety and tension in the patients. When assessing the psychic effects of premedication attention must be paid to the subjective impressions on the part of the patient.

Adult↗
PubMed1980

Prevention of allergoid (cutaneous anaphylactoid) reactions to polygeline (Haemaccel) in orthopaedic patients by premedication with H1- and H2-receptor antagonists.

"Purified" polygeline (Haemaccel) was examined for its anaphylactoid and allergoid reactions in a controlled clinical trial on a homogenous sample of orthopaedic patients. In two test groups histamine H1- and H2-receptor antagonists were applied, in the control group saline as a placebo premedication. Unexpectedly no anaphylactoid reaction associated with histamine release greater than or equal to 1 ng/ml plasma occurred in the trial. Clinically unimportant allergoid reactions restricted to the skin occurred with a lower frequency (18%) than observed in previous trials. The specific premedication was highly effective in preventing these reactions in the two test groups (p less than 0.0005). Due to the apparent improvement of the product a general premedication with histamine H1- and H2-receptor antagonist seems not to be necessary before polygeline is administered to patients. For reasons of safety, however, it seems to be indicated in patients at risk, such as those with carcinoma, a proven allergic diathesis and in those who have already suffered from an incident to plasma substitutes.

Anaphylaxis↗
PubMed1984

[Stress reduction by i.m. premedication with 6 different single substances].

In three prospective randomized studies six substances for intramuscular premedication were investigated and compared to placebo (NaCl 0.9%): diazepam (10-20 mg), flunitrazepam (1-2 mg), droperidol (2.5-5 mg), triflupromazin (10-20 mg), pethidin (50-100 mg) and buprenorphin (0.15-0.3 mg). The effects on preoperative stress were evaluated with psychometrical methods (ESB), heart rate, blood pressure and plasma-cortisol levels. Degree of sedation and side effects were recorded. Good effects on anxiety were found after flunitrazepam, diazepam and triflupromazin. The worst effects were found after droperidol and pethidin. Good effects on depression were found after pethidin, buprenorphin, diazepam and triflupromazin. The worst effects were found after droperidol. Asthenic patients were improved with diazepam and flunitrazepam, but deteriorated after placebo, pethidin, triflupromazin and droperidol. The physiological stress parameters were positively influenced by diazepam and flunitrazepam, but not after placebo and droperidol. Nausea and vomitus were found after buprenorphin, pethidin and droperidol; psychological and neurological problems occurred after droperidol. The highest degree of sedation was found after flunitrazepam, diazepam and droperidol. The day after surgery the patients found placebo, flunitrazepam, diazepam and triflupromazin to be the best premedications, pethidin and buprenorphin were inferior and droperidol was the poorest premedication.

Adolescent↗
PubMed1984

Effects of diazepam premedication and epinephrine-containing local anesthetic on cardiovascular and plasma catecholamine responses to oral surgery.

The effects of diazepam premedication and administration of an epinephrine-containing local anesthetic on plasma catecholamine levels and cardiovascular parameters were evaluated prior to and during a minor surgical procedure, the removal of impacted third molars. Significant elevations in circulating epinephrine levels (203% above control) and cardiac output (30%) were seen in unsedated patients after administration of lidocaine with epinephrine before surgery, while no changes were seen after lidocaine alone. Unsedated patients had increased norepinephrine (24%) and epinephrine (57%) levels during surgery. Diazepam premedication decreased norepinephrine levels 29% below preoperative levels, followed by an increase during surgery to preoperative levels. These results indicate that intraoral injections of epinephrine-containing local anesthetics result in increased circulating epinephrine levels that are associated with cardiovascular changes and that diazepam premedication decreases plasma norepinephrine levels and attenuates the sympathoadrenal response to surgical stress.

Adolescent↗
PubMedDate not supplied

Atropine and glycopyrronium premedication. A comparison of the effects on cardiac rate and rhythm during induction of anaesthesia.

The effect of premedication with the cholinergic blocking drugs, atropine and glycopyrronium, was investigated in two groups, each of twenty patients, with regard to their effects on cardiac rate and rhythm during induction of anaesthesia and tracheal intubation. Another similar group of twenty patients was given no anticholinergic premedication. The incidence of dysrhythmias was 35% in the atropine group and 10% in the glycopyrronium group but there were no dysrhythmias in patients given no anticholinergic drug. The average rises in arterial pressure were similar in all three groups. Atropine administration led to a greater initial rise in heart rate before the induction of anaesthesia, although the average heart rates were similar in the three groups at the time of intubation and cuff inflation. The routine use of anticholinergic premedication seems to be unnecessary since the antisialogogue effect does not make any difference to the course of anaesthesia. However, if the antisialogogue action is important, glycopyrronium offers an advantage over atropine.

Adult↗
PubMed1981

Studies on premedication and ventilatory responses to minaxolone.

The effect of three premedications on induction, maintenance and recovery characteristics of minaxolone as a supplement to nitrous oxide and oxygen anesthesia were studied in 70 patients. Morphine and atropine premedication provided superior operative conditions with fewer side-effects when compared with atropine alone or diazepam and atropine. Recovery was significantly longer after minaxolone compared with a similar group of patients given Althesin. The ventilatory responses to the induction of anesthesia with minaxolone were measured in 25 patients. All patients showed an increase in respiratory frequency and a decrease in tidal volume. This effect was most marked in the group premedicated with diazepam and atropine.

Adult↗
PubMedDate not supplied

[Analysis of induction with 5% isoflurane and 60% nitrous oxide in premedicated adults].

OBJECTIVES: To analyze rapid inhalatory anesthetic induction in premedicated adults (fentanyl, droperidol, diazepam and atropine) with an inspired mixture of O2, N2O (60%) and 5% isoflurane as a means for accelerating induction time and reducing complications. PATIENTS AND METHODS: We studied a series of 35 adult ASA-I patients at four times: baseline (1), premedication (2), induction (3) and postintubation (4). Measurements taken were arterial hemoglobin oxygen saturation (SpO2), arterial pressure (AP), heart rate (HR), end-tidal CO2 pressure (PETCO2) and respiratory frequency. We also recorded maximum end-tidal isoflurane pressure (FEtiso) at time 3; presence of apnea, cough and mask rejection at time 3; arrhythmia at times 3 and 4, and induction recall at time 3. Mean time of induction (time from start of induction to laryngoscopy) and the double product (HR x systolic AP) were calculated. RESULTS: Coughing was observed in 20% (7/35) and was significantly associated with smoking; mask rejection was observed in 5.71% (2/35). The lowest SpO2 measurements occurred during period 2 and the highest during 3 (98.2 +/- 0.76). The incidence of apnea (77.14%, 27/35) was high during period 3, with mean PETCO2 values (+/- SD) of 40.71 +/- 4.19 mmHg and mean maximal FEtiso values of 1.6 +/- 0.53%. Mean time of induction was 96.28 +/- 5.19 s. There were no cases of recalled induction of arrhythmia in periods 3 and 4. The highest levels of AP and HR were recorded during period 4. The only difference in AP and HR between periods 2 and 3 was in diastolic AP, which was higher (p < 0.05) in period 3. CONCLUSIONS: Rapid induction with 5% isoflurane is achieved within 1.5 min, with a 20% incidence of coughing and a 5% incidence of mask refusal. The high frequency of apnea (77%) is caused by the rapid elevation of alveolar isoflurane, which has an impact on the apneic threshold. Anesthetic induction with 5% isoflurane and 60% nitrous oxide in premedicated adults is accomplished with good maintenance of hemodynamic stability. However, tachycardia and arterial hypertension appear after laryngoscopy and tracheal intubation.

Adolescent↗
PubMedDate not supplied

[Oral premedication with clonidine in patients undergoing coronary revascularization surgery].

OBJECTIVES: To analyze the effect of premedication with clonidine on level of sedation, anesthetic requirements and hemodynamic repercussions in patients undergoing coronary revascularization. PATIENTS AND METHODS: Thirty patients were divided into two groups and randomly assigned for premedication with clonidine 0.005 mg/kg p.o. (C) or lorazepam 0.03 mg/kg p.o. (L), along with morphine 0.15 mg/kg i.m. and scopolamine 0.005 mg/kg i.m. in a prospective double-blind study. The level of sedation before surgery and anesthetic requirements in the two groups were compared, as were systolic and diastolic arterial pressure, heart rate and hemodynamics during and after surgery. Fentanyl was used for anesthetic induction in boluses of 0.15 mg every 10 seconds; maintenance boluses of 0.5 mg were used up to a maximum dose of 0.07 mg/kg. If hemodynamic variables analyzed (systolic and diastolic arterial pressure and heart rate) were not kept within 30% of baseline values with this regimen, isoflurane was added. RESULTS: No differences between the two groups were found for level of sedation. The total dose of fentanyl was lower in group C (0.052 +/- 0.002 mg/kg vs 0.058 +/- 0.002 mg/kg) (p < 0.05). The number of patients requiring isoflurane was similar (4/11 and 6/9) in both groups. The hemodynamic profile prior to extracorporeal circulation (ECC) revealed arterial pressures and heart rates to be lower in the group treated with clonidine (p < 0.05); after ECC systemic resistance in group C was lower (630 +/- 103 vs 795 +/- 106 din.s.cm-5) (p < 0.05) and this was not compensated for by a significant rise in cardiac index (2.62 +/- 0.09 vs 2.40 +/- 0.08 l/min/m2) at similar occlusion pressures. CONCLUSIONS: Use of clonidine in the type of patient studied does not improve the level of sedation over that achieved with lorazepam. Fentanyl requirements decreased with clonidine. With respect to hemodynamic profile, systemic vascular resistance fell in the clonidine group after removal of ECC, and thus this drug offers no advantages for routine premedication.

Administration, Oral↗
PubMed1994

[Midazolam and lorazepam as premedication. A randomized double-blind study].

Oral administration of midazolam and lorazepam as premedication was compared in a double-blind randomized clinical trial. Eighty patients scheduled for minor gynaecological surgery in general anaesthesia and 80 patients scheduled for hip arthroplasty in spinal anaesthesia were included. Assessments were: 1. patients subjective evaluation of the premedication, 2. sedation scale, 3. recovery of cognitive function assessed by Simple Paper-and-Pencil test and Postbox test, 4. amnesic effects. In the general anaesthesia group midazolam caused less postoperative sedation, less postoperative amnesia and cognitive function returned more rapidly. In the spinal anaesthesia group cognitive function returned more rapidly after midazolam. Midazolam should be preferred for premedication if rapid recovery is desired.

Administration, Oral↗
PubMed1993

[Pharmacodynamics and clinical adverse effects of mivacurium. The effect of oral premedication with H1/H2 antagonists].

Duration of neuromuscular block may be prolonged by H1/H2 antagonists. This study was designed to determine the influence of H1/H2 antagonist treatment on onset, duration and recovery after mivacurium chloride (MIV), a new nondepolarizing neuromuscular blocking agent with a relatively short duration of action, which is metabolized by human plasma cholinesterase (PChE). METHODS. After approval from the hospital ethical committee and written informed consent, 48 ASA I-II patients of either sex (ages 18-65 years, weight 45-100 kg) were included in this double blind study and randomly allocated to four groups of 12 each: group A, 0.105 mg/kg MIV (1.5 x ED95) and H1/H2 antagonist; group B, 0.105 mg/kg MIV and placebo; group C, 0.21 mg/kg MIV (3 x ED95) and H1/H2 antagonist; Group D 0.21 mg/kg MIV and placebo. Premedication consisted of 2 mg lormetazepam p.o., 300 mg ranitidine and 0.1 mg/kg dimetindene, or placebo p.o. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with N2O/O2 at a 65/35 ratio, enflurane (0.8-1.5%) and supplements of fentanyl. The ulnar nerve was stimulated with supramaximal 2 Hz train-of-four (TOF) every 10 s. Neuromuscular twitch response was recorded with EMG. Onset time (time from end of injection to maximal or total block), maximal block (%), T125 (time from end of injection to 25% recovery) were recorded after each dose, and recovery index (T1 from 25% to 75% recovery) and TOF70 (time from end of injection to TOF ratio of 70%), after the last dose. RESULTS. The four groups did not differ with respect to age, weight or height. There was no difference in the pharmacodynamics of mivacurium between the groups receiving H1/H2 antagonists and those receiving placebo. Following 1.5 x ED95 the onset was at 3.7 +/- 1.2 (H1/H2) and 3.8 +/- 0.9 min (placebo), respectively. Clinical duration (T125) was 13.1 +/- 3.4 and 12.8 +/- 3.4 min. 3 x ED95 led to a significant faster onset and longer duration (P < or = 0.05). Onset was at 1.9 +/- 0.7 (H1/H2) and 2.1 +/- 0.5 min (placebo), respectively, and clinical duration 19.1 +/- 6.1 and 19.3 +/- 3.8 min. Duration of repetitive doses (10.1 +/- 5.3 min), recovery index (6.8 +/- 2.9 min) and interval from last dose to spontaneous recovery (22.4 +/- 7.0 min) did not differ between groups. Three patients in group D (placebo and 0.21 mg/kg MIV) had haemodynamic changes of over 20% from baseline. Flush and erythema were significantly less pronounced after H1/H2 premedication than after placebo (4 vs 12 pts). CONCLUSIONS. Our results suggest that time of onset and clinical duration of effects of MIV are not altered by dimetindene and ranitidine. The duration depends more heavily on the dose of MIV. The recovery of neuromuscular function, once it has begun, is prolonged neither by MIV nor by H1/H2 antagonists. As MIV is mainly broken down by PChE, it is evident that its duration of action is more prolonged by atypical PChE activity than by interaction with other drugs. Oral H1/H2 premedication may diminish haemodynamic side-effects and clinical signs of histamine release.

Administration, Oral↗
PubMedDate not supplied

[Intubation with propofol without neuromuscular blockade. Effect of premedication on fentanyl and lidocaine].

AIMS: Laryngotracheal reflexes, and possibilities of intubations following anaesthetic induction with propofol, with or without premedication and without neuromuscular blockade were evaluated. Hemodynamic parameters were also measured. METHODS: Sixty ASA I-II patients were randomly allocated into 3 groups according to anaesthetic premedication. Group P: (placebo), 2 and 4 ml of saline 0.9%; group F, 4 micrograms/kg of fentanyl and 2 ml of saline 0.9%; group L, 4 micrograms/kg of fentanyl and 1.5 mg/kg of lidocaine 5%. Two point five mg/kg of propofol were administered and 45 seconds later intubation was attempted. Mandibular relaxation, visualization of the glottis, opening of the vocal chords, reflex reactions to laryngoscopy and intubation, time used, blood pressure and heart rate were evaluated. RESULTS: Mandibular relaxation and visualization of the glottis were acceptable in all the patients. The aperture of the vocal chords was enough so as to carry out intubation in 65% (P), 100% (F) (p < 0.05) and 95% (L) (p < 0.05). Laryngeal reactivity significantly decreased (p < 0.001) from 40% (P) to 15% (F) and 10% (L). Tracheal reflexes decreased from 84.6% (P) to 55% (F) (p < 0.01) and 37% (L) (p < 0.001). Blood pressure and heart rate rose with intubation over the basal levels in group P and significantly decreased in groups F and L. CONCLUSIONS: The use of propofol without neuromuscular blockade is inadequate for intubation since laryngotracheal reflexes are not suppressed. Besides, propofol does not prevent hemodynamic reactions. Premedication with fentanyl and/or lidocaine improves the responses not sufficiently to safely perform intubation.

Adult↗
PubMed1995

[Efficacy of the EMLA cream in the reduction of pain caused by venipuncture in children premedicated with oral midazolam].

OBJECTIVE: EMLA cream, a lidocaine-prilocaine mixture, penetrates skin easily. Our aim was to compare EMLA and placebo to assess the efficacy of EMLA in decreasing the pain of venipuncture in children premedicated with oral midazolam 0.5 mg/kg. PATIENTS AND METHODS: This was a prospective study enrolling 100 children 3 to 9 years of age (5.6 +/- 2) randomly distributed in 2 groups of 50. EMLA cream was applied in group 1 while placebo was applied in group 2 (control group). All were premedicated with oral midazolam. Either EMLA or placebo was applied at least 30 minutes before transfer to the operating theater and the area was covered with a transparent dressing. Parameters recorded upon arrival in the operating room and upon hand puncture with a 22-G needle were systolic and diastolic arterial pressures (SAP and DAP) and heart rate (HR). Pain was assessed on a behavior scale, a visual analog scale evaluated by the anesthesiologist (VAS-anesthesiologist) and a VAS evaluated by a nurse (VAS-nurse). Adverse events were also recorded. A Student t-test and a Mann-Whitney U-test were used for statistical analysis; the level of significance was p < 0.05. RESULTS: There were no significant differences in mean age or weight between the 2 groups. In the area EMLA was applied, 2 children presented erythema and 2 pruritus. Mean scores on the pain scales were lower in the EMLA group (p < 0.05) than in the control group: behavior scale 1.8 +/- 1.3 versus 3.2 +/- 1.7; VAS-anesthesiologist 2.8 +/- 2.3 versus 5.1 +/- 2.7; VAS-nurse 2.7 +/- 2.1 versus 5.9 +/- 1.9. HR increased in both groups (with placebo from 105 +/- 16 to 118 +/- 19, and with EMLA from 99 +/- 19 to 109 +/- 21), but the increase in SAP was statistically significant only in the placebo group, in which it rose from 113 +/- 11 to 125 +/- 16. CONCLUSION: EMLA cream decreases the pain of hand venipuncture in children premedicated with oral midazolam.

Adjuvants, Anesthesia↗
PubMed1998

[Premedication with intranasal midazolam in children of various ages].

BACKGROUND AND AIM: To evaluate the efficacy of premedication with midazolam (mdz) administered using a nasal route compared to diazepam (dz) administered by mouth in children of different ages. EXPERIMENTAL DESIGN: A comparative type study was performed in randomly selected pediatric patients undergoing surgery. The study lasted 3 months. SETTING: Recovery room and operating theatre for Pediatric Surgery and ENT. PATIENTS: A total of 248 patients were studied, divided into 3 age groups: group A were aged under 2 years; group B were pre-school age and group C were school-age. OPERATIONS: Two subgroups were formed based on the premedication used: group M = 0.2 mg/kg of mdz using a nasal route on arrival in the operating unit; group D = 0.2 mg/kg of dz per os 45' before induction. PARAMETERS STUDIED: In addition to acceptance of treatment, which was deemed to be good, poor or refused, the authors evaluated the level of sedation (score from 5 to 1: awake-asleep), anxiety on entering SO (score from 1 to 4: none-excessive) and the level of collaboration during the induction of general anesthesia (score 1-4: excellent-nil). RESULTS: The nasal route was well accepted by 59% of patients in group A, 62% of group B and 97% of group C. Statistical analysis using Kruskall Wallis test showed significant differences in groups A and B between the two subgroups M and D for all the parameters studied, whereas there were no significant differences in group C. CONCLUSIONS: Premedication with mdz using a nasal route was safe and efficacious, above all in early and later infancy.

Adjuvants, Anesthesia↗
PubMed2002

Premed survival: understanding the culling process in premedical undergraduate education.

PURPOSE: Why undergraduate students pursue or drop a premedical curriculum has received only scant attention. In this study the authors attempted to uncover reasons why students either persevere in their premedical studies or seek alternative careers. METHOD: Using convenience sampling, the authors surveyed 97 undergraduates at a small liberal arts college from November 2000 to March 2001. Of those surveyed, 44 were former premed students who completed a three-page questionnaire about why they had decided not to become physicians; 53 premed students completed a two-page questionnaire about their career aspirations. RESULTS: The response rate was 100%. Premed students were attracted to the field by the intellectual stimulation and the power to help others, yet most were also very concerned about being in debt, dealing with patients who might die, and the compatibility of medicine with having a family. Women students were more concerned than the men about having only limited time to become acquainted with patients on a social level (71% of women versus 45% of men: p =.05). The decision of students to forgo a career as a physician was shaped by apprehensions regarding the years of work required in residency, the need to be on call, unacceptably low grades, and the realization that other attractive career options are available. Of those who said low grades were a deciding factor, most (78%) named organic chemistry as the single course that had affected their plans. Students who acknowledged the role of their poor performance in organic chemistry were more likely to be dissatisfied with their change in plans than were those who did not identify this course as influential (44% versus 29%). CONCLUSIONS: Although the sampling technique and sample size severely limit the authors' ability to generalize their findings, the data offer a starting point for those interested in the reasons for the drop in medical school applicants. The authors state the fact that most former premed students admitted organic chemistry had played a significant role in the change in their career plans deserves attention, and it may be time to consider whether a single course should contribute to eliminating persons who might otherwise excel as physicians.

Career Choice↗