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PubMed1983

Does premedical academic background influence medical graduates' perceptions of their medical school or their subsequent career paths and decisions?

A survey of McMaster University's first six medical classes (1972-1977) has shown that neither completion of the science courses that are usually required for admission to other medical schools nor achievement of high grades in premedical studies has an important impact on graduates' perceptions of the medical curriculum or on their evaluation of their preparation for the first year of postgraduate training in comparison to other trainees. No influence of either premedical science background or grade point average was detected on career choices in relation to field of medicine entered, level of specialization, location and type of practice, or on factors influencing these choices.

Career Choice↗
PubMed1995

Premedication with sublingual buprenorphine for out-patient arthroscopy: reduced need for postoperative pethidine but higher incidence of nausea.

The effect of preoperative sublingual buprenorphine (B) on postoperative pain (VAS), the need for postoperative opioid injections and on time to discharge, was evaluated in a prospective randomised double-blind study. Forty ASA I-II patients scheduled for arthroscopy of the knee received premedication with 0.4 mg buprenorphine (group B) and 42 patients were given placebo (group P). Postoperatively, pethidine was given to patients with pain. Three of the 40 patients in group B vs 11 of the 42 in group P received pethidine (P < 0.05). In group B, however, 13 of the 40 patients complained of nausea, prolonging median time to discharge from 155 to 255 minutes (P < 0.05). In group P, 3 of the 42 patients were nauseated, P < 0.01, compared with group B. Time to discharge did not differ between the groups in patients without nausea. The median respiratory rate was significantly lower in group B, but no patient required ventilatory support. In conclusion, premedication with sublingual buprenorphine cannot be recommended for this procedure. It reduces the need for postoperative injections of pethidine but increases the incidence of postoperative nausea which prolongs the recovery time. Careful monitoring is also mandatory because of the possibility of respiratory depression.

Administration, Sublingual↗
PubMed2000

A prospective study of atropine premedication in flexible bronchoscopy.

AIM: This study aimed to assess the effect of atropine premedication prior to flexible bronchoscopy. The rationale for using atropine is that it will dry secretions and allow a better view of the bronchial tree. There is also the theoretical benefit of protection against vasovagal episodes and bronchospasm. METHODS: Twenty patients were randomised in a double-blind manner to receive either 500 mcg of atropine intramuscularly or 1 mL of 0.9% saline intramuscularly 30 minutes prior to bronchoscopy. Both groups received a standard dose of intramuscular pethidine. Variables studied included a pre-procedure electrocardiograph, a rhythm strip during the procedure, serial measurements of blood pressure, continuous pulse oximetry, and spirometry pre- and post-bronchoscopy. Subjective measures recorded were a secretion score, rated 0-3 by the bronchoscopist using a four point visual analogue scale. A patient questionnaire was designed to establish the presence or absence of symptoms, including those related to atropine. RESULTS: There were no significant differences recorded in the duration of procedure, percentage fall in FEV1, secretion scores, or other physiological measures. The only significant difference between the two groups was dry mouth in the atropine group (p<0.001). There was a fall in forced vital capacity from baseline which was significant in the saline group (p<0.005), and not the atropine group, but it was not significant when compared between groups. A beta2 adrenergic agonist would, however, be more appropriate to prevent such a fall in spirometry. CONCLUSIONS: These results fail to demonstrate a benefit of intramuscular atropine as premedication for fibreoptic bronchoscopy.

Aged↗
PubMed1997

Randomised placebo controlled trial of mefenamic acid for premedication at outpatient hysteroscopy: a pilot study.

An increasing number of diagnostic hysteroscopies are being performed in an outpatient setting. Most women tolerate the examination well, but the single commonest reason for failure is pain. We assessed the efficacy of a nonsteroidal, anti-inflammatory analgesic as premedication before hysteroscopy in a double-blind, placebo controlled trial. Our results showed that 500 mg mefenamic acid given one hour before hysteroscopy had no significant benefit in the discomfort experienced during the procedure but did significantly reduce pain after hysteroscopy. A larger dose or a longer interval between premedication and hysteroscopy may possibly be associated with greater benefits.

Adult↗
PubMed1999

A double-blind placebo controlled trial of oral midazolam as premedication before flexible sigmoidoscopy.

OBJECTIVE: We aimed to determine the efficacy of oral midazolam as premedication to improve tolerance of flexible sigmoidoscopy. METHODS: Ninety-nine patients were randomized to receive 7.5 mg of oral midazolam solution mixed with apple juice or placebo (apple juice), 20 min before sigmoidoscopy. Patients' anxiety and pain experienced before sedation, before the procedure, and during the procedure were assessed using a 10-cm visual analog scale (VAS) by both patients and physicians (0 = no pain, anxiety, 10 = severe pain, anxiety). Extent of sedation, amnesia, overall tolerance, adequacy of sedation, and willingness to repeat the procedure were assessed, and changes in vital signs and oximetries were recorded. RESULTS: Fifty-one patients received midazolam and 48 patients received placebo. Patients reported less pain and anxiety (VAS 2.56, 1.64) compared with placebo (VAS 4.62, 4.16) during the procedure (p < 0.005, p < 0.0005). Physicians observed less pain and anxiety (VAS 2.19, 1.52) with midazolam than placebo (VAS 5.00, 3.97) during the procedure (p < 0.0001, p < 0.0001). A significantly greater number of patients judged tolerance of the procedure to be "excellent" using midazolam (p < 0.005) compared with placebo. A majority of patients in both groups was willing to repeat the procedure if recommended. Two patients in the midazolam group had transient asymptomatic hypotension during sigmoidoscopy, but no patients were observed to have desaturation by oximetry. CONCLUSIONS: Oral midazolam significantly reduces anxiety and pain during flexible sigmoidoscopy as assessed by both patients and physicians. Oral midazolam is a safe and effective premedication before flexible sigmoidoscopy in patients who require or prefer sedation.

Administration, Oral↗
PubMed2003

Premedical education: the contribution of small local colleges.

CONTEXT: Small local colleges may be sources of medical students with the gender, ethnicity, and background that promote identity with and empathy for underserved populations. PURPOSE: This study examined the impact of attendance at these premedical colleges on outcomes of medical education. METHODS: Data for 2508 matriculates to the University of Alabama School of Medicine, a state-supported medical school, were examined according to premedical colleges attended. FINDINGS: Medical students who had graduated from small local colleges were more diverse in gender, race, and rural background than other students. They had slightly lower academic performance in medical school, were more likely to drop out (10.6% versus 5.3% overall), and were more likely to locate in rural areas of the host state. CONCLUSIONS: Small local colleges may be rich sources of student diversity and medical students who choose rural practice, outcomes that are gained at a cost in terms of drop-out rate. Compared with other students, minor differences in performance and larger differences in the drop-out rate raise the question of cultural context and social support during medical school as points for intervention.

Adult↗
PubMed1971

A comparative study of conventional premedication (pethidine, promethazine, and atropine) and neuroleptanalgesia (droperidol and phenoperidine) for peroral endoscopy.

A double blind comparison of conventional premedication (pethidine, promethazine, and atropine) and neuroleptanalgesia (droperidol and phenoperidine) failed to demonstrate any difference in either the comfort of the patient or ease of instrumentation in 70 upper gastrointestinal tract endoscopies. Further trials are needed before conventional premedication is abandoned.

Adult↗
PubMed1993

Effects of acepromazine, pethidine and atropine premedication on lower oesophageal sphincter pressure and barrier pressure in anaesthetised cats.

Combinations of acepromazine maleate, pethidine hydrochloride and atropine sulphate (0.05 mg/kg) or acepromazine maleate and pethidine hydrochloride and acepromazine maleate alone or atropine sulphate (0.1 mg/kg) alone were used to premedicate cats before they were anaesthetised with thiopentone, to investigate their effects on gastric pressure, lower oesophageal sphincter pressure and barrier pressure under anaesthesia. Manometric measurements were made by using a non-perfused manometric technique. The lower oesophageal sphincter pressure was lowest in the cats premedicated with atropine sulphate alone. The difference in barrier pressure between the atropine (0.1 mg/kg) and acepromazine treated cats was highly significant. The risk of gastro-oesophageal reflux appeared to be highest with atropine (0.1 mg/kg) if barrier pressure is used as an indicator of the likelihood of reflux.

Acepromazine↗
PubMed1995

Gastro-oesophageal reflux during anaesthesia in the dog: the effect of preoperative fasting and premedication.

Lower oesophageal pH was monitored in 240 anaesthetised dogs. The incidence of gastro-oesophageal reflux was 16.3 per cent and most of the reflux episodes occurred shortly after the induction of anaesthesia. The refluxate was nearly always acid (pH < 4.0), but in 10.3 per cent of the cases it was alkaline (pH > 7.5); gastric contents of pH below 2.5 were refluxed on 19 occasions (7.9 per cent). Regurgitation occurred in only one dog. Prolonging preoperative fasting was associated with an increased incidence of reflux and increased gastric acidity. Premedication with diazepam was associated with fewer reflux episodes than premedication with atropine and propionylpromazine.

Anesthesia↗
PubMedDate not supplied

Oral low-dose midazolam as premedication for intraocular surgery in retrobulbar anesthesia: cardiovascular effects and relief of perioperative anxiety.

The aim was to investigate the efficacy and practicability of oral low-dose premedication with 3.75 mg midazolam (1/2 tablet Dormicum 7.5 mg) for selective intraocular surgery with retrobulbar anesthesia. Forty-six ASA II-III patients were randomly assigned to either group I: midazolam (n = 24) or group II: placebo (n = 22). Sedation was objectively quantified with a scale derived from the Glasgow-Coma-Scale and a verbal self-rating scale. Trait-anxiety was studied with the State-Trait Inventory by Spielberger, perioperative situative anxiety with the Erlanger Anxiety Scale. Cardiovascular variables and oxygenation were automatically monitored. Midazolam produced significant and sufficient sedation and significant anxiolysis. Systolic, diastolic and mean blood pressure were moderately but significantly, reduced. The effect on diastolic pressure was more pronounced. There was no effect on heart-rate. Oxygenation at all times remained well above 90% SpO2. In conclusion low-dose oral midazolam proved to be a single and effective premedication before intraocular surgery under local anesthesia.

Administration, Oral↗
PubMedDate not supplied

The endocrine stress response after oral premedication with low-dose midazolam for intraocular surgery in retrobulbar anaesthesia.

PURPOSE: It was the purpose of this study to examine the endocrine stess response in patients undergoing elective intraocular surgery in retrobulbar anaesthesia (RBA), and the effect of an oral premedication with 3.75 mg midazolam on this reaction. METHODS: In a prospective double-blind study, 23 patients were randomly assigned to either group I (n = 12), receiving 3.75 mg midazolam, or group II (n = 11), receiving a matched placebo 60 min before RBA. Plasma concentrations of known mediators of the endocrinological stress response were analysed at five perioperative times: adrenocorticotropic hormone (ACTH), cortisole (CORT), somatotropic hormone (STH), epinephrine (EPI), norepinephrine (NOR), and dopamine (DOP). RESULTS: The observed endocrinological reaction was moderate. Perioperative anxiety and, above all, RBA were the main stressors. The endocrine stress response could best be seen within the fast-reacting sympathoadrenergic system. Midazolam significantly suppressed the epinephrine and the cortisole answer (p < 0.01). After RBA an ACTH plasma peak only was observed after placebo. Plasma-STH showed extreme variability. An STH-peak after midazolam is presumably due to a gonadotropic hormone-releasing hormone (GHRH) secretion directly stimulated by midazolam. Midazolam had no significant effect upon norepinephrine. A significant (p < 0.01) increase for plasma-cortisole was seen 60 min after the operation when compared to preoperative values. CONCLUSIONS: The results indicate that even at a low dose midazolam positively influences the endocrine stress response. The combination of this stress-reducing effect with the well-known hemodynamic stability, the distinct anxiolytic and sedative action, suggest low-dose midazolam as a favourable premedication for intraocular surgery.

Adjuvants, Anesthesia↗
PubMed1991

Ventilatory effects of premedication with clonidine.

Clonidine has been proposed as a premedication before surgery because of its beneficial effects on hemodynamics, especially in patients with a high cardiovascular risk. However, reports on the effects of clonidine on ventilation are conflicting. Accordingly, eight fasting ASA physical status I volunteers received in a double-blind randomized order 300 micrograms of oral clonidine, the effects of which were compared with placebo given in a crossover design. Hypotension, bradycardia, and sedation were significantly more profound and of longer duration after clonidine. Clonidine did not decrease minute ventilation more than the placebo, and separate analysis of tidal volume and respiratory rate changes also showed the absence of a significant difference between the two groups. However, clonidine produced episodes of obstructive pattern associated with moderate decreases in oxygen saturation, which were not observed with placebo. We conclude that the potential detrimental effects of these obstructive airway patterns of clonidine should be taken into account when prescribing this drug for premedication.

Administration, Oral↗
PubMed2006

Giving toys to children reduces their anxiety about receiving premedication for surgery.

Children have increased anxiety during the preoperative period. The administration of oral premedication to children is often met with apprehension, reluctance, or refusal. We sought to determine whether giving a small toy to the children would decrease the anxiety associated with taking oral premedication. This was a prospective study involving 100 children 3-6 yr of age randomized into two equal groups. The anxiety of each child was assessed using the Modified Yale Preoperative Anxiety Scale. The results showed significantly less anxiety in children who received a toy before oral administration of midazolam.

Ambulatory Surgical Procedures↗
PubMed2007

Premedication with gabapentin: the effect on tourniquet pain and quality of intravenous regional anesthesia.

BACKGROUND: Gabapentin, an oral non-opioid analgesic, has been used to decrease pain after a variety of surgical procedures. We hypothesized that premedication with gabapentin would minimize tourniquet-related pain in patients receiving IV regional anesthesia (IVRA). METHODS: Patients undergoing elective hand surgery with IVRA were randomly assigned to one of two study groups using a double-blind study design. The control group (n = 20) received placebo capsules 1 h before the surgery, and the gabapentin group (n = 20) received gabapentin 1.2 g p.o. before the operation. IVRA was achieved in all patients with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Fentanyl, 0.5 microg/kg IV, was administered as a rescue analgesic during surgery. Sensory and motor block onset and recovery times, tourniquet pain, and quality of anesthesia were assessed at specific time intervals during the perioperative period. Visual analog scale pain scores (0-10) were recorded during the 24 h follow-up period, and patients received diclofenac, 75 mg IM, if their pain score was >4. RESULTS: The onset of the sensory and motor block did not differ between the two study groups. However, tourniquet pain scores at 30, 40, 50, and 60 min after cuff inflation were lower in the gabapentin group (P < 0.05). The time to intraoperative analgesic rescue was prolonged in the gabapentin group (35 +/- 10 min vs 21 +/- 13 min, P < 0.05), and less supplemental fentanyl was required (35 +/- 47 microg vs 83 +/- 73 microg, P < 0.05). The quality of anesthesia, as independently assessed by the anesthesiologist and the surgeon, was significantly better in the gabapentin (versus control) group. In the gabapentin group, the time to requesting a rescue analgesic after surgery was prolonged (135 +/- 25 min vs 85 +/- 19 min, P < 0.05), and postoperative pain scores at 60 min (3.8 +/- 0.9 vs 2.2 +/- 0.5) and 120 min (3.2 +/- 1.4 vs 1.8 +/- 0.8), as well as diclofenac consumption (30 +/- 38 mg vs 60 +/- 63 mg), were reduced after surgery. CONCLUSIONS: Premedication with oral gabapentin (1.2 g) decreased tourniquet-related pain and improved the quality of anesthesia during hand surgery under IVRA. Gabapentin also reduced pain scores in the early postoperative period.

Adult↗
PubMed2003

Toward a career development model for postbaccalaureate premedical programs: from theory to practice.

The purpose of this study was to assess the career maturity of 168 minority and disadvantaged premedical students upon entry into a medical education preparatory program. All took the Medical Career Development Inventory as a pre-assessment in the course. Students' scores identified three instructional groups: on, below, and above instructional level. A model for career intervention for postbaccalaureate premedical programs is presented.

Adult↗
PubMed1983

Myocardial preservation during anoxic arrest. Premedication with propranolol, verapamil or methylprednisolone.

Anoxic cardiac arrest was studied for one hour in five groups of dogs. Groups I-III were given methylprednisolone (30 mg/kg b.w.) before aortic cross-clamping. Normothermia was used with electrically induced ventricular fibrillation in group I, and without such fibrillation in group II, while group III was studied in local hypothermia. Propranolol (10 micrograms/kg) was given to group IV and verapamil (0.2 mg/kg) to group V before the anoxic arrest in local hypothermia. Judged from the ability of the heart to take over the circulation after anoxic arrest, local cooling preceded by propranolol or verapamil gave working performance comparable with the pre-arrest values. In the cooled, steroid-pretreated hearts the work capacity was depressed to the same degree as in locally cooled hearts without steroid premedication. Methylprednisolone prevented ischemic contracture during normothermic arrest with induced fibrillation, but not in the absence of such fibrillation. As adjuvant to local cooling, pretreatment with metabolism-reducing drugs is favorable for cardiac performance after arrest. Steroid premedication should be considered when normothermic arrest with electrically induced ventricular fibrillation is planned.

Animals↗
PubMed1999

The role of local anaesthetic inhalation during premedication before bronchoscopy.

In a prospective randomized study, the efficacy of local anaesthetic inhalation during premedication before bronchoscopic examination was evaluated. Eighty patients with chronic nonproductive cough were inhaling either nebulized anaesthetics (10 ml of 1% trimecain; 40 patients--group A) or an isotonic chlorine solution (40 patients--group B). This was followed by topical anaesthesia using spray and laryngeal syringe. Comparing the score of cough and episodes of gagging, the inhalation of local anaesthetics appeared to make the procedure slightly more comfortable for some patients. Additional anaesthesia was less frequently needed in group A than in group B (12 vs. 19 patients). However, none of the observed differences reached statistical significance. In conclusion, the inhalation of local anaesthetics at the beginning of premedication before bronchoscopy was not confirmed as a useful method that made the examination more comfortable for patients with chronic non-productive cough, but did produce a moderately beneficial effect in some of them.

Administration, Inhalation↗
PubMed2001

[Influence of intubation maneuver with or without premedication for intracranial hemorrhage with unconsciousness].

PURPOSE: To clarify the influence of intubation maneuver with or without premedication for intracranial hemorrhage with unconsciousness. METHODS: Between May 1995 and May 2000, we analyzed retrospectively 46 patients who had received intubation for unconsciousness and were found non-traumatic intracranial hemorrhage by head computer tomography at the Trauma and Critical Care Center, National Defense Medical College. They were divided into two groups, Drug group in which drugs were used before intubation and Control group which were intubated without drugs. Physical findings on admission, head CT findings, Glasgow Outcome Score(GOS) at discharge were analyzed between the groups. RESULTS: There were no significant differences for background of subjects between the groups. In the Drug group, diazepam, pentazocine, lidocaine, nifedipine and nicardipine were used before intubation. GOS in the Control group was significantly greater than in the Drug group(p < 0.01). CONCLUSION: In case of intubation for unconscious patients who may suffer intracranial hemorrhage, using premedication leads to favorable outcome.

Adult↗