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PubMed1979

[Characteristics of combined nitrous oxide nacrosis and premedication with phentanyl and droperidol or phentanyl and seduxen in patients with pain syndrome caused by blood vessel diseases of the lower extremities].

66 patients were subjected to nitrous oxide narcosis after various types of premedication. The premedication with phentanyl and seduxen or droperidol proved to be more effective than the routine premidication. The authors consider endotracheal narcosis with nitrous oxide combined with fractional injections of phentanyl and seduxen of phentanyl and droperidol to be a method of choice.

Adult↗
PubMed1983

A double-blind controlled study comparing temazepam with papaveretum as premedication for fibreoptic bronchoscopy.

One hundred patients undergoing routine fibreoptic bronchoscopy were randomly allocated to receive premedication with either intramuscular papaveretum or oral temazepam in a double-blind manner. They all received atropine before and oxygen during the procedure. Patients found the drugs equally acceptable in terms of discomfort, anxiety and the possibility of repeat bronchoscopy, but more had recall of the procedure with papaveretum. There was no difference in secretions, coughing, relaxation and consciousness, as assessed by the bronchoscopist, but patients who had received papaveretum were more cooperative. Arterial blood gases were performed before and 45 minutes after bronchoscopy. Those given papaveretum had a significant fall in mean arterial oxygen tension of 0.96 kPa, while there was no significant change in the temazepam group. There was also a small mean rise in arterial carbon dioxide tension in both groups, with the mean rise in the papaveretum group (0.625 kPa) being significantly higher than the temazepam group (0.2 kPa). Premedication with temazepam is a useful alternative to papaveretum and has the advantage of oral administration and causing less respiratory depression.

Anti-Anxiety Agents↗
PubMed1994

Premedication reduces the incidence of systemic reactions during inhalant rush immunotherapy with mixtures of allergenic extracts.

BACKGROUND: Rush immunotherapy, while having many potential benefits, is associated with an increased incidence of systemic reactions. OBJECTIVE: To determine whether pretreatment with medications reduces the rate of systemic reactions during rush immunotherapy and to identify predictors of such reactions if possible. METHODS: We conducted a double-blind, placebo-controlled study of 22 allergic children ages 6 to 18 years who received rush immunotherapy. Active treatment consisted of a combination of H1 and H2 histamine antagonists and a corticosteroid in gelatin capsules given prior to administration of rush immunotherapy whereas placebo patients received lactose. Rush immunotherapy consisted of eight injections of increasing doses of a mixture of allergens to which each patient was skin-reactive over 1 1/2 days. Serial skin tests and peak expiratory flow rate measurements were performed during the procedure. Following the initial series of injections, patients were followed for 8 weeks and had blood drawn at 2-week intervals for measurements of specific IgG and IgE. RESULTS: Systemic reactions were observed in 3 (27%) active and 8 (73%) placebo patients (Fisher's exact test: P = .047). The mean time for systemic reactions was 63 minutes after a previous injection. The most common dose causing a systemic reaction was 0.3 mL of 1:1000 (wt/vol). The best predictors of development of a systemic reaction were degrees of skin sensitivity to the extract before and after premedication. Local reactions were not associated with subsequent systemic reactions. Specific IgG rose by 2 weeks while specific IgE did not change significantly during the 8-week follow-up period. Pretreatment did not change the number of systemic reactions seen with subsequent injections. CONCLUSIONS: Premedication significantly reduces the incidence of systemic reactions during rush immunotherapy and is therefore recommended. Degree of skin sensitivity to the injected extract may eventually prove to be a clinically useful predictor for the development of systemic reactions.

Adolescent↗
PubMed1994

[Clinical evaluation of diazepam suppository for premedication in children].

Anesthesiologists need a safe and effective premedication before general anesthesia and want to help decrease anxiety and minimize psychologic trauma to children. Therefore, we evaluated diazepam suppository (0.5 mg.kg-1 body weight) administered to 21 children before minor surgery under general anesthesia. We evaluated the sedative effect of the diazepam suppository (tablet) on the arrival at the operating room, during anesthesia induction and in the recovery room. On the arrival at operating room, 86% of children were sedated, and 65% of children could be induced smoothly under mask. There was no delayed emergence. Plasma diazepam level at induction was 376.5 +/- 28.4 ng.ml-1, which is the level needed for sedation. We conclude that diazepam suppository is a useful drug for premedication in children.

Anesthesia, General↗
PubMed1993

Retention of traditional premedical students in a medical career pathway compared with students in a combined baccalaureate-medical degree program.

This study compared the retention in medical career pathways of students enrolled in a combined baccalaureate-medical degree program to traditional premedical students at Brown University. Whereas 84% of the combined-degree students went on to medical school, only 36% of the traditional premedical students did. Among underrepresented minority students, the proportions were 74% and 39%, respectively. Scholastic Aptitude Test (SAT) scores accounted for some of the difference, yet even when SAT scores were controlled using a multiple logistic regression model, students enrolled in the combined-degree program were more than eight times as likely to continue in a medical career pathway.

Aptitude Tests↗
PubMedDate not supplied

Changes in pharmacodynamics and pharmacokinetics of psycholeptic drugs in the course of radiation disease. Effects of premedication with cystamine on dynamics and kinetics of thioridazine.

Changes in pharmacodynamics and pharmacokinetics of psycholeptic drugs in the course of radiation disease. Effect of premedication with cystamine on dynamics and kinetics of thioridazine. Acta Physiol. Pol. 1977, 28 (2): 169--179. The effect of premedication with cystamine (100 mg/kg) applied before irradiation (600 R) on exploring mobility and cataleptic action of thioridazine was investigated in rats. The levels of thioridazine in blood serum, brain tissue and in bile were determined. It was found that cystamine prevents the changes in dynamics of thioridazine action in radiation disease through abolition of disturbances in kinetics of this drug. Half-life period of thioridazine was found to be reduced and its level in the brain tissue was diminished in the irradiated, cystamine-pretreated animals in comparison with the irradiated, untreated ones.

Animals↗
PubMed1996

Do premedical students know what they are getting into?

The number of medical school applications continues to rise despite recent reports of decreased physician job satisfaction. To better understand this paradoxical trend, I surveyed 84 premedical students about their expectations of a medical career. Almost all respondents anticipated that as physicians they would be able to cure, heal, and help their patients (98%) and that their work would be intellectually satisfying (95%). Most anticipated that their jobs would be prestigious (83%) and even fun (73%). Far fewer than half the respondents would be discouraged from pursuing a medical career by the fear of being sued (38%), business worries (22%), or administrative duties (20%). Comparison of the student responses with results of a physician job satisfaction survey carried out the same year showed that the students, as a group, were modestly idealistic with respect to the daily work of being a physician and somewhat naive about the problems caused by various business and administrative issues. I conclude that premedical students could be better informed about the current reality of being a physician and that practicing physicians are responsible for providing this education.

Adult↗
PubMed1996

Physiologic effects of anesthesia induced and maintained by intravenous administration of a climazolam-ketamine combination in ponies premedicated with acepromazine and xylazine.

OBJECTIVE: To examine the physiologic and pharmacokinetic effects of a technique of total intravenous anesthesia in ponies. ANIMALS: 6 healthy ponies. PROCEDURE: Ponies were premedicated with acepromazine (0.03 mg/kg of body weight, IV) and xylazine (1.0 mg/kg, IV). Two minutes later, anesthesia was induced with ketamine (2.0 mg/kg, IV) followed by climazolam (0.2 mg/kg, IV). Anesthesia was maintained for 120 minutes by an infusion of climazolam (0.4 mg/kg/h) and ketamine (6.0 mg/kg/h). Oxygen (5 L/min) was supplemented. 20 minutes after the infusion was stopped sarmazenil (0.04 mg/kg, IV) was administered. Cardiovascular and respiratory function measurements were taken before and after premedication, and during anesthesia. Plasma cortsol, ACTH, and catecholamine concentrations were used to assess adrenal and pituitary gland function Ketamine and climazolam kinetics were calculated, on the basis of plasma drug concentrations. RESULTS: There were no significant changes from pre-xylazine values in heart rate, respiratory rate, arterial blood pressure, cardiac index, systemic vascular resistance, or arterial PO2, PCO2, and pH. Plasma cortisol concentration decreased during anesthesia, but plasma ACTH and catecholamine concentrations did not change. Recovery was fairly smooth, but some excitement and ataxia were noted in 2 ponies. CONCLUSION: Ketamine-climazolan infusion appeared suitable for maintenance of anesthesia in ponies, although recovery was not ideal in 2 of 6 ponies.

Acepromazine↗
PubMed1976

[Problems of premedication in pediatric gynecologic consultation hours].

It is reported about the behavior of 300 children, which were examined and treated gynecological after premedication, which was performed with Elroguil, Faustan, Lepinal, Myocuran, Sinophebin liqu. The sedative effect was not good in all cases. A premedication is not generally indicated, but in some of the cases the situation of examination is better.

Adolescent↗
PubMed1998

[99mTc pertechnetate scintigraphy and premedication for the search for ectopic gastric mucosa in Meckel's diverticulum].

BACKGROUND: Meckel's diverticulum (MD) is the most common anomaly of the large intestinal tract (1-3%) and is more frequent in children (62% < 2 years) and in males (66%). It often involves ectopic gastric mucosa which manifests through gastrointestinal bleeding in 50% of cases. 99m-Technetium scintigraphy (99mTcO4) is one of the procedures available for the non-invasive diagnosis of ectopic gastric mucosa. METHODS: Twenty-eight patients (11 females, 17 males), including 16 children and 12 adults, aged 8 months-80 years old, were included in the study. The patients were admitted to hospital for hematochezia and melena (22) associated with abdominal pain (5): 3 patients repeatedly presented occult blood in their stools. Two patients only suffered from abdominal cramps and one only anemia. Patients were studied using plain abdominal radiographs and ultrasound; 10 underwent gastroscopy and colonoscopy; radiological contrast studies were performed in 5 patients. All tests were inconclusive. All the patients were premedicated with oral cimetidine (20 mg/kg in pediatric patients and 300 mg q.i.d. for adults, 48 hours before the test) or with ranitidine i.v. (1 mg/kg, max 50 mg, in 20 minutes, one hour before the test); barium meals and colonoscopy were deferred for 2-3 days after examination. An intravenous injection of 37-180 Mbq of 99mTcO4 was given followed by a dynamic study of the abdomen in anterior projection. Images were acquired for one hour or until the visualisation of abnormal foci of intake: in this case, lateral and oblique images were acquired for a better localisation of the suspicious area. Some patients were administered furosemide i.v. (0.75 mg/kg). All underwent a follow-up period of 12 months. RESULTS: Pertechnetate scintigraphy was positive in 10 cases and the presence of ectopic gastric mucosa was confirmed by surgery. The study was negative in 18 cases: 3 of them were discharged with a diagnosis of Salmonella infection, polyp of the small bowel or ulcer of the large bowel respectively; the other 15 patients did not show symptoms of onset during follow-up. CONCLUSIONS: These results confirm the high diagnostic accuracy of pertechnetate scintigraphy to detect ectopic gastric mucosa if associated with H2-receptor-blocking agent premedication.

Adolescent↗
PubMed1983

Comparison of oral pentazocine, oral diazepam and intramuscular pentazocine for paediatric premedication.

Oral pentazocine-atropine, oral diazepam-atropine and IM pentazocine-atropine were compared as preoperative medication in children. Observations in 300 children ages 1-14 years included the emotional state at time of induction of anaesthesia, smoothness of induction, dryness of oral mucosa and tongue, incidence of vomiting, and emotional state and length of stay in the recovery room. The incidence of a calm state at the time of induction and smoothness of induction of anaesthesia was the same following oral and IM premedication. There was satisfactory drying of salivary secretions. The incidence of vomiting in the recovery room was the same following oral and IM premedication. However, children in age groups 1-4 and 5-9 years who received diazepam-atropine were more restless in the recovery room than those who received oral or IM pentazocine-atropine. More children in groups 1-4 and 5-9 years who received IM pentazocine-atropine stayed longer in the recovery room. We conclude that oral diazepam-atropine and oral pentazocine-atropine are comparable as to preoperative medication IM pentazocine-atropine and that they can be given as an alternate to intramuscular injection.

Administration, Oral↗
PubMed1982

Comparison of thiopentone and midazolam for induction of anaesthesia: influence of diazepam premedication.

Forty-eight healthy patients undergoing routine surgery participated in this double-blind parallel study in which thiopentone sodium and midazolam maleate were compared for induction of anaesthesia. Twelve patients in each group received diazepam premedication. The purpose of this study was three fold; first to compare the efficacy of these two drugs as induction agents using fixed criteria, second to find the optimal dose of midazolam for induction and, finally, to evaluate the effects of diazepam premedication on the induction dose of both drugs. The results showed that adequate induction of anaesthesia was achieved using 0.30 milligrams per kilogram of midazolam and 3.99 milligrams per kilogram of thiopentone. These doses were not altered by pre-operative medication with diazepam. The recovery time was significantly prolonged in those patients who had received midazolam. The shortest recovery time was observed in those patients who had received thiopentone with diazepam. There were four cases of phlebitis in the thiopentone group and two in the midazolam group. In conclusion, midazolam maleate, which is a water soluble benzodiazepine, provided satisfactory induction of anaesthesia at a dose of 0.30 milligrams per kilogram. However, recovery time was significantly prolonged in patients who received midazolam.

Adult↗
PubMed1980

Arterial hypoxaemia following premedication in patients with coronary artery disease.

The effect of premedication with morphine and scopolamine, morphine alone, and scopolamine alone on arterial oxygen tension has been studied in patients with coronary artery disease undergoing bypass operations. Control arterial blood samples were obtained with the patients in the supine position breathing room air the day before operation. A second arterial blood sample was taken in the induction room with the patient breathing room air in the supine position. In the first group (scopolamine only) and second group (morphine only) cH+ (pH), PaCO2 and PaO2 did not change. In the third group (morphine and scopolamine), however, PaO2 decreased, while PaCO2 and cH+ increased (pH decreased). The changes in cH+ and PaCO2 were statistically significant, but of no clinical importance. The present study suggests that, when morphine and scopolamine premedication is used for patients with coronary artery disease, simultaneous administration of oxygen is important in helping to eliminate a possible cause of preoperative myocardial ischaemia.

Adult↗
PubMed1993

Premedication with sublingual triazolam compared with oral diazepam.

The clinical effects of a new administration form of triazolam, 0.2 mg sublingual (sl) tablet, were compared with those of a 10 mg tablet of diazepam in a double-blind study, in 100 ASA I-II patients scheduled for ophthalmic surgery under local anaesthesia. The sedative and anxiolytic effects of the study drugs were followed at 15 min intervals by plotting the patient's assessments on a visual analogue scale and by a trained observer. The onset of sedative and anxiolytic effect was similar. At 75 min after premedication and after the operation triazolam 0.2 mg caused deeper sedation than diazepam 10 mg according to the observer (P < 0.001, P < 0.01) and according to the patient (P < 0.01, P < 0.05). Ten patients (20%) in the triazolam group and one in the diazepam group were assessed to be too sedated during the operation. All these patients were 61-70 yr old. The study drugs resulted in equal reduction of anxiety during the preoperative period. Both premedications provided good patient comfort but caused total amnesia only to one patient in each group. Neither caused any severe cardiorespiratory or other side effects. It is concluded that 0.2 mg triazolam sl produces deeper sedation than 10 mg oral diazepam. For elderly patients this dose is excessive for intraocular surgery.

Administration, Oral↗
PubMed1993

Oral midazolam premedication in children: the minimum time interval for separation from parents.

To determine the minimum time interval between oral midazolam (0.5 mg.kg-1) premedication and separation from parents that ensures a smooth separation, 30 children were assigned randomly to one of three groups (ten children per group). The groups differed only in the time interval between administration of midazolam and separation from their parents: 10, 20 or 30 min. Heart rate, systolic blood pressure, and sedation and anxiolysis scores were assessed before midazolam premedication (baseline), at the time of separation from parents, and during the application of a face mask at the induction of anaesthesia. We found that heart rate and systolic blood pressure changes were similar for all three groups throughout the study period. Sedation scores at the time of separation from parents and on application of the mask for all three groups were greater than baseline values. Sedation scores at separation did not differ among the three groups. Anxiolysis values did not differ from baseline values at any time for all three groups. We conclude that children may be separated from their parents as early as ten minutes after receiving oral midazolam, 0.5 mg.kg-1.

Administration, Oral↗
PubMed1994

Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine.

To compare the clinical characteristics of two oral premedicants, midazolam and ketamine, 40 healthy children, one to six years of age, who were scheduled for ambulatory dental surgery, were assigned to receive either oral midazolam 0.5 mg.kg-1 or oral ketamine 5.0 mg.kg-1 in a double-blind, randomized study. Sedation and anxiolysis scores before induction, cooperation at induction of anaesthesia and recovery times and complications were assessed. We found that both drugs effectively sedated the children within 20 min of administration. Although sedated, 10% of the children in the midazolam group and 20% of those in the ketamine group became tearful on separation from their parents and 20% of those in the midazolam group and 35% of those in the ketamine group became tearful when the facemask was applied. No important side effects were attributable to either premedication. The time until the children were fit for discharge from the hospital after midazolam was approximately 20 min less than after ketamine. In conclusion, midazolam and ketamine offer similar clinical characteristics when used as oral premedications for children undergoing ambulatory surgery, although the time to discharge from hospital may be more rapid after midazolam than after ketamine.

Administration, Oral↗
PubMed1999

Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia.

PURPOSE: To evaluate whether oral clonidine premedication affects the induction dose of propofol and awakening time from epidural and propofol anesthesia. METHODS: Thirty-nine female patients (ASA I or II) were randomly allocated to receive 5 microg x kg(-1) clonidine p.o. or no clonidine 90 min before induction of anesthesia. After epidural anesthesia was achieved with lidocaine, general anesthesia was induced with continuous i.v. infusion of propofol at a rate of 50 mg x min(-1) until loss of eyelash reflex and responses to verbal commands, which were judged by a blinded observer. After a laryngeal mask airway was inserted, anesthesia was maintained with N2O 67%, O2 33% and propofol adjusted to maintain hemodynamic stability. After completion of surgery, a blinded observer recorded the time from discontinuance of propofol and N2O until the patient was awake and responsive (awakening time), and then, the laryngeal mask airway was removed. RESULTS: The induction dose of propofol in the clonidine group (1.4 +/- 0.3 mg) was less than that in the control group (1.9 +/- 0.4 mg, P < 0.05), while the awakening time of the clonidine group (470 +/- 145 sec) was longer than that of the control group (329 +/- 123 sec, P < 0.05). CONCLUSION: Premedication with 5 microg x kg(-1) clonidine p.o. reduced the induction dose of propofol, but delayed emergence from propofol anesthesia.

Adrenergic alpha-Agonists↗
PubMed1983

Oral diazepam premedication reduces the incidence of post-succinylcholine muscle pains.

In a prospective, double-blind placebo controlled trial, the effect of oral diazepam premedication on post-succinylcholine fasciculations and myalgia was studied. Forty patients undergoing septoplasty procedures received orally identical capsules containing either 10 mg of diazepam or a placebo 90 minutes preoperatively. A standardized anaesthetic regimen included induction with 5 mg X kg-1 of thiopental and 1 mg X kg-1 of succinylcholine. The diazepam and control groups did not differ significantly in extent of fasciculations or ease of intubation. However, only 15 per cent of the diazepam premedicated patients had myalgias postoperatively compared to 50 per cent of the control patients, a statistically significant difference (p = 0.04).

Adult↗