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PubMed2003

[Comparison of premedication with clonidine and midazolam combined with TCI for orthopaedic shoulder surgery].

OBJECTIVE: The most frequently used drugs for premedication are benzodiazepines and alpha (2)-adrenoceptor agonists. In this study we examined midazolam and clonidine for premedication in combination with target controlled infusion anaesthesia (TCI) in patients undergoing orthopaedic shoulder surgery and analysed the effects on the peri- and postoperative course. METHODS: Forty-five Patients (ASA I-III) were included in this prospective randomized, double blind study. Sixty minutes prior to anaesthetic induction the patients received clonidine in a dosage of 2 microg x kg(-1) (group ND) or 5 microg x kg(-1) (group HD) or 0.1 mg x kg(-1) midazolam (group midazolam) per orally. Anaesthesia was performed as TCI with propofol (plasma concentration 2.0-4.0 microg x ml(-1)) und remifentanil (plasma concentration 0.2-0.4 microg x ml(-1) x min(-1)). 15 minutes before the operation was finished, all patients received a bolus dose of 0.1 mg x kg(-1) piritramid i.v., followed by administration of piritramid via a PCA pump (patient controlled analgesia) for a duration of 24 hours. During the time of the operation the influence of premedication on the anaesthetic course was determined by vital parameters and ranking scales. For statistic evaluation we used the Kruskal-Wallis test, ANOVA with Tukey as post hoc test and the test named after Fisher (p < 0.05). RESULTS: The effects of premedication on haemodynamic parameters and ranking scales for sedation as well as anaesthetic requirements were comparable in all three groups. In the postoperative period the incidence of postoperative nausea and vomiting (PONV) (ND: n = 8, HD: n = 2, midazolam: n = 6) and the use of pritramid were lower in the clonidine HD group (HD: 38.7 +/- 30.7 mg, ND: 51.7 +/- 25.1 mg, midazolam: 45.1 +/- 30.4 mg) than in the other groups. CONCLUSIONS: Premedication with the alpha(2)-adrenoceptor agonist clonidine is as good as with benzodiazepines in combination with TCI. Because of the lower incidence of PONV and the need of piritramid in the postoperative period patients premedicated with 5 microg x kg(-1) clonidine may benefit from this premedication.

Adolescent↗
PubMed2000

[Study of presurgical anxiety in urologic, gynecologic, and ophthalmologic surgery as a function of the administration or non-administration of anxiolytic premedication].

OBJECTIVE: Anxiety commonly appears before surgery, triggering a set of events that can be described as a general stress response. We measured changes in preoperative stress in relation to premedication or not with diazepam in patients undergoing urologic, gynecologic and ophthalmologic surgery. PATIENTS AND METHOD: We enrolled 87 patients undergoing elective surgery in urology (n = 30), gynecology (n = 30) and ophthalmology (n = 27). Randomly, the patients were premedicated with diazepam, placebo or nothing. During the preoperative visit the patient was administered a test to determine the level of anxiety and blood pressure, heart rate and potassium plasma concentration (K+) the night before surgery and moments before entering the operating theater. RESULTS: No significant differences in anxiety between patients undergoing different types of surgery were detected in the operating theater; however, at that time, anxiety was found to be significantly less among patients premedicated with diazepam than among those given placebo. Preoperative anxiety was significantly less in ophthalmology patients and in those premedicated with diazepam. Both systolic and diastolic blood pressure increased significantly among urologic and ophthalmologic surgery patients and in those who were not premedicated with diazepam regardless of type of surgery. Heart rate did not change significantly. Potassemia decreased significantly in all patients. CONCLUSION: The discrepancy between the psychological and somatic response to the stress conditions studied may be the result of the calming effect of the preoperative visit by the anesthesiologist and to premedication with a tranquilizer. However, neither the preoperative visit nor premedication seem to completely block the stress response.

Adolescent↗
PubMed1994

[Electroencephalographic demonstration of central nervous system effects of different premedication regimens].

INTRODUCTION: For many years, the main goal of premedication was prevention of the dangerous side effects sometimes encountered in anesthetics with anticholinergics, antiemetic antihistaminics, and opioids. Because the rules were always preoperative fasting, premedication was administered i.m. Thus, the onset of action was within 15-30 min from administration. In recent years, with the introduction of newer anesthetics with fewer side effects, anxiolysis became the main aim in premedication. Moreover, the oral route became popular since it obviously did not increase the acidity or volume of the gastric content. However, the uptake and thus onset of action of orally administered drugs may take longer and can differ considerably between individual patients. Therefore, the optimum interval between administration and induction of anesthesia remains controversial. The present study was carried out to examine the time course of drug action and the effects of different premedication regimens on the electroencephalogram (EEG). PATIENTS AND METHODS: After obtaining informed consent, in 38 unselected adult patients (ASA I and II, < 65 years) scheduled for elective surgery, the EEG was recorded continuously before and after premedication. The patients were randomly assigned to four groups: M: midazolam, 0.2 mg/kg BW orally; N: nordazepam, 0.2 mg/kg BW orally; AP: atropine, 0.5 mg, plus promethazine, 50 mg i.m.; APP: atropine, 0.5 mg, plus promethazine, 50 mg, plus pethidine, 0.7 mg/kg BW i.m. The EEG was recorded for a reference period of 10 min before and a study period of 30 min after premedication. Automated EEG processing was performed with CATEEM (computer-aided topographical electroencephalometry). Surface electrodes were placed according to the 10-20 system. Date were collected via an amplifier (resistance 10 M omega) and a digitalization unit (filter 0.2-35 Hz, sampling rate 512 Hz, 12 bit A/D convertor). The original EEG signals were used in an interpolation algorythm to produce an additional 82 virtual recording points, allowing for high topographical resolution. After spectral analysis (fast Fourier transformation), the different frequency ranges of the EEG power spectrum are displayed in different colors. The screen displays the on-line map with color-based topographical power distribution. In order to achieve a pharmacodynamic time profile, the study period was subdivided into three periods of 10 min each. For clinical evaluation of vigilance, a 6-grade scoring system was used 1 = awake, 6 = not arousable). RESULTS: All data are presented with respect to reference period. The power density of each frequency range for each electrode is integrated over the selected period and mean values are shown. Changes in power density with time are expressed as percentage change from reference period. Biometrical data showed no significant differences between groups. The median vigilance score 30 min after premedication (end of study period) was 4 in groups M, AP, and APP, and 3 in group N. In both benzodiazepine groups, a distinct increase in power density was found in the beta-bands, while in groups AP and APP the increase was most pronounced in the delta and theta bands. In group M, there was a linear increase in beta 1 power up to 310%, while in the beta 2 range there was a 170% maximum within the second period of 10 min. In group N, there was a similar course with a lower increase in beta 1 (220%) and beta 2 (130%). Increases in both beta-bands were most pronounced with frontal electrodes. While group M showed an increase in delta power (150%), together with moderate suppression in alpha (alpha 1 50%, alpha 2 40%), nordazepam caused only a slight increase in delta (124%) and a distinct increase in alpha 2 to 150%, predominantly in the frontal areas. Group APP showed a linear increase in both delta up to 210% and theta power to 190%. (ABSTRACT TRUNCATED)

Adult↗
PubMed2006

Antivenom use, premedication and early adverse reactions in the management of snake bites in rural Papua New Guinea.

OBJECTIVE: To examine antivenom use, premedication, early adverse reactions and patient outcomes after snake bite in rural Papua New Guinea. DESIGN: Retrospective chart analysis of all admissions for snake bite with documented antivenom use at 11 rural health facilities from January 1994 to June 2004. No formal protocol was followed and there was no attempt at randomisation or blinding of prophylaxis. RESULTS: Antivenom use was documented in 136/1881 (7.2%) snake bite admissions and most (121/136: 88.9%) received a single vial. CSL Polyvalent antivenom was administered to 112/136 (82.4%). One hundred and eleven patients (81.6%) happened to have been given premedication with adrenaline and/or promethazine and/or hydrocortisone. Early adverse reactions were reported in 25 patients (18.4%) including 23 treated with polyvalent antivenom. Intravenous test doses of antivenom were given to 32 patients, none of whom had a positive test result. Subsequent adverse reactions occurred in 9 of these 32 (28.1%) patients. One death may have been attributable to anaphylaxis after polyvalent antivenom. Reaction rates were significantly (p < or = 0.005) lower in adrenaline premedicated patients (7.7%) compared to patients premedicated without adrenaline (28.3%) and unpremedicated patients (28.0%). Adrenaline premedication caused no detectable changes in vital signs. The case fatality rate was 9.6% (13/136 patients). CONCLUSIONS: Polyvalent antivenom is the main treatment for envenomation in rural health centres, and early adverse reactions are common. Adrenaline premedication appears to significantly reduce acute adverse reaction rates. Premedication with promethazine and/or hydrocortisone without adrenaline did not reduce early adverse reactions.

Adolescent↗
PubMed1989

Effect of midazolam and diazepam premedication on central nervous system and cardiovascular toxicity of bupivacaine in pigs.

To determine the effect of benzodiazepine premedication on central nervous system and cardiovascular effects of bupivacaine, the authors administered toxic doses of bupivacaine to awake spontaneously breathing pigs after intravenous premedication with midazolam (0.06 mg/kg), diazepam (0.15 mg/kg), or saline. Five minutes after administration of one of these solutions, they began an infusion of bupivacaine at 2 mg.kg-1.min-1. The bupivacaine infusion was continued until cardiovascular collapse. They then attempted to resuscitate the animals via open chest cardiac massage and a standard resuscitation protocol. Premedication with midazolam or diazepam significantly delayed the onset of ventricular dysrhythmias (P less than 0.05), decreased the incidence of seizures (P less than 0.05), and prevented the increase in blood pressure and heart rate following bupivacaine infusion (P less than 0.05). Benzodiazepine premedication did not affect the dose of bupivacaine or the blood concentration required to produce cardiovascular collapse. The ability to resuscitate animals premedicated with midazolam did not differ from control; however, significantly fewer animals premedicated with diazepam were resuscitated (P less than 0.05). A clinically relevant observation was that almost all animals premedicated with a benzodiazepine progressed directly to cardiovascular collapse without first manifesting seizures.

Animals↗
PubMed2005

Clonidine: an alternative to benzodiazepines for premedication in children.

PURPOSE OF REVIEW: The aim of this review is to summarize the use of clonidine for paediatric premedication and to make a comparison with benzodiazepines. A routine clonidine premedication protocol is also presented. RECENT FINDINGS: In the US 50% of young children undergoing surgery receive premedication and midazolam is the most frequently used drug. The number of trials that compare midazolam with active controls are few and this premedicant is not adequately validated. Clonidine is still used as premedication in a small number of centres but the literature on paediatric use of clonidine is steadily growing. A recent review article has concluded that the use of clonidine does enhance the quality of perioperative management in infants and children and more recent publications support the use of clonidine for premedication. Its effect on the circulation is mild but routine atropine administration is recommended. Contraindications to the use of clonidine are few. Apart from a general overview on the effects of clonidine this article will also summarise the published trials that have compared clonidine with benzodiazepines for premedication in children. SUMMARY: Midazolam the most commonly used drug for paediatric premedication worldwide. Despite having a number of beneficial effects it is far from an ideal premedicant, especially concerning its effect on cognition/amnesia, confusion and long-term behavioural disturbances. Clonidine lacks the majority of the negative effects associated with midazolam and is associated with a number of beneficial perioperative effects. Our clinical experience of replacing midazolam with clonidine as premedicant in children, including also outpatients, has been favourable.

Journal Article↗
PubMed1997

Infusion rates and levels of premedication in tumescent liposuction.

BACKGROUND: Tumescent liposuction has proven to be an extremely safe and effective method of liposuction. However, the infusion of tumescent anesthesia can take 1 hour or more to complete. OBJECTIVE: To document the types, dosages, and routes of administration of premedication utilized by four experienced tumescent liposuction surgeons. To determine if infusion rates for tumescent anesthesia are affected by types of premedication. METHODS: Four experienced liposuction surgeons were asked to review their most recent 100 tumescent liposuction patients with respect to types and dosages of premedication and routes of administration. Data were also provided on corresponding infusion pump settings and infusion rates. Volumes of tumescent anesthesia and corresponding volumes of fat aspirated were also collected on the same 400 patients. RESULTS: Infusion of tumescent anesthesia could be performed more rapidly in patients who were given greater amounts of premedication. Volumes of tumescent anesthesia infused were generally two or more times the volume of fat aspirated. Patients could be infused with less premedication if slow infiltration was employed. CONCLUSION: Infusion rates for tumescent anesthesia can be increased of greater amounts of premedication are given. However, this must be balanced against the safety of the premedication.

Adult↗
PubMed1990

Effect of premedication on arterial blood gases prior to cardiac surgery.

The effect of premedication on arterial blood gas tensions was studied in thirty adult surgical patients with valvular disease. They were divided into three groups, each group having a different premedication regimen. Blood gas tensions were compared in these patients when awake on the night before surgery, asleep, after premedication and just prior to induction of anaesthesia. Samples were taken while the patient breathed air and each patient acted as his/her own control. The patients were randomised into one of three premedication regimens: 1. intramuscular lorazepam, 2. intramuscular morphine and hyoscine (scopolamine) and 3. oral lorazepam plus intramuscular morphine and hyoscine. There was a statistically significant though not clinically significant rise in PaCO2 and fall in pH following premedication with lorazepam, morphine and hyoscine. There was also a significant fall in PaO2 associated with morphine and hyoscine premedication which was greater than that which occurred with unsedated sleep. Patients who are to undergo cardiac valvular surgery should receive supplementary oxygen following premedication and during transfer to the operating room.

Administration, Oral↗
PubMed1989

A rational approach to anaesthetic premedication.

Rational use of premedication for anaesthesia must always be modified and updated to keep pace with the evolving fields of anaesthesiology and surgery, as well as to meet changing patient needs and preferences. It is no longer axiomatic that all patients require, and therefore should receive, premedication. Unfortunately, a variety of traditional reasons have been proposed to justify routine premedication in many institutions. Smoothing induction, decreasing reflexes and arrhythmias, decreasing nausea and vomiting, decreasing pain, decreasing secretions, and producing sedation and amnesia have all been claimed historically as beneficial results of premedication. Modern anaesthetic agents and techniques have come a long way towards eliminating the routine need for premedication. In the preoperative period, the goal of an anxiety-free patient who is physiologically uncompromised requires an individualised approach based on experience and an adequate knowledge of current pharmacology. As our knowledge of potential problems associated with anaesthesia has expanded, we have added other classes of drugs such as the H2-histamine receptor blockers and antacids to our premedicant armamentarium. Outpatient and short-stay patients have further challenged our preoperative goal of an anxiety-free patient by requiring individuals to be 'street ready' within a brief period of time after surgery. Even for in-house elective procedures, not every patient is a candidate for routine premedication. A frank preoperative discussion is all that is necessary to effectively allay anxiety in many persons. In these and other special situations, this article will hopefully guide the reader toward a more rational approach to premedicating patients.

Barbiturates↗
PubMed2002

Clinical comparison of xylazine and medetomidine for premedication of horses.

OBJECTIVE: To compare the analgesic and cardiopulmonary effects of medetomidine and xylazine when used for premedication of horses undergoing general anesthesia. DESIGN: Randomized clinical trial. ANIMALS: 40 horses. PROCEDURE: Twenty horses were premedicated with medetomidine (10 microg/kg [4.5 microg/lb], i.m.) and the other 20 were premedicated with xylazine (2 mg/kg [0.9 mg/kg], i.m.). Horses were then anesthetized with a combination of guaifenesin and ketamine; anesthesia was maintained with halothane. Additional doses of medetomidine or xylazine were given if horses were not sufficiently sedated at the time of anesthetic induction. After induction of anesthesia, sodium pentothal was administered as necessary to prevent limb movements. Hypotension was treated with dobutamine; hypoventilation and hypoxemia were treated with intermittent positive-pressure ventilation. The quality of anesthetic induction, maintenance, and recovery and the quality of the transition to inhalation anesthesia were scored. RESULTS: Scores for the quality of the transition to inhalation anesthesia were significantly higher for horses premedicated with medetomidine than for horses premedicated with xylazine. However, other scores, recovery times, and numbers of attempts needed to achieve sternal recumbency and to stand were not significantly different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that medetomidine is suitable for premedication of horses undergoing general anesthesia. Analgesic and cardiopulmonary effects of medetomidine were similar to those of xylazine, except that the transition to inhalation anesthesia was smoother when horses were premedicated with medetomidine, rather than xylazine.

Adrenergic alpha-Agonists↗
PubMed2002

[Oral and rectal premedication of children with midazolam]].

Premedication in children continues to be a problem in anaesthesiology. Apart from the application of premedication drugs, a strongly committed anaesthetist and sound psychological work are decisive prerequisites for adequate premedication. In this randomized study, 329 children aged between 1 and 14 who were scheduled for small surgical procedures were examined. Based on the results of a preliminary trial using different dosages of midazolam, the children were premedicated either orally with 0.4 mg/kg BW midazolam or with 0.3 mg/kg BW midazolam as a rectal solution and the premedication effect was recorded according to the classification of Lindgren. These reduced doses of midazolam, which were much lower than those described in the literature, led to very good premedication effects, too. Regarding cardiovascular behaviour, an increasing anxiolysis and the effect of premedication led to a significant decline in mean arterial blood pressure and heart frequency. The circulatory changes that occurred were at no time clinically relevant in any child, and therefore no treatment was needed. Based on the measured oxygen saturation, no significant respiratory changes were seen during the observation period. The frequency and extent of the registered side-effects were classified as slight. Side-effects such as singultus, salivation and ataxia/gesticulations were of no danger during the entire perioperative period.

Adjuvants, Anesthesia↗
PubMed1991

[A comparative study of the efficacy and tolerance of dipotassium clorazepate and flunitrazepam for oral premedication].

The literature shows that benzodiazepines, in view of their anxiolytic, sedative, amnesic, muscle relaxant and anticonvulsive action, are the most important substances for premedication. Eminent workers regard anxiolysis as the most important aim of premedication. In the present clinical study, oral administration of the two different benzodiazepine derivatives, flunitrazepam (F) and chlorazepate dipotassium (CD) have been explored with a view to side effects, tolerance, quality of sleep during the night, anxiolytic effect and sedation. The study involved 108 women patients aged from 20 to 60 years (ASA class I or II), all scheduled to undergo gynecological surgery in general anesthesia. There were also 20 women who received no premedication. The three groups of patients were further divided into early (operation started before 10:30 a.m.) and late-operation (operation started after 10:30 a.m.) groups. The test drugs were administered as follows: 43 women received 50 mg CD p.o. on the evening before the operation, followed by 25 mg p.o. in the morning; 45 women received 2 mg F p.o. on the evening before the operation, followed by 1 mg p.o. in the morning. All patients took the preoperative premedication at 7 o'clock in the morning. Following this medication, the anxiolytic, sedative, and amnesic effects, side effects, vigilance and O2 saturation (SaO2) were determined at defined points during the day of the operation and the 1st postoperative day. Blood pressure and heart rate were recorded and interpreted as physiological stress parameters. Anxiolysis was determined using the Erlangen Anxiety Scale (EAS) of Galster and Spörl; the degree of sedation was assessed by the anesthesiologist; amnesia was determined by the patients' recognition of picture cards; vigilance and side-effects were assessed by standardized questionnaires. Both active drugs clearly improved the quality of sleep in the night before the operation over that experienced with no premedication. There were no significant differences among the three groups in the physiological stress parameters. The preoperative SaO2 saturation was decreased significantly by oral F, but it was always more than 95%. CD had little influence on the SaO2. Unwanted somatic symptoms were found a little more frequently in the group without any premedication. There were no signs of restricted tolerance for either of the test drugs. In the premedicated groups, pre- and postoperative anxiety decreased significantly.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMed1991

[Effects of rectal premedication and the mother's presence on induction of pediatric anesthesia].

The effects of the rectal premedication and the mother's presence on induction of anesthesia were studied with 67 children between the ages of 1 and 6 years. All children were induced with mask using nitrous oxide-oxygen-halothane. Children's emotional states during induction were categorized as excellent, good or fair. Rating of excellent or good was considered to indicate satisfactory induction. Forty-seven children were accompanied by their mother. Twenty-two of them were premedicated with rectal bromazepam (3 mg), while another twenty-five children were not premedicated. Satisfactory induction after premedication was performed on 78% of the 1-3 year olds and 100% of the 4-6 year olds, whereas without rectal premedication, satisfactory induction was achieved in 42% of the 1-3 year olds and 69% of the 4-6 year olds. Rectal premedication was important for satisfactory induction. Another twenty of all children were premedicated with rectal bromazepam (3 mg) and induced without mother presence. Satisfactory induction was performed on 38% of the 1-3 year olds and 100% of the 4-6 year olds. Mother's presence tended to lead to satisfactory induction. Furthermore, we sought feedback from the mothers about their presence during induction of anesthesia. Almost all of the mothers said they appreciated the opportunity to be present, with the exception of four mothers (8.5%) who reported feeling of some anxiety to be in an operating room.

Administration, Rectal↗
PubMed1998

Effect of oral clonidine premedication on hemodynamic response during sedated nasal fiberoptic intubation.

Although oral clonidine premedication is known to reduce the hemodynamic response under general anesthesia, effects of the hemodynamic response during sedated fiberoptic nasal intubation have not yet been examined. Our aim was to compare the effects of clonidine premedication on hemodynamic responses with those of atropine and hydroxyzine premedication during sedated fiberoptic nasal intubation. Thirty adult patients were randomly assigned to one of two groups: Group 1 patients (n = 15) were premedicated with atropine sulfate (0.01 mg/kg) and hydroxyzine hydrochloride (1mg/kg) intramuscularly, and group 2 patients (n = 15) were premedicated with clonidine (5 micrograms/kg) orally. We compared the hemodynamic response and sedation level in fiberoptic nasal intubation between the two groups. there were no significant differences in sedation levels and postoperative complaints between the two groups. But the oral clonidine premedication (Group 2) blunted hemodynamic changes during the fiberoptic intubation. No profound hypotension or marked bradycardia was noted in group 2. We concluded that the oral clonidine premedication might contribute to hemodynamic stability during sedated fiberoptic nasal intubation.

Administration, Oral↗
PubMed1996

Preclinical science course "preludes" taken by premedical students: do they provide a competitive advantage?

BACKGROUND: Premedical students often elect advanced science courses whose content will reappear during preclinical courses. Are such "preludes" useful? METHOD: The study participants were the 176 first-year students entering the University of Iowa College of Medicine in 1992. Their grades in medical school courses in biochemistry, gross anatomy, histology, physiology, and microbiology were compared with their grades in similar premedical courses. RESULTS: The students who had taken a premedical prelude in advanced science performed no better than their classmates except in biochemistry, where the 118 students (67%) with prior biochemistry exposure had a significantly higher mean score (96.3 vs 87.6, p < .0001 using Student's t-test). A biochemistry prelude appeared to benefit all students, especially those from minorities underrepresented in medicine. In addition, among the 13 students who failed biochemistry in medical school, a number of them had low grades in organic chemistry and had not taken a premedical course in biochemistry. To test the replicability of the findings, an analysis was undertaken of the biochemistry performances of the 162 students who had entered in 1991, and again a significant difference was found between the students who had and those who had not taken a biochemistry prelude. CONCLUSION: A premedical biochemistry course, required by only two schools in 1995-96, appears advantageous, especially for students with weak academic preparation. Lack of such benefit from other preludes suggests that premedical students might better choose electives in arts and humanities to enhance their educational breadth.

Education, Premedical↗
PubMed1984

A survey on the 'premedical syndrome'.

The "premedical syndrome" has been widely discussed but only anecdotally described. To learn whether the syndrome exists in the South Carolina schools and which traits compose it, the authors surveyed faculty members and students of 13 undergraduate colleges in the state. Premedical students were perceived as differing from nonpremedical students in being excessively competitive, academically, overspecialized , overachieving , more highly motivated, more highly self-disciplined, goal-oriented, and proud of their career choice. The perception by students and faculty members of the premedical syndrome may have important effects on the undergraduate curriculum and students' choices of major areas of study. Only 3 percent of the premedical students who responded to the survey were majoring in the liberal arts, and only 9 percent of the nonpremedical students were majoring in the natural sciences. These data suggest that the natural science departments in U.S. colleges may have become training grounds for premedical students to the exclusion of others. Modification of medical school admissions policies may be able to reverse some features of the premedical syndrome and some of its effects.

Achievement↗
PubMed1997

Effects of anesthetic technique on side effects associated with fentanyl Oralet premedication.

STUDY OBJECTIVES: To evaluate the efficacy of 5 to 10 micrograms/kg of oral transmucosal fentanyl citrate (OTFC) as an anesthetic premedication, and to determine whether propofol induction reduces postoperative nausea and vomiting (PONV) in pediatric patients premedicated with OTFC undergoing outpatient surgery. DESIGN: Prospective, randomized, double-blinded study. SETTINGS: University of Michigan Health Care Systems and University of Arizona. PARTICIPANTS: 62 ASA physical status I and II children aged 4 to 14 years (8.9 +/- 0.5 years). INTERVENTIONS: Subjects were randomly assigned to one of four groups: (1) OTFC premedication and halothane induction; (2) OTFC premedication and propofol induction; (3) placebo premedication and halothane induction; and (4) placebo premedication and propofol induction. OTFC or placebo was administered 30 minutes prior to induction, and activity (sedation), apprehension, and cooperation scores were recorded before, at 15 and 30 minutes after study drug, and on induction. All perioperative adverse events were recorded. MEASUREMENTS AND MAIN RESULTS: Children who received OTFC became drowsier and had a significant change from baseline in combined activity, apprehension, and cooperation scores, whereas those who received placebo became less cooperative at induction. Patients who received OTFC experienced more adverse events overall (p < 0.001) than patients who received placebo. Additionally, OTFC patients experienced more vomiting (p < 0.001) and pruritus (p = 0.049) than controls. The incidence of PONV in patients who received OTFC and halothane induction was 50%, compared to 30% in patients receiving OTFC and a propofol induction (p = NS). CONCLUSIONS: OTFC in doses of 5 to 10 micrograms/kg was effective in producing sedation and facilitating cooperation with induction; however, it was associated with significant PONV in our study. Although propofol induction did not significantly reduce PONV in our study, further study with a larger sample, and with propofol as the sole anesthetic, may be warranted.

Administration, Oral↗
PubMed1999

Relation between bispectral index and plasma catecholamines after oral diazepam premedication.

The efficacy of anaesthetic premedication has been assessed using sedative scores or a visual analogue scale. However, in both it may be difficult to exclude evaluators' subjectivity or a placebo effect. Plasma concentration of catecholamines may also be useful for the assessment of patient anxiety. Recently bispectral electro-encephalographic analysis has been developed, and the bispectral index monitor has been reported to give measurements which correlate well with the depth of sedation. In the present study, we have examined the relation between bispectral index values and plasma catecholamine concentrations after oral diazepam premedication. Twenty-eight patients scheduled for elective surgery were randomly assigned to one of two groups: diazepam premedication group (group D(+), n = 14) and no premedication group (group D(-), n = 14). The patients were premedicated orally with diazepam 10 mg and roxatidine 75 mg in group D(+), and with roxatidine 75 mg only in group D(-) 90 min before arrival in the operating theatre. After patients arrived in the operating theatre, the bispectral index monitor was applied. Venous blood samples (6 mL) were collected in the case of patients in group D(+) for the measurement of plasma catecholamines levels using high-performance liquid chromatography. The bispectral index level (mean +/- SD) in group D(+): 93.5 +/- 773.5 was significantly lower than that in group D(-): 96.1 +/- 1.8 (P < 0.05). There was a significant correlation between bispectral index and plasma norepinephrine levels (r = 0.567, P < 0.05). The present study suggests that the bispectral index monitor may detect the effect of oral diazepam premedication.

Administration, Oral↗