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Mathematical analysis of the heart rhythm and expressive methods of emotional stress determination have been used in 90 children prepared for surgical intervention with the help of three types of premedication. It has been shown that premedication with diazepam and droperidol (according to scheme) was effective for the elimination of preoperative psychoemotional stress in children.
Omeprazole, a proton pump inhibitor was used for premedication for general anesthesia, and its effects on gastric secretion and serum gastrin level were investigated in 60 patients. The patients were divided into the following 4 groups and each group received one of the following medications; (I) a tablet of omeprazole 20 mg before sleep at the night before the surgery, (II) a tablet 2 hours before the induction of anesthesia, (III) one on the night before and another tablet 2 hours before the induction, or (0) no tablet. In the patients who received any dose of the drug, the volume of gastric juice at the beginning of the surgery was significantly less than that in those who received no drug (P less than 0.05). Gastric pH showed a tendency to increase depending on the dose of omeprazole (0 less than I less than II less than III), but it was not significant. No significant change in serum gastrin level was observed in this study. A 20 mg omeprazole tablet may not be adequate as the premedication for general anesthesia.
We evaluated the sedative and amnesic effects of oral midazolam as premedication in children. Sixteen children, aged 4-12 yr, undergoing elective minor surgery were divided into 2 groups. One group received midazolam 0.5 mg.kg-1 with atropine 0.03 mg.kg-1 orally. The other control group received only atropine 0.03 mg.kg-1. There was no significant difference in the sedative scale at induction between the 2 groups. Doll-recall was used to assess the amnesic effects. In the midazolam group, 75% of the children forgot dolls they had seen on entering the operating room. Midazolam produced significant anterograde amnesia but no retrograde amnesia. This result suggests that children who received midazolam as premedication forget unpleasant memories at induction and their postoperative emotional responses are least influenced by their memories. We conclude that oral midazolam 0.5 mg.kg-1 is an effective preanesthetic medication in children.
Midazolam presents the properties of a good premedication because of its sedative and anxiolytic activity. The aim of this study, concerning 84 children, was to compare the efficacy of midazolam according to the three ways of administration: intrarectal, oral and intranasal, in reference to a group without premedication. Results have shown the superiority of intrarectal midazolam at the dose of 0.35 mg.kg-1 30 minutes before surgery. The tolerance of this way of administration is excellent and it allows a greater sedative activity compared to the control group and to the intranasal group.
Should atropine be administered for premedication? This question continues to be controversial; in particular, the combined administration of atropine and succinylcholine has been investigated with conflicting results by numerous researchers. The present study was carried out to assess the effect of premedication with atropine on hemodynamic variables and salivation in patients assigned to ASA class II and III. METHODS. Eighty ASA class II or III patients received pethidine 1.0 mg/kg and promethazine 0.5 mg/kg i.m. 30 min prior to induction of anesthesia and atropine, either 0.01 mg/kg i.v. 10 min or 0.01 mg/kg i.m. 30 min prior to a standardized anesthetic induction with alcuronium (precurarizing dose), thiopental, and succinylcholine. In the control groups (20 patients each), no atropine was given. Systolic, diastolic, and mean arterial pressures (MAP) were measured. The ECG was monitored for arrhythmias. Salivation was assessed semiquantitatively using swabs positioned within the pharyngeal space. RESULTS. Ten minutes after the administration of atropine i.v., a significant increase in heart rate (HR) was observed; this did not occur within 30 min after administration of atropine i.m. At the time of tracheal intubation, HR was significantly increased in both i.v. atropine risk groups. After atropine i.m., an increase in heart rate during intubation was observed in ASA class II patients only. No increase in heart rate occurred in the control groups during tracheal intubation. Neither i.m. nor i.v. atropine had any significant effect on blood pressure. Arrhythmias occurred in a few cases with both routes of administration; several instances of marked tachycardia were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)
The incidence of cardiac dysrhythmias was investigated in 60 patients undergoing dental operations under halothane anaesthesia following either hyoscine, glycopyrrolate or placebo as a supplement to nalbuphine for premedication. Forty-five percent of the patients given 6 micrograms/kg hyoscine exhibited cardiac dysrhythmias compared to 25 percent of the group given 4 micrograms/kg glycopyrrolate and to 5 percent in the placebo group. The difference between the first two groups was not significant. But there was a significant difference between these two groups and the placebo group in which only 5 percent of the patients had cardiac dysrhythmias. There was neither a connection between the frequency of cardiac dysrhythmias and the demographic characteristics of the patients nor with their PaCO2. The author recommends to avoid premedication with anticholinergic combined with halothane anaesthesia with spontaneous respiration during dental operations.
One hundred children aged between 6 months and 10 years undergoing elective urological surgery, received 0.4 mg/kg midazolam orally about 20 minutes prior to the arrival in the operation theatre. The physiological state of the children was estimated and recorded pre- and postoperatively at defined, comparable and representative circumstances by a specially developed design. In the preoperative period orally administered midazolam had only a mild or non sedative effect in 76-84% of the children, 67-88% of the small patients behaved cooperatively or passively and 70-84% showed an indifferent or euphoric state of mind. Postoperatively 57-89% of the children were markedly sedated; therefore, the estimation of behaviour and state of mind was of minor significance. The circulatory parameters were altered only minimally. Systolic blood pressure and heart rate changed slightly but significantly compared to the preoperative values the day before surgery: a preoperative increase to a maximum immediately after the insertion of the venous cannula and a postoperative maximum after recovery. Side effects were rare (hiccough 5%, vomitus 4%, laryngospasm 1%, stridor 1%). Our results suggest that oral premedication with midazolam in children can be recommended to avoid traumatic or unpleasant alterations resulting from intramuscular injections or rectal applications. Therefore, we prefer this kind of premedication in paediatric patients.
The study involved 40 children ASA I to II type who were randomly divided into two groups of 20 patients with comparable age and sex profile. Premedication consisting of 0.2 mg/kg of midazolam (Dormicum, Roche) and 0.015 mg/kg of atropine was administered 30 to 40 min before surgical intervention by intramuscular way in one group and by intranasal in the other one. In the operating room a peripheral vein was cannulated and general anesthesia was induced with thiopental sodium and succinylcholine. Arterial blood oxygen saturation, heart rate, arterial blood pressure and respiratory rate were measured at baseline, beginning of sedation (closing eyes), and arrival at the operating room. The time at the onset of sedation, the degree of sedation at the operating room, and the reaction to the venopuncture were also measured. In both groups of patients heart rate and systolic arterial blood pressure measured at the arrival to the operating room were significantly higher than those recorded at baseline and at the onset of sedation. Diastolic blood pressure in patients with intranasal premedication increased on arrival to the operating room with respect to the sedation values. Arterial oxygen saturation significantly decreased from the baseline values in both groups at the onset of sedation and on arrival at the operating room. There were no significant changes in respiratory rate. None of the alterations had clinical consequences. There were no significant differences in the onset of sedation (12.42 +/- 4.07 min in the intramuscular group and 15.26 +/- 7.99 min in the intranasal administration), degree of sedation and response to venopunction in either group.(ABSTRACT TRUNCATED AT 250 WORDS)
The effect of oral trimeprazine alone or in combination with either atropine or glycopyrrolate or pethidine as oral premedication in children was studied. The effects of different drug combinations were evaluated in respect of pre-operative sedation, salivary secretion, induction characteristic, postoperative sedation and postoperative vomiting. The study concludes that trimeprazine in combination with either atropine or glycopyrrolate is mostly effective, safe and satisfactory as oral premedication in children. Trimeprazine along with pethidine can be recommended for all purpose oral medication both in pre- and post-operative period.
Eighty healthy children, between the ages of 2 and 7 years, undergoing dental procedures were monitored with a pulse oximeter for changes in arterial oxygen saturation. The children were randomly allocated into 4 groups in this double-blind study. Three groups received rectal midazolam, and the other group a placebo (saline) as premedication 30 min prior to induction of anesthesia. Group A children received midazolam 0.25 mg/kg, Group B 0.35 mg/kg and Group C 0.45 mg/kg. The results from this trial show no statistical significant difference between the treatment groups as to the effect on either systolic or diastolic blood pressure, respiration, or pulse rates at either pre- or post-sedation levels. However, the oxygen saturation levels for groups B and C differed significantly from those of the placebo groups 30 minutes after premedication (P = 0.0259).
The suitability of triazolam for oral premedication was evaluated in comparison to flunitrazepam. 65 consenting female patients scheduled for gynaecological surgery took part in the trial, were randomly allocated in two groups and were given 0.5 mg triazolam or 2 mg of flunitrazepam as oral premedication 90 min preoperatively. No difference was found in the anxiolytic potency (possible difference d = 0.65 standard deviation, less than 3 points on the anxiety score). Both drugs significantly reduced anxiety (alpha less than 0.01). Anxiolysis depended on the initial anxiety; the higher the initial anxiety score, the better the anxiolytic effect. Triazolam was found to have an antidepressant effect (alpha less than 0.05) and asthenic affects decreased (n.s.). Flunitrazepam had a tendency to increase depression (n.s.) and asthenic effects increased (alpha less than 0.05). No differences were found in the degree of sedation and in the amnestic effect. Systolic pressure remained unchanged in both groups, whereas values of diastolic pressure increased to the same extent in both groups. While heart rate increased after triazolam, it decreased after flunitrazepam. Both groups had comparable initial heart rates. Possible mechanisms to explain this discordance of heart rate-changes are discussed. Triazolam is comparable to flunitrazepam as an oral premedicant and is a suitable drug for short surgical procedures if rapid postoperative recovery is required.
Over the last 15 years a rapid growth has occurred in the number of pediatric patients that are encountered in the operating room. A developing sophistication on the part of both children and parents, coupled with a rapidly expanding recognition of the need to minimize the amount of physical and psychological trauma that a child has to experience, has led to a growing use of premedication agents for children. A review of the premedication agents currently in use, their various routes of administration, as well as their associated benefits and risks, is presented.
To investigate the effect of anesthesia on gastric secretion, we measured pH and volume of gastric juice during anesthesia using the following anesthetic techniques: halothane anesthesia in three age groups, halothane without atropine premedication, halothane with thoracic epidural block, and enflurane anesthesia. Halothane anesthesia increased pH in all age groups and the increase in pH was greater in older age groups. Gastric pH also increased in halothane anesthesia group with thoracic epidural block and in enflurane anesthesia group. However, the increase in gastric pH and the decrease in gastric juice volume were not significant in halothane anesthesia group without atropine premedication. These results suggest that the increase in gastric pH during halothane anesthesia is due to parasympathetic nerve block.
The clinical effects of midazolam (7.5, 10 and 15 mg), diazepam 10 mg, fentanyl 0.1 mg and fentanyl 0.1 mg-droperidol 5 mg, administered intramuscularly for surgical premedication, were compared in a double-blind placebo-controlled study. The degree of sedation provided by midazolam was significantly superior to diazepam, fentanyl or placebo. The largest dose of midazolam also impaired the lucidity of the patients and induced a moderate degree of muscular hypotony. A dose-effect relationship was observed only for the sedative effects of midazolam 60 min after administration. Midazolam scored consistently better than diazepam, fentanyl, placebo and fentanyl-droperidol for incidence of amnesia, stability of cardiovascular measurements and physician's acceptance. In all treatment groups, including placebo, anxiety decreased significantly with time. However, if expressed as percentage change, the greatest decrease occurred in the midazolam 15 mg group compared to all other treatments. Midazolam appeared to be a more effective premedicant than diazepam, analgesics or placebo. The intensity of the combined central nervous system effects suggested the dose of 10 mg might be the most suitable for intramuscular premedication.
Propofol, in both its new oil-in-water emulsion and the former cremophor-EL solution, is known to produce significant decreases in arterial blood pressure. The aim of this study was to obtain a precise hemodynamic profile of anesthesia induction with propofol under conditions of daily routine (additional 70% nitrous oxide) and to evaluate the influence of (1) premedication with lormetazepam and (2) additional i.v. injection of fentanyl. Forty patients (ASA classes I and II) were randomly assigned to one of four groups (A, B, C, and D). Anesthesia was induced with a sleep dose of propofol (mean: 2.4 mg/kg) and the patient was ventilated with 30% O2 and 70% N2O via a face mask. In groups B and D, 3 micrograms/kg fentanyl were injected immediately prior to propofol injection. Patients in groups A and B received no premedication. Patients in groups C and D received 2 mg lormetazepam on the evening prior to the anesthetic and 1 mg 2 h prior to the anesthetic orally. The following parameters were determined immediately prior to induction of anesthesia and 1, 3, 5, 8, and 10 min after the start of the propofol injection: heart rate (HR), mean arterial blood pressure (MAP), mean pulmonary artery pressure (PAP), central venous pressure (CVP), pulmonary occlusion pressure (POP), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). In all four groups a slight decrease in HR and SVR occurred while a marked decrease in arterial blood pressure (SAP, MAP, DAP) and cardiac output was seen. PAP and preload pressures showed no significant changes.(ABSTRACT TRUNCATED AT 250 WORDS)
Benzodiazepines have an anxiolytic, sedative, amnesic, muscle relaxant and anticonvulsive action. An analysis of the literature shows that benzodiazepines are the most important substances for premedication. They are preferred the evening before surgery for sleep induction. At the day of surgery they reduce stress better than any other substances or combinations. The different characteristics of different substances are presented. The way of application is discussed. Benzodiazepines, especially midazolam, offer new perspectives in the premedication of small children. Especially this group of patients remains to be a severe anaesthesiological problem.
The ventilatory response to CO2 after intravenous bolus injection of alfentanil 15 micrograms/kg was studied in a group of 10 healthy volunteers of both sexes, aged 19 to 30 years. Following randomized intravenous premedication with either placebo, diazepam 5 mg, droperidol 5 mg or etomidate 10 mg, a total of four test-series were performed with each individual in two-weekly intervals, in order to assess the additive effect of central depressants on opiate-induced respiratory depression. CO2-response curves were obtained during six-minute rebreathing periods up to 60 minutes after alfentanil. Slope as well as position of the curves were compared with pre-drug control values. In contrast to previous work with fentanyl 4 micrograms/kg, CO2-response curves after alfentanil 15 micrograms/kg were usually displaced to the right without concomitant decreases in slope. Ventilation almost completely returned to control levels after one hour. Due to strong inter- and intraindividual variations, no clearly significant differences could be observed between the premedication groups. Alfentanil plasma concentrations, determined by radioimmunoassay at 1, 3, 6, 10, 20, 30, 45, 60, 75 and 120 minutes after injection, showed only a poor correlation to the changes of the CO2-response curves.
Oral premedication with benzodiazepines is well established in clinical anaesthesia. Appreciation of the specific pharmacodynamic profile of available drugs suggest individual prescription for certain groups of patients. We report a case of severe respiratory depression following oral premedication with flunitrazepam 1 mg in a patient with intracranial neoplasma. With respect to this complication and a review of the literature we suggest administration of short acting benzodiazepines with pronounced anxiolytic and moderate sedative properties (lormetazepam type) for neurosurgical patients.