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PubMed1988

[Midazolam in combination with piritramid versus Thalamonal in premedication in ambulatory ENT interventions in childhood].

70 children aged between 15 months and 8 years who had to undergo outpatient surgery (adenotomy) were divided into two groups and given different premedication. Group A received Midazolam (0.15 mg/kg) combined with Piritramid (0.1 mg/kg), group B Thalamonal (0.04 ml/kg). Based on vigilance schemes, the degree of sedation and the mood tone were rated during initiation of anaesthesia, in the awakening phase and on discharge of the patient. Cooperation during initiation (via a mask) was definitely higher in group A (72%) than in group B (44%). During the awakening phase the children in group A showed a more balanced mood tone combined with improved vigilance. For example, 3 hours postoperatively 65% of the children in group A had got up and participated in getting dressed, whereas in group B only 11% of the children did so. Intramuscular premedication with Midazolam/Piritramid must be considered as especially advantageous in outpatient ENT treatment requiring a large number of small surgical interventions in children in respect of effective preparation and with a minimum of problems regarding postoperative follow-up.

Adenoidectomy↗
PubMed1987

Rectal benzodiazepines for premedication in children. Review and personal experience.

Modern anesthetic techniques have modified the aims of premedication in pediatric practice. Anxiolysis, amnesia and easiness of induction are now the the main targets. This paper reviews both the literature and the personal experience of the authors on the subject. Many authors now prefer a benzodiazepine. Rectal instillation of benzodiazepine in solution avoids the trauma of the intramuscular route and produces a faster and more predictable effect, than suppositories. Diazepam (.1 to .2 mg/kg) and flunitrazepam (40 to 80 micrograms/kg) have been extensively used in this indication. Diazepam's duration of elimination being much longer than that of flunitrazepam, this last drug is preferred by many pediatric anesthetists. Midazolam (.4 to .5 mg/kg) has a much faster onset and shorter duration of action. It should thus be preferred if the environment enables the administration of premedication within 10 to 15 minutes of induction.

Administration, Rectal↗
PubMed1986

[Effects and side effects of transdermal scopolamine for premedication in general anesthesia in elderly patients].

Transdermal scopolamine has already proved an effective premedication to prevent postoperative nausea and vomiting. In a double-blind study, the effects and above all the side effects of TTS-scopolamine (TTS-s) and TTS-placebo (TTS-p) were investigated in elderly patients (greater than 50 years), who are particularly susceptible to adverse drug reactions. The 59 (out of 61) male and female patients who could finally be evaluated had to undergo long (1-6.3 hrs.) surgical or gynaecological interventions in general anaesthesia after premedication with benzodiazepines in the evening and in the morning. The operations were performed under intubation anaesthesia induced by barbiturate (3-5 mg/kg bw) or etomidate (0.2-0.3 mg/kg bw), together with enflurane (0.5-2.5 vol.%) or isoflurane (0.5-1.5 vol.%), N2O/O2 (2:1) and fentanyl (0.05-0.45 mg). Alcuronium or vecuronium were given for relaxation, pyridostigmine/atropine was administered for antagonisation. The patient groups did not differ significantly with regard to age (mean = 65 years vs. 63 years), sex, height, weight, concomitant diseases, method and duration of operation, method and duration of anaesthesia, postoperative antagonisation and analgesia. In patients under TTS-s postoperative nausea was less intensive and of shorter duration. In contrast to 7 patients of the placebo group (p less than 0.05), no case of vomiting could be observed in the TTS-s group. The efficacy of TTS-s was significantly better than that of TTS-p. TTS-s and TTS-p were both tolerated equally well. In both groups, the most frequent side effect was dryness of the mouth, but without any significant differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1987

[Effect of premedication and fentanyl administration on the endocrine stress reaction during halothane anesthesia].

The influence of two different premedication regimens (diazepam versus pethidine/promethazine with fentanyl substitution before induction) on the endocrine stress-response during halothane anaesthesia was investigated in twenty orthopedic surgery patients. After premedication, the levels of plasma catecholamines, ADH, ACTH and cortisol were lower in the pethidine/promethazine-than in the diazepam-group. The levels of adrenaline remained significantly lower during the whole observation period. Thirty minutes after extubation all endocrine parameters except noradrenaline were lower in the pethidine/promethazine-group than in the diazepam-group.

Adolescent↗
PubMed1986

Supplemental chloralose anesthesia in morphine premedicated dogs.

This study evaluated the cardiorespiratory stability of six dose-regulated, 12-hour, chloralose anesthetic maintenance protocols. Thirty mongrel dogs were premedicated with morphine sulfate (5mg/kg) and anesthetized with an induction dose of chloralose (80mg/kg). Fifteen animals were permitted to breathe spontaneously and 15 animals were ventilated mechanically to maintain a constant arterial pCO2 (40 +/- 5 mmHg). The spontaneously breathing dogs were separated into three groups in which animals (n = 5) were given different bolus doses of supplemental anesthetic. Initially the spontaneously breathing animals were hypoxemic, acidemic and hypercapnic. No consistent hemodynamic difference was noted among these groups. The mechanically ventilated animals were also divided into three groups that received varying doses of supplemental chloralose by constant infusion. Significant (p less than 0.01) myocardial depression was noted in the heavy-dosed animals by the third hour. Systolic pressure decreased 44%, pulse pressure decreased 37% and peak left ventricular dP/dt decreased 52%. All heavy-dosed animals expired before the eighth hour. Although these data suggest that morphine-premedicated, chloralose-anesthetized animals generally provide a stable cardiopulmonary model, high-dose chloralose supplementation depressed ventilation and produced a dose-dependent cardiotoxicity.

Anesthesia↗
PubMed1985

[Effect of premedication in general anesthesia on periodic variability of heart rate].

During the premedication phase the temporary course of the sinus arrhythmia was studied on 10 patients without cardiocirculatory diseases undergoing insufflation anaesthesia. The progress of heart rate variability was observed in periodic components by calculation of power density spectra. The results reveal a significant decrease of the spontaneous variations of the heart rate after 40 to 50 minutes action of atropine and pethidine. Periodic components of respiration and circulation are more reduced than long wave spectral ranges. Their residue is a measure for the size of the inhibition of the vagal impulse. The inverse atropine effect is preponderantly to be observed in periodic components of respiration and circulation. About 30 minutes after the injection of the premedication mixture a new steady state was found concerning the circulatory and respiratory rhythm.

Adult↗
PubMed1979

[Role of premedication in the prevention of accidents during aorto-coronary bypass].

Study of the type of premedication used in aorto-coronary bypass surgery involved 60 clinical cases of patients operated upon in the department of Professor GALEY (Henri Mondor Hospital, Creteil). The choice of drugs used showed the important role of tranquilisers and anxiolytics: diazepam, dipotassium chlorazepate, to which, in the majority of cases, were added an antihistamine: promethazine and a parasympatholytic: atropine. No accidents or complications were seen during the pre-anaesthetic period, and above all during the induction of anaesthesia in these patients, more than half of whom were in major cardiovascular decompensation. This would appear to confirm the efficacy of the drugs chosen for the premedication of these patients.

Adult↗
PubMed1979

The influence of dosage and premedication on induction of anesthesia with minaxolone.

Minaxolone, a new steroid induction agent, was administered to unpremedicated patients at three dose levels and at 0.5 mg . kg-1 to patients receiving three different premedicant regimes. The main side effects observed at induction were involuntary muscle movements but hypertonus and tremor were also seen. Respiratory complications consisted mainly of hiccough. Over the range of doses studied only the latter complication appeared to be dose-related. Premedication with diazepam and especially opiate combinations reduced the frequency and severity of excitatory effects and respiratory upset and increased the proportion of acceptable anesthesia. Marked respiratory depression and hypotension of greater than 20 mm Hg were rare even after opiate premedication.

Adult↗
PubMed1982

Comparison of old and new types of premedications.

By random allocation 41 patients received 1 mg flunitrazepam orally the night before operation and 1 mg on the morning of operation (group 1), and another 41 received 100 mg pentobarbital orally the night before operation, followed by intramuscular scopolamine (0.006 mg/kg) + morphine (0.02 mg/kg) on the morning of operation (group 2). All patients received 0.5 mg atropine intravenously just before the induction of anesthesia. The patients in group 2 were better sedated and had less salivary secretion than those in group 1, but otherwise both were comparable. In group 2 the induction requirements of thiopentone were significantly decreased in comparison with group 1, again indicating a more potent sedative effect. Because even in the total scoring of the results there was no significant difference between the two groups, the easy oral route of administration of flunitrazepam offers a clinically relevant alternative to the conventional premedication. In some of these E.N.T. patients who received flunitrazepam, intravenous atropine given just before the induction of anesthesia was unable to prevent salivary secretion. Oral benzodiazepine derivatives (flunitrazepam) appear to be useful before surgery as the old type of premedication (oral pentobarbital + i.m. scopolamine and morphine).

Administration, Oral↗
PubMed1983

[Respiratory and sleep-inducing effects of i.m. midazolam as premedication for regional anesthesia. Comparison with diazepam, promethazine/pethidine and placebo].

The effects of respiratory depression and sleep induction produced by 0.1 mg/kg and 0.15 mg/kg of midazolam i.m. were examined in patients in whom urological interventions had to be performed under spinal anesthesia. The same parameters were evaluated for 0.2 mg/kg of diazepam i.m. as well as 50 mg/50 mg of pethidine/promethazine i.m. and placebo i.m. The major difference between 0.1 mg and 0.15 mg/kg body weight of midazolam was a more pronounced PCO2-increase in the group with the higher dosage. Both dosages led to anterograde amnesia in 8 or 9 of 10 patients respectively. No amnesia developed in the control groups. Respiratory depression and sleep induction occurred later with promethazine/pethidine (at 60 min) or diazepam (at 120 min) than with midazolam. Noteworthy in the Diazepam and placebo group was a hyperventilation lasting 60 and 120 min respectively. The arterial PO2 decreased in all groups during the intervention. Under midazolam, the decrease was significantly higher statistically than in the control groups during the first 60 min at both dosages. Premedication with 0.1 mg/kg i.m. of midazolam proved to be sufficient in all patients. The rapid onset of action, the sleep during the intervention and the amnesia associated with it suggest that this form of premedication is more favorable than the other procedures examined. The dosage of 0.15 mg/kg of midazolam proved to be too high: in addition to producing a stronger respiratory depression, it had the effect of rendering cooperation with some patients more difficult.

Aged↗
PubMed1984

[Catheter peridural anesthesia with bupivacaine HCI and bupivacaine CO2. A comparison and the effects of premedication].

A controlled prospective randomized study was carried out to compare the action of 0.5% bupivacaine-CO2 and 0.5% bupivacaine-HCI both with and without diazepam premedication. Those patients given an epidural with 0.5% bupivacaine-CO2 and diazepam premedication showed both the briefest time to onset of action and the greatest degree of motor block. In contrast to the other three groups, none of these patients had missed segments. Despite the fact that no significant differences could be calculated, the difference in intensity of action observed in this investigation may well be of clinical relevance.

Aged↗
PubMed1983

[Premedication with flunitrazepam, lormetazepam or pethidine-promethazine. Psychometric study of subjective conditions].

In the course of a clinical study oral administration of two different diazepine derivatives as well as i.m. injection of pethidine and promethazine have been explored with a view to their anxiolytic, sedating and hypnotic action. The study involved 128 patients, randomized into four groups. Group 1 received flunitrazepam 1,5-2 mg p.o. only the evening before operation to group 2 flunitrazepam 1,5-2 p.o. was administered the evening before and the morning of the operation, group 3 were given lormetazepam 2-2,5 mg p.o. at the same time as group 2, in group 4 nitrazepam, 5 mg p.o. the evening before operation and pethidine, 50-100 mg combined with promethazine, 25 mg was given i.m. 60 min before surgery. In group 1 anxiolytic and sedating effect of flunitrazepam were not persistent enough to provide the patient with adequate premedication until the onset of surgery. Intensive sedation and fatigue as well as minimum recollection were observed under medication 2, however, increase in anxiety and depression as well as deterioration of mood were not prevented. Under medication 3 patients felt less exhausted and fatigued than under medication 2, but likewise anxiety and depression increased in the course of the operating day. Group 4 emerged as the last effective premedication both with regard to sleep during the previous night and the conditions of the day of the operation itself.

Adult↗
PubMed1984

Use of atropine in connection with oral midazolam premedication.

The clinical significance of intramuscular premedication with 0.01 mg/kg of atropine in a procedure involving oral benzodiazepine premedication (15 mg midazolam the evening before surgery and on the morning of surgery) was investigated in a double-blind study. As far as sedation, apprehension, excitement, dizziness, emesis, and headache were concerned, there were no significant differences between group 1 (atropine) and group 2 (placebo) patients; however, both during and after anesthesia patients in group 1 had less excessive salivary secretion (especially during extubation). As a result of sympathetic overactivity, patients in group 1 had an increased heart rate and an increased incidence of supraventricular tachycardia. In group 1 intravenous infusion proved more difficult, and in addition, the patients complained more of subjective side effects (dry mouth). There was no significant correlation between the radioimmunologically measured serum concentrations and the clinical effects of atropine measured just before the induction of anesthesia. Substantial interindividual differences were found in these serum levels. From the anesthetist's viewpoint, atropine has both beneficial effects (antisecretory) and unwanted effects (cardiovascular effects). For the patient atropine caused only subjective unwanted effects. Midazolam, a new short-acting, sedative benzodiazepine derivatives, can be used without atropine as an oral premedicant.

Administration, Oral↗
PubMed1981

The effects of oral diazepam premedication on blood gases.

Blood gas analysis was performed before and 1 h after 10 mg oral diazepam premedication on 50 adult male patients undergoing different surgical operations. There was a significant (p less than 0.01) decrease in arterial oxygen tension, a significant (p less than 0.01) increase in alveolar--arterial oxygen tension difference, and no significant change in arterial carbon dioxide tension or pH after administration of the drug. It is concluded that diazepam given by mouth 1 h before operation increases venous admixture. It is suggested therefore that oral diazepam premedication should be given cautiously to patients with impaired cardiorespiratory reserve, preferably without adding a narcotic drug.

Administration, Oral↗
PubMedDate not supplied

Evaluation of certain tranquillisers and sedative premedications on the safety index of volatile anaesthetics.

Safety index (S.I.) of ether, chloroform and halothane was determined in mice following premedication with chloral hydrate, phenobarbitone, diazepam and trifluoperazine given alone or in combination with atropine or hyoscine. The S.I. of ether was significantly raised by chloral hydrate and phenobarbitone when combined with atropine while trifluoperazine in combination with atropine or hyoscine lowered it. The S.I. of chloroform and halothane was raised by chloral hydrate, phenobarbitone and diazepam. The S.I. raising effects were augmented in chloroform anaesthesia and reduced in cases of halothane (except diazepam-hyoscine) when these premedications were combined with atropine or hyoscine.

Accident Prevention↗
PubMed1981

Nausea and vomiting after local anesthesia for cataract extraction in elderly female patients -- effect of droperidol premedication.

One hundred fifty elderly female patients undergoing cataract extraction were divided into three groups. Fifty patients were premedicated with droperidol, pethidine and atropine; another group of 50 patients with pethidine and atropine. They were operated on under local anesthesia. The control group consisted of 50 patients premedicated with pethidine and atropine, and they were given general anesthesia. Postoperative nausea and vomiting were registered until noon the next day. Comparison of different groups showed that droperidol decreases the occurrence of postoperative sickness.

Aged↗
PubMed1980

[EEG effects of premedication with thalamonal. a clinical study on 16 patients (author's transl)].

Changes of EEG and cEEG have been studied in two groups of patients (n=16) premedicated with 2 ml Thalamonal iv. (dosage: 5 mg droperidol; 0.1 mg fentanyl). Study group A consisted of patients, whose age ranged from 20 to 50 years, in study group B the patients' ages were avove 70 years. EEG and cEEG observation time was 15 min in general; in a few cases on hour. Changes in clinical behaviour were registered; blood pressure and pulse-rate measurements were taken at regular intervals. The base line electroencephalogram of twelve patients was unremarkable. Four elder patients of group B showed deviations from normal. Characteristic changes in the electroencephalogram after the tested premedication were: a decent accentuation and a light shifting to lower frequency of alpha-activity; in addition a light increase of delta-frequency. In good correlation to these findings were the clinical effects of sedation and light sleep. Light side effects in behaviour were seen in one patient. The tested disage of Thalamonal i.v. lowered the blood pressure particularly in younger patients.

Adult↗
PubMed1980

[The influence of the premedication on subjective postanaesthetic complaints in out-patients (author's transl)].

Outpatients, premedicated with atropine i.v. (n=54) or the combination droperidol-fentanylatropine (n=123) complain significantly less frequently about nausea and/or vomiting than patients receiving pentazocine-atropine (n=64). Patients receiving the combination droperidol-fentanyl-atropine are significantly more sleepy and dysphoric in the post-anesthetic period. We do not recommend any premedication in outpatients with the possible exception of atropine.

Ambulatory Care↗