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At least 613 records · Page 34Linked to original sources
PubMed1995

Safety and effectiveness of an oral premedication regimen before cardiac surgery.

Thirty-five adult cardiac surgical patients received 20 mg dipotassium clorazepate orally the evening before surgery and 2 mg flunitrazepam 60 min before induction of anaesthesia. If anaesthesia was to be induced after 08.30 hours patients received an additional 20 mg dipotassium clorazepate at 06.15 hours. The following measurements were made: peripheral arterial oxygen saturation (Spo2) breathing room air; anxiety by visual analogue scale; degree of sedation; and haemodynamic variables. Mean (Spo2) was 95.9% (SD 1.8%) on the day before surgery and 95.4% (SD 1.5%) on arrival at the operating room. When the operation started after 08.30 hours, mean (Spo2) at 09.00 hours was 96.0% (SD 1.4%). There were no detected episodes of hypoxaemia after premedication. Mean anxiety score decreased significantly from 3.9 (SD 2.6) on the day before surgery to 3.3 (SD 2.1) on arrival at the operating room (patients' score; P < 0.002) and from 4.6 (SD 2.4) to 3.3 (SD 2.0) (anaesthesiologists' score; P < 0.001). Nearly all patients were considered well sedated, which was reflected by normal haemodynamic variables on arrival at the operating room. The combination of clorazepate and flunitrazepam is effective oral premedication for adult cardiac surgery, causing no obvious desaturation even when supplemental oxygen is not given.

Administration, Oral↗
PubMedDate not supplied

[Intramuscular and oral clonidine in premedication of the heart surgery patient: hemodynamic effects and interaction with high-dose fentanyl induction].

OBJECTIVE: The aim of the study was to evaluate the efficacy of oral and i.m. clonidine as premedication in reducing the requirements of fentanyl for induction and to analyze its effects on the hemodynamics of patients with ischemic heart disease. SETTING: University Hospital. MATERIALS AND METHODS: The authors considered 30 patients (27 male and 3 female) undergoing CABG. Patients were premedicated 60-90 min before induction of anesthesia and were randomly distributed in three groups: Group A: oral diazepam 0.1 mg x kg -1; Group B: oral diazepam 0.1 mg x k-1 + oral clonidine 5 micrograms x kg-1; Group C: oral oral diazepam 0.1 mg kg-1 + i.m. clonidine 4 micrograms x kg-1. Induction of anesthesia was realized with fentanyl at speed of 500 mcg x min-1 until loss of consciousness was reached (no answer to three consecutive questions). MEASUREMENT: Hemodynamic data were recorded at TO(baseline), T1(induction of anesthesia), T2(3 min after intubation), T3(3 min. after skin incision). Results were analyzed by utilizing the average comparison Student "t" test and paired "t" test. A value of p < 0.05 was regarded as statistically significant. MAIN RESULTS: In groups B and C the inductive dose of fentanyl was much lower (p < 0.001) compared to control group (B = 19.23 +/- 3.57 micrograms x kg-1; C = 19.92 +/- 4.15 micrograms x kg-1; A = 28.39 +/- 6.4 micrograms x kg-1). This difference remained statistically significant (p < 0.001) also at T2 and T3 (T1: A = 42.79 +/- 3.21 mcg x kg-1; B = 29.07 +/- 6.18 micrograms x kg-1; C = 29.84 +/- 5.46 micrograms x kg-1; T2: A = 57.28 +/- 5.32 micrograms x kg-1; B = 43.22 +/- 3.87 micrograms x kg-1; C = 43.48 +/- 4.25 micrograms x kg-1). Considering the hemodynamic data, we report the heart rate in group B increased at T2 (p < 0.01), and systolic artery pressure raised in groups A (p < 0.05) and C (p < 0.01) at T2. Compared to baseline cardiac index showed a decrement at T3 in all groups of patients (p < 0.05). Systemic vascular resistance increased in all groups at T3 compared to baseline (p < 0.05). CONCLUSIONS: Clonidine proved to be useful to reduce narcotic requirements and to provide hemodynamic stability.

Administration, Oral↗
PubMed1994

[Evaluation of midazolam premedication for preoperative anxiolysis].

To evaluate the anxiolysis property of midazolam, 60 patients undergoing minor gynecological surgery were given midazolam 0 mg (n = 20), 2.5 mg (n = 20) or 4 mg (n = 20) intramuscularly as premedication 1 h before their entrance to operating theater. The degree of anxiety was evaluated objectively using the State-Trait Anxiety Inventory (STAI). STAI test was performed twice: on the day before operation and 1 h after receiving preanesthetic premedication. In only midazolam 4 mg group, anxiety was reduced significantly in the operating room compared to the day before operation. It is concluded that midazolam (4 mg) is suitable to reduce the preoperative anxiety in patients who are to undergo minor gynecological surgery.

Adolescent↗
PubMed1975

[Premedication with doxepin (author's transl)].

The effects of doxepin on the circulation and its anxiety relieving properties were studied in 67 patients who were premedicated with this drug before surgical operations. The findings showed that doxepin is very suitable for premedication on account of its sedative, tranquilizing and analgesic properties. It also reduced secretion of mucus and saliva. In a few cases it caused mild orthostatic circulatory dysregulation. The drug was well tolerated and has proved its value for routine administration.

Adult↗
PubMedDate not supplied

[Premedication with clonidine in the neurosurgical patient: sedation, anesthetic requirements and hemodynamic perfusion].

OBJECTIVES: To analyze the effect of premedication with clonidine on postoperative sedation, anesthetic requirements and hemodynamic repercussions in patients undergoing craniotomy due to supratentorial intracranial pathology. PATIENTS AND METHODS: Twenty ASA I/II patients in a double-blind prospective study were assigned randomly to receive lorazepam (0.03 mg/kg/po, n = 10) or clonidine (0.005 mg/kg/po, n = 10) the night before and 90 minutes before surgery. Arterial pressure and heart rate were monitored continuously during and immediately after surgery (first 24 hours). Anesthetic induction was achieved with thiopental (maximum 6 mg/kg) and maintained with O2/N2O and an infusion of alfentanyl (1 microgram/kg/min). Hemodynamic response to surgical stimulus was treated with additional boluses of alfentanyl up to a maximum dose of 0.1 mg/kg and with an increase in infusion dosage to 2 micrograms/kg/min. When these were ineffective, isoflurane was given. All patients were extubated in the operating room. RESULTS: No differences in level of sedation were found between the two groups. The infusion dose and total amount of alfentanyl given were smaller for patients treated with clonidine (0.8 +/- 0.04 vs 0.6 +/- 0.01 microgram/kg/min and 22.4 +/- 5.3 vs 17.5 +/- 4.9 mg, respectively) (p < 0.05). No differences were found in isoflurane requirements (5/5 vs 2/8). Mean arterial pressure and heart rate were lower with clonidine from 3 minutes after intubation until the patient's arrival in the recovery room (p < 0.05), with marked bradycardia (49 +/- 5 vs 73 +/- 7 bpm) (p < 0.05) upon intubation. CONCLUSIONS: Premedication of neurosurgical patients with clonidine offers no advantages over lorazepam with respect to sedation. Nevertheless, clonidine may offer advantages with respect to the amount of alfentanyl required and attenuation of perioperative adrenergic response.

Adult↗
PubMed1994

[Effects of inhaled furosemide after indomethacin premedication on bronchial hyperresponsiveness in patients with chronic congestive heart failure].

We studied the effects of inhaled furosemide (40 mg) on bronchial responsiveness to acetylcholine (ACh) in patients with chronic congestive heart failure who had been premedicated with indomethacin (75 mg/day) for five days. The measurement of bronchial responsiveness was performed by inhaling doses of ACh and calculating the provocative concentration of ACh needed to cause a 20% fall in FEV1.0 (PC20-ACh). Inhaled furosemide (N = 11) had no effect on resting pulmonary function but did cause a significant increase in the median value of PC20-ACh, from 7.58 to 11.9 mg/ml (p < 0.01). Irrespective of premedication with indomethacin, inhaled furosemide reduces bronchial hyperresponsiveness to ACh in patients with chronic congestive heart failure. Therefore, we speculate that the mechanism of bronchial hyperresponsiveness noticed in our patients is not related to prostaglandins such as PGE2 or PGI2.

Administration, Inhalation↗
PubMed1994

[Trazodone versus flunitrazepam in premedication in day-care surgery].

A prospective single-blind study was conducted to compare flunitrazepam vs trazodone in the premedication of patients undergoing day-case surgery for termination of pregnancy, with particular regard to the degree of preoperative sedation, intraoperative analgesia and postoperative recovery. 86 patients were randomly allocated to receive orally 45 minutes before the surgical procedure either flunitrazepam 2 mg (group F) or trazodone 50 mg (group T). In both groups anaesthesia was achieved by i.v. fentanyl 2.5 micrograms/kg and ketamina 250 micrograms/kg. Patients in group F showed a deeper degree of preoperative sedation. There were no significant differences in intraoperative analgesia and in the immediate arousal time. In the postoperative period, the incidences of emetic symptoms and dizziness were similar in both groups; the incidence of drowsiness was significantly higher in group F at 120 minutes but not at 180 minutes of observation. Psychomotor performance was assessed preoperatively two days before the surgical procedure and 60, 120 and 180 minutes after surgery, using the Toulouse-Pieron test and the reaction time to a luminous stimulus with the aid of a computerized analogic tachystoscope (Neurometer). Trazodone allowed a more rapid recovery of psychomotor performance and it can represent a valid alternative to the use of benzodiazepines in the premedication of day-case surgical patients.

Abortion, Induced↗
PubMed1993

[Delayed hypersensitivity and the primary antibody reaction after administration of infectious bovine rhinotracheitis inactivated oil vaccine to calves premedicated with glucan].

The level of delayed skin hypersensitivity (DSH) to DNFB and of the primary immune reaction was evaluated in the calves immunized with an inactivated oil IBR vaccine (V group) and in the calves premedicated with glucan (seven days before vaccine administration) and subsequently immunized with the mentioned vaccine (GV group). The DSH test did not reveal an alteration of cellular immunological reactivity in the calves immunized with an inactivated oil IBR vaccine; after the vaccine administration there was no significant difference in the DSH level from the value before vaccine administration nor in comparison with the value of control calves (K group), Tab. I. But in the immunized calves which were glucan-premedicated (from Pleurotus ostreatus; 10 mg/kg l.w.) a significantly higher DSH level was determined not only in comparison with the initial value (P < 0.05) before glucan administration but also with the value of control calves (P < 0.05), Tab. I. The categorization of calves according to the DSH level also points to the immunomodulating effect of glucan in this sense (Fig. 1); while the value of skin test ranged from 3.6 to 6.5 mm in the highest percentage of the calves of V and K groups on the dates before and after administration of the mentioned preparations, a marked increase (on the date after administration) in the number of calves (from 22 to 67%) with the value of skin test higher than 6.5 mm was observed in the calves of GV group. The vaccine administration in itself (V group) did not induce the production of measurable amounts of serum IBR antibodies till day 14 after immunization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvants, Immunologic↗
PubMedDate not supplied

Pharmacodynamics and pharmacokinetics of psycholeptic drugs in the course of radiation disease. The effect of premedication with cystamine on pharmacodynamics and Pharmacokinetics of nitrazepam.

Pharmacodynamics and pharmacokinetics of psycholeptic drugs in the course of radiation disease (I). Effect of premedication with cystamine on pharmacodynamics and pharmacokinetics of nitrazepam. Acta Physiol. Pol. 1977, 28 (2): 161--168. In the experiments carried out on rats the radiation disease was evoked by exposure to 600 R. The strongest radioprotective action of cystamine was found on the 3-rd day of radiation disease. The tendency to normalization of both the pharmacodynamics (exploring mobility and anticonvulsant action) and pharmacokinetics of nitrazepam in the animals premedicated with cystamine was described.

Animals↗
PubMed1997

[Patient preparation and premedication--legal aspects].

The legal demands concerning the methods of treatment required of an anaesthetist are determined by the quality of the specialist and the professional standard. As long as there is no premedication procedure which is generally considered superior to all others, the anaesthetist can freely choose the procedure, while carefully considering benefits and risks on the basis of the individual circumstances of each case. The patient must be informed about the anaesthesia before premedication since the latter inhibits his/her ability to make decisions.

Humans↗
PubMed1996

An evaluation of the effect of oral ketamine and standard oral premedication in the sedation of paediatric dental patients.

We compared the effectiveness of ketamine with standard oral premedication (SOP) in 60 children, 2-7 years of age, sedated orally for dental treatment under local anaesthesia. Children were assigned randomly to receive either 12.5 mg/kg ketamine or 0.5 ml/kg of SOP orally 60 min before the dental procedure. Pulse rate, systolic, diastolic and mean arterial pressures, respiratory rates and blood oxygen saturation were recorded prior to drug administration, 60 min thereafter and immediately before the dental procedure. Anxiety levels were measured at the same time intervals. The level of sedation was measured 60 min after drug administration. No significant differences were found in the anxiety levels between the groups 60 min after oral administration. The level of sedation in both groups before surgery was excellent. Operator evaluation for overall effectiveness of treatment showed that sedation was very good in 60 per cent of children in the ketamine group compared with 20 per cent in the SOP group. More children in the ketamine group were better sedated (p < 0.05). Both premedicants produce good sedation and anxiolysis 60 min after premedication and immediately before the surgical procedure.

Administration, Oral↗
PubMed1998

[Nasal ketamine compared with nasal midazolam in premedication in pediatrics].

OBJECTIVE: To compare the efficacy and side effects of midazolam and ketamine administered nasally for pediatric premedication. PATIENTS AND METHODS: In this double blind trial 60 children scheduled for elective surgery were randomly assigned to two groups to receive 0.25 mg.kg or 5 mg.kg nasal ketamine. We measured level of acceptance of medication, sedation, hemodynamic variables, reaction to separation from parents, side effects and time until recovery from anesthesia. RESULTS: The two groups were homogeneous. Acceptance of medication was good or adequate in all patients. The level of sedation was significant in both groups 10 min after premedication. Systolic arterial pressure was higher in the ketamine group 20 min after administration of the drug and upon arrival in the operating theater. Reaction to separation from parents was good in all groups. Secretions were higher in the ketamine group and hallucinations were experienced by three patients in the ketamine group and by two in the midazolam group. We found no difference in time until spontaneous eye opening after surgery. No complications were observed. CONCLUSIONS: The nasal route is adequately accepted by children. Both drugs are effective by this route and sedation is rapid. Time until postanesthetic recovery is similar with both drugs. The doses used have wide safety margins.

Adjuvants, Anesthesia↗
PubMed1998

[Oral premedication with clonidine as an alternative in dental practice. The effects on the pain threshold, blood pressure and salivary flow].

BACKGROUND: Clonidine, an alpha 2-adrenoceptor agonist, has been recently shown to be effective in conscious sedation because of its analgesic and sedative properties, having also proven to be active in reducing neuroendocrine responses to stressful stimuli perioperatively. The current study was designed to investigate the efficacy of 150 micrograms oral clonidine as a premedicant in dentistry. METHODS: In a prospective, randomized, double-blind controlled clinical trial, 40 patients, aged 16-64 yr, undergoing conservative, or prosthetic, or dental surgery procedures, received placebo (n = 20) or 150 micrograms of oral clonidine (n = 20) 90 min before the estimated time of induction of local anesthesia. A blinded observer recorded: salivary flow, systolic and diastolic blood pressure each 30 min lasting 2-3 hours, as well as the degree of pain and sedation intra and postoperatively. RESULTS: Clonidine produced significant salivary flow reduction (p < 0.001) and sedation (p < 0.001) as well as significant difference in postoperative pain scores (p < 0.05) compared to placebo. Xerostomia persisted postoperatively in clonidine premedicated patients as compared to those given the placebo (p < 0.01). Systolic blood pressure decreased significantly only after 120 (p < 0.01) and 150 min (p < 0.001) following clonidine pretreatment, but none of the patients were treated for hypotension. 55% of the clonidine treated patients positively evaluated the experience. CONCLUSIONS: These results suggest that a dose of 150 micrograms of clonidine, given orally 90 min preoperatively, is an effective premedication in dentistry, without causing excessive haemodynamic depression and sedation, and moreover confirm that the oral route of administration is very well accepted.

Administration, Oral↗
PubMed1986

BioPrep. A premedical program for rural high school students.

To address physician maldistribution in Alabama and the Southeast region. The University of Alabama established the Biomedical Sciences Preparation Program (BioPrep) in five rural high schools. Its purpose is to help rural, disadvantaged high school students develop academically and socially so that they will be motivated and able to enroll in and progress successfully through college, specifically in pre-health professional curricula. It aims to develop their desire to return eventually to rural areas of Alabama as professionals. Project students are compared with two control groups. Performance on the American College Testing Program college entrance examination revealed significantly higher achievement by the project students. The project students also chose professional careers earlier and more frequently than matched high school students not receiving this special program, but similar to medical students and premedical students. The implications of the project for increasing the size of the rural, disadvantaged student applicant pool are discussed.

Alabama↗
PubMed1991

Midazolam premedication for pediatric bone marrow aspiration and lumbar puncture.

The ability of midazolam, a benzodiazepine, to reduce the distress associated with lumbar puncture and bone marrow aspiration was examined in 23 children with acute lymphocytic leukemia. Patients were randomized to receive 0.2 mg/kg midazolam HCl or placebo intravenously 3-5 min before the procedures, under double-blind conditions. Based on prior experiences, children in both groups anticipated severe pain from these procedures. Postprocedure pain ratings by patients were markedly reduced in the midazolam but not the placebo group. Both physicians and parents judged the midazolam group as significantly less distressed than controls during and after the procedures. Trained observers recorded significantly fewer pain- and anxiety-related behaviors in the midazolam group immediately before and after, but not during the procedures. The amnestic effects of midazolam, confirmed in a visual recall/recognition test, appear to account for the decreased pain ratings since the behavioral manifestations were similar in the two groups. There were no adverse drug reactions or significant changes in vital signs. Midazolam warrants further investigation as a premedication for painful diagnostic and treatment procedures in children with cancer.

Adolescent↗
PubMed1987

Haemodynamic and blood gas changes in buffaloes (Bubalus bubalis) in the supine position following thiopentone anaesthesia with premedication.

Studies were undertaken on seven adult female buffaloes (Bubalus bubalis) premedicated with triflupromazine hydrochloride (0.3 mg/kg) and chloral hydrate (30 mg/kg). Anaesthesia was induced with thiopentone sodium (10 mg/kg) and animals were kept under intermittent positive pressure ventilation. Measurements were made for 30 min in the lateral position, for 20 min in the supine position and subsequently for 40 min again in the lateral position. Regurgitation during anaesthesia was avoided by evacuation of the rumen by rumenotomy two days prior to the experiment. When animals were in the lateral position there were minimal changes in arterial pressure and heart rate but central venous pressure rose. These changes were related to intermittent positive pressure ventilation. In the supine position, increase in heart rate (28%) was associated with profound hypotension (56%) and decrease in central venous pressure (171%) in these animals. There was a fall in venous oxygen tension and a marked increase (91%) in oxygen extraction ratio. Restoration to the lateral position ameliorated all these changes rapidly. It was suggested that a 'low pressure-low flow' circulatory state exists in anaesthetised adult buffaloes in the supine position.

Anesthesia↗
PubMed1982

A comparison of diazepam and phenoperidine in premedication for upper gastrointestinal endoscopy: a randomized double blind controlled study.

A variety of agents are used as premedication for upper gastrointestinal endoscopy (U.G.E.). To our knowledge, no double blind studies have been performed to compare their value. In this study phenoperidine (2 mg i.v.) was compared with diazepam (t mg i.v.) in 200 consecutive patients undergoing elective U.G.E. The study was randomized and double blind in regard to both endoscopists and patients. All patients were given atropine (0.4 mg i.v.) and a throat spray with 2% amethocaine. Patients who needed supplemental medication were given diazepam and excluded from final analysis. A graded questionnaire was recorded by endoscopists and patients after U.G.E., and a further anonymous questionnaire was returned by patients four days later. Statistical analysis revealed that phenoperidine was superior at facilitating intubation and providing more relaxation as judged by the endoscopist. Patient questionnaires, four days after U.G.E., indicated less distress during intubation and examination with phenoperidine. Nausea, vomiting, amnesia and phlebitis were uncommon after either phenoperidine or diazepam.

Clinical Trials as Topic↗
PubMed1982

Ventricular fluid pressure in neurosurgical patients receiving intravenous lorazepam for premedication.

The effect of 0.05 and 0.03 mg/kg of intravenously administered lorazepam on the ventricular fluid pressure (VFP) was recorded continuously for 45-90 minutes in 13 wakeful spontaneously breathing unanaesthetized patients with hydrocephalus. The initial VFP was low in 11 patients with low-pressure hydrocephalus, and at the upper level of normal in 2 who had stenosis of the aqueduct. Lorazepam caused minute changes in VFP. The largest transient increased (7 and 16 torr) occurred in the two patients with the highest initial VFP. Blood acid-base balance, blood pressure, and heart rate remained unaltered. However, lorazepam caused such drowsiness that it was difficult to check the patients' level of consciousness. For this reason, intravenously administered lorazepam in a dosage of 0.03 mg/kg or more seems unsuitable for premedication in neurosurgical patients with brain disease.

Adult↗