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PubMed1976

[Experimentally induced heart muscle fiber necroses after premedication with strophanthin (author's transl)].

Number and degree of angiotensin-induced heart muscle necrosis in the rat (75 mg/kg body weight) are diminuished by premedication with strophanthin (2 X 10(-2) MG/KG BODY WEIGHT). The electron-microscopic findings are also changed: the application of angiotensin only results in vacuolization of mitochondria and a dilatation of theendoplasmatic reticulum while myofibrils are unaltered. Angiotensin in combination with strophanthin has a direct destructive effect on the myofibrils without evident changes of the mitochondria and tubular system of the heart. The protective action of Strophanithin on the heart muscle cell is discussed in the sense of an exonomization of the cellular metabolism under conditions of relative coronary insufficiency, induced by the vasoconstructive effect of angiotensin.

Angiotensin II↗
PubMed1990

Oral transmucosal fentanyl citrate for premedication in paediatric outpatients.

Two doses (10-15 micrograms.kg-1, Group I, and 15-20 micrograms.kg-1, Group II) of oral transmucosal fentanyl citrate (OTFC) plus a placebo (Group III) were evaluated for premedication in 105 healthy children, aged 2 to 13 yr, undergoing short (less than 1 hr) operations in the hospital short-stay unit. The study was randomized and double-blinded and 91 of the 105 children also received droperidol, 25 micrograms.kg-1 IV, after induction of anaesthesia with halothane and N2O in oxygen. Both doses of OTFC produced significantly greater sedation (first present at 20 min) and anxiolysis (first present in Group I at 40 min) than the placebo. Recovery times were similar in the three groups and analgesic requirements in the recovery room were significantly lower in Group I than Group III. Both OTFC groups took longer to tolerate oral fluids in the postoperative discharge unit than the placebo group and this caused patients in Group I to have a delayed discharge from the hospital compared to Group III. Preoperative pruritus occurred significantly more frequently in Groups I and II (58 and 76 per cent, respectively) than Group III (23 per cent). Although the incidences of nausea and vomiting tended to be slightly higher in the OTFC groups in the preoperative holding and postoperative discharge units, the differences among the groups were not statistically significant. Likewise droperidol did not reduce the incidence of postoperative nausea or vomiting. The data indicate that OTFC may be a safe and effective premedicant in paediatric patients having short operations but delays discharge from the hospital (by 30-50 min) by delaying the time patients tolerate fluids early after operation.

Administration, Oral↗
PubMed1976

Anticholinergic premedication.

Two hundred and forty-four surgical patients who received no anticholinergic premedication were compared with 160 patients who had received atropine or scopolamine before the induction of anaesthesia. Infants and patients undergoing heart surgery were excluded. Eleven anaesthetists participated in the study. They were asked to report problems with oropharyngeal and tracheobronchial secretions. Two per cent of unpremedicated patients experienced problems with secretions of a degree sufficient to require treatment. This small percentage appears insufficient to warrant routine preoperative anticholinergic medication.

Atropine↗
PubMed1977

A re-evaluation of anticholergic premedication.

One hundred and twenty healthy Nigerian female patients undergoing minor gynaecological operations were divided randomly into two groups. One group of 58 patients received intramuscular atropine as the only premedication on the ward while the other group of 62 patients received their atropine intravenously at the time of induction of anaesthesia. Anaesthesia was induced with thipentone and maintained with nitrous oxide, oxygen, and halothane using a facemask. There was equally satisfactory control of secretions in both groups. However, due to the occasional difficulties in achieving optimal timing of intramuscular atropine as well as the uncomfortably dry mouth complained of by 87.7 per cent of the patients who had intramuscular atropine, the intravenous administration at induction is to be preferred. Moreover, one saves the patient an extra injection.

Adult↗
PubMed1980

Cimetidine premedication in elective caesarean section.

A single intramuscular injection of Cimetidine was compared to oral antacid premedication in 17 patients undergoing elective Caesarean section. Seven patients in the Cimetidine group and four in the antacid group had gastric volumes in excess of 50 ml after induction of anaesthesia, while two patients in each group had gastric pH less than 2.5 after induction. Cimetidine was as effective as antacid in raising gastric pH but neither was completely reliable. This study reconfirms the high gastric volumes in pregnant patients with the need for preventative measures against aspiration during the induction of anaesthesia.

Adolescent↗
PubMed1993

Comparison between alprazolam and hydroxyzine for oral premedication.

The safety and efficacy of alprazolam and hydroxyzine administered orally as surgical premedicants were compared in a double-blind controlled study. Sixty-five patients were given either alprazolam 1 mg or hydroxyzine 75 mg, one to two hours before surgery. Anxiety was assessed by both the patient and the anaesthetist, the patient using a visual analogue scale, the anaesthetist employing both analogue and ordinal ratings. Sedation was assessed by the anaesthetist only, using the same two methods. Amnesia was appraised with a simple memory test. Safety was assessed by recording adverse effects and measuring haemodynamic variables. Premedication with alprazolam produced a modest reduction in anxiety (28%) (P < 0.01) while hydroxyzine had no detectable effect. The comparison of the sedation level and of the memory test revealed no difference between the two premedicants. Minor side effects were only observed in the hydroxyzine group. Changes in blood pressure were more pronounced in the hydroxyzine group. This study shows that alprazolam and hydroxyzine are safe and efficient oral premedicants. However, alprazolam is preferable to hydroxyzine in terms of anxiolytic and adverse effects.

Administration, Oral↗
PubMed1993

Oral clonidine premedication attenuates the haemodynamic effects associated with ketamine anaesthetic induction in humans.

Induction of anaesthesia is often associated with undesirable variations in blood pressure and heart rate. Clonidine has been demonstrated to attenuate many of these undesirable effects when used as a premedicant. Other alpha 2 adrenergic agonists have been used to ameliorate the cardiostimulatory effects of ketamine in animals but there are few data on the use of this combination in humans. The effect of oral clonidine premedication, 5 micrograms.kg-1 on the haemodynamic changes induced by i.v. ketamine was studied in 42 patients volunteers. Ninety minutes before surgery, patients randomly received clonidine (C), diazepam (D), or a placebo (P) in a double-blinded fashion. Anaesthesia was induced with a ketamine infusion of 1 mg.kg-1 x min-1 until loss of consciousness. Heart rate and phasic blood pressure were measured noninvasively prior to induction, before and up to seven minutes after tracheal intubation. There were no differences in demographics or baseline vital signs among the three groups. With ketamine administration, increases in heart rate and blood pressure were less in those patients given C preoperatively than in those who received either D or P. The peak increase in mean blood pressure was 39% (C) versus 70% (D) and 55% (P) (P < 0.01). Heart rate increased by a maximum of 20% (C) versus 41% (D) and 46% (P) (P < 0.01). We conclude that oral clonidine attenuates the hyperdynamic effects of anaesthetic induction with i.v. ketamine.

Administration, Oral↗
PubMed1998

Clonidine premedication modifies responses to adrenoceptor agonists and baroreflex sensitivity.

PURPOSE: To evaluate the effects of clonidine on responses to adrenoceptor agonists and baroreflex sensitivity, we examined arterial blood pressure (AP) responses to phenylephrine and heart rate (HR) responses to isoproterenol and baroreflex sensitivity (HR response to AP changes due to phenylephrine or nitroglycerin). METHODS: We studied 60 anaesthetized patients who either did or did not receive 5 micrograms.kg-1 clonidine po before they were anaesthetized. After induction of general anaesthesia, the patients received 3 micrograms.kg-1 phenylephrine, 0.02 microgram.kg-1 isoproterenol, or 2-3 micrograms.kg-1 nitroglycerin, and haemodynamic measurements were taken. Baroreflex sensitivity was expressed as the slope of the linear regression line (msec.mmHg-1; in msec of R-R interval change vs mmHg change in systolic arterial pressure) following the administration of phenylephrine and nitroglycerin. RESULTS: Patients who received clonidine had greater augmented responses in AP to phenylephrine and in HR to isoproterenol (47.2 +/- 15.6% vs 23.7 +/- 11.9% for increase in systolic AP and 59.8 +/- 22.6% vs 26.2 +/- 11.0% for increase in HR, P < 0.05 respectively). There were no differences between the baroreflex sensitivities in the pressor (phenylephrine) test groups (3.77 +/- 1.08 vs 4.41 +/- 1.66 msec.mmHg-1). In contrast, the slopes of depressor (nitroglycerin) test groups were decreased in patients receiving clonidine (1.98 +/- 0.73 vs 3.68 +/- 1.72 msec.mmHg-1, P < 0.05). CONCLUSION: The results suggest that premedication with clonidine might enhance critical hypotension during anaesthesia and surgery, but restoration both of AP and HR decrease can be achieved effectively by phenylephrine and isoproterenol i.v., respectively.

Adrenergic alpha-Agonists↗
PubMed1983

Cimetidine - antacid combination as premedication for elective Caesarean section.

The effect of premedication with an oral antacid (magnesium trisilicate), oral cimetidine or a combination of both was studied in 80 patients undergoing elective Caesarean section. Twenty patients served as untreated controls. Seventy per cent of the patients were in the high risk range for acid aspiration pneumonitis (pH less than 2.5 plus gastric content volume greater than 25 ml). Antacid therapy was effective in raising pH but the gastric volume remained high in 50 per cent of the patients. Cimetidine was effective in decreasing gastric volume and raising pH but the pH was still less than 2.5 in two patients. None of the patients given the cimetidine-antacid combination were in the high risk range for acid aspiration pneumonitis. The combination of an oral dose of cimetidine 400 mg, three to four hours before the operation followed by 20 ml of magnesium trisilicate one hour preoperatively proved to be the most efficacious regimen for prophylaxsis against Mendelson's syndrome in elective Caesarean section. Recent reports have suggested that non-particulate antacids (e.g., sodium citrate) may be preferable to particulate antacids such as magnesium trisilicate.

Adult↗
PubMed2000

Premedication with low dose oral clonidine does not enhance postoperative analgesia of intrathecal morphine.

PURPOSE: A number of studies have demonstrated that perioperative intravenous, intrathecal, and epidural clonidine enhance postoperative analgesia. The results of previous studies on the usefulness of oral clonidine on enhancing postoperative analgesia have been mixed. The effect of a single preoperative dose of oral clonidine on postoperative analgesia was assessed in this study. METHODS: Forty-three male patients undergoing radical prostectomy were randomized to receive either 3 microg x kg(-1) clonidine or placebo po 90 min prior to surgery. All patients received isobaric 15 mg bupivacaine and intrathecal 5 microg x kg morphine, followed by a standardized general anesthetic, consisting of thiopental, sufentanil, rocuronium, isoflurane, oxygen and air. Postoperatively, PCA morphine use and visual analogue pain scores were recorded for the first 48 hr. The incidence and severity of side effects such as sedation, nausea, and pruritus were assessed, as well as patient satisfaction. Usage of PCA morphine was compared. RESULTS: There was no difference in total morphine requirements between the placebo and oral clonidine groups, nor in six hourly morphine usage (P = 0.96). Second, there was no difference in visual analogue pain scores, or the incidence of side effects. Patient satisfaction was high in both groups and again, no differences between groups was noted. CONCLUSIONS: Oral clonidine 3 microg x kg(-1) as a premedication does not prolong the effect of intrathecal morphine: there was no difference in PCA morphine requirements (P = 0.96). Clonidine did not effect the incidence or severity of nausea or pruritus.

Administration, Oral↗
PubMed1991

Cardiovascular and endocrine effects of clonidine premedication in neurosurgical patients.

The present study was conducted to examine the haemodynamic and endocrine effects of clonidine, given as sole preanaesthetic medication, in neurosurgical patients. Nineteen patients of ASA physical status I and II, subjected to craniotomy, randomly received po premedication of either clonidine (300 micrograms, n = 9) or placebo (n = 10). Blood pressure and heart rate were monitored continuously, while arterial blood samples were collected at specific times, from induction of anaesthesia to recovery, for the measurement of plasma concentrations of epinephrine, norepinephrine, cortisol, aldosterone, and glucose. Clonidine treatment led to a decrease in mean arterial blood pressure (MABP), heart rate (HR), and plasma cortisol and aldosterone concentrations throughout the study, compared with placebo (P less than 0.05). Clonidine, however, did not prevent increases in MABP (16 +/- 5 mmHg, mean +/- SE, P less than 0.05) and HR (18 +/- 4 bpm, P less than 0.05) during induction of anaesthesia, which was comparable to the placebo group. Plasma catecholamine concentrations did not differ between the two groups. Plasma glucose concentrations increased in both groups at the end of the study (P less than 0.05), but were lower in clonidine-treated patients (P less than 0.05). Though statistically significant, the observed inhibitory haemodynamic and endocrine effects of clonidine seem to be of minor clinical importance. As the action of clonidine on cerebral blood flow regulation is not well known, we see no advantage in the preanaesthetic administration of clonidine to neurosurgical patients with normal cardiovascular status.

Administration, Oral↗
PubMed2005

Effect of flumazenil on recovery from sevoflurane anesthesia in children premedicated with oral midazolam before undergoing herniorrhaphy with or without caudal analgesia.

PURPOSE: Oral midazolam is frequently used to treat children, but its effect on recovery from anesthesia is controversial. This study was designed to evaluate the effect of flumazenil on reversal of midazolam during recovery from sevoflurane-induced anesthesia in children who underwent caudal analgesia compared to those who did not. METHODS: A series of 60 children 1-8 years of age, with an American Society of Anesthesiologists (ASA) physical status of 1 or 2, who were scheduled to undergo herniorrhaphy were randomly assigned to one of four groups: group 1, control/placebo; group 2, control/flumazenil; group 3, caudal/placebo; group 4, caudal/flumazenil. After oral administration of midazolam 0.5 mg x kg(-1), anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen via a face mask with spontaneous ventilation. The time from the discontinuation of anesthetics to emergence was recorded, and at the time of discharge from the operating room each patient's recovery characteristics were assessed using a three-point scale. RESULTS: Emergence from anesthesia was significantly less agitated in the group of children who underwent caudal analgesia without flumazenil compared to the other three groups. Flumazenil shortened the time to emergence regardless of the application of caudal analgesia, and caudal analgesia delayed the time to emergence regardless of flumazenil administration. CONCLUSION: Caudal analgesia and avoiding the use of flumazenil synergistically resulted in the emergence from anesthesia in a less agitated state for children who underwent herniorrhaphy after oral midazolam premedication.

Anesthesia Recovery Period↗
PubMed2001

Clonidine premedication prevents sympathetic hyperactivity but does not prevent hypothalamo-pituitary-adrenocortical responses in patients undergoing laparoscopic cholecystectomy.

PURPOSE: The effects of oral administration of clonidine on sympathetic and endocrinological responses were investigated in patients undergoing elective laparoscopic cholecystectomy. METHODS: Twenty adult patients were allocated randomly to the clonidine group (n = 10) or the control group (n = 10). The control and clonidine groups received placebo on clonidine 4 microg.kg(-1) orally 2 h before the induction of anesthesia. All patients underwent laparoscopic cholecystectomy under isoflurane anesthesia. The hemodynamic variables were observed perioperatively. Plasma concentrations of cortisol, ACTH, noradrenaline, adrenaline, and dopamine were determined before administration of clonidine or placebo, 2 h after the beginning of the operation, and 3 h after the end of the operation. RESULTS: Systolic and diastolic blood pressures were lower in the clonidine group than in the control group immediately after endotracheal intubation and extubation (P < 0.05). Patients in the clonidine group showed lower plasma concentrations of noradrenaline 2 h after the beginning of the operation than patients in the control group (P < 0.01). However, the plasma concentrations of the other hormones did not differ between groups. CONCLUSION: Clonidine premedication prevents sympathetic hyperactivity but does not suppress hypothalamo-pituitary-adrenocortical responses in patients undergoing laparoscopic cholecystectomy.

Clinical Trial↗
PubMed1991

Rectal ketamine and midazolam for premedication in pediatric dentistry.

Rectally administered midazolam (0.30 mg/kg) and ketamine (5 mg/kg) were compared for preanesthetic medication in children undergoing dental extractions. Sixty patients between the ages 2 and 9 years were randomly allocated to three groups in this double-blind study. In one group of patients who received ketamine rectally, intravenous midazolam (0.05 mg/kg) also was administered immediately after induction of anesthesia. The results from this trial show that 30 minutes after rectal administration of the two drugs, good anxiolysis, sedation, and cooperation were obtained in most patients. Although midazolam appeared to be marginally more efficacious than ketamine in the majority of assessments made and seemed to have less adverse effects, no statistically significant differences could be shown. Ketamine showed a slight decrease and midazolam a slight increase in average blood pressures after premedication. These blood pressure differences were, however, considered to be of little clinical importance.

Administration, Rectal↗
PubMed1996

Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients.

STUDY OBJECTIVE: To examine how premedication with clonidine affects opioid use, hemodynamic effects, hormonal responses, and recovery effects. DESIGN: Double blind, placebo-controlled study. SETTING: Operating room and surgical intensive care unit of a university medical center. PATIENTS: 54 patients undergoing elective coronary artery bypass graft (CABG) surgery. INTERVENTIONS: Patients received approximately 5 micrograms/kg of oral clonidine or a placebo together with 40 micrograms/kg lorazepam 90 minutes prior to titrated sufentanil induction of anesthesia. Thirty minutes prior to cardiopulmonary bypass, a second dose of either approximately 5 micrograms/kg clonidine or placebo was given as a slurry via a nasogastric tube. MEASUREMENTS AND MAIN RESULTS: Opioid use, hemodynamic effects, hormonal responses, and recovery effects were recorded. Values for ten hemodynamic variables were compiled on the evening prior to surgery, prior to induction, and during seven additional events and compared. Catecholamines and beta-endorphins were measured prior to induction, after intubation, and after sternotomy. The amount of sufentanil used for induction, maintenance, and total opioid were compared. The times to awakening and response to verbal commands were compared. The two groups exhibited similar patient demographics, cardiopulmonary bypass time, and duration of surgery. Patients receiving clonidine required significantly (p < 0.04) less sufentanil for induction (clonidine: 2.19 +/- 0.95 micrograms/kg vs. placebo: 2.93 +/- 1.07 micrograms/kg) and total amount of sufentanil (clonidine: 9.1 +/- 3.9 micrograms/kg vs. placebo: 11.7 +/- 4.6 micrograms/kg). Patients receiving clonidine required significantly (p < 0.01) less isoflurane (9.7 +/- 6.8 MAC min vs. 19.7 +/- 9.9 MAC min) to maintain heart rate (HR) and mean arterial pressure (MAP) to within 15% of baseline without significant differences in other vasoactive drugs. Catecholamine concentrations were significantly (p < 0.02) lower in patients receiving clonidine without any difference in beta-endorphin concentrations. Patients receiving clonidine had significantly (p < 0.02) lower HR, systolic arterial pressure, MAP, and systemic vascular resistance prior to induction than patients receiving placebo without differences in other hemodynamic variables. CONCLUSION: Clonidine decreases opioid use and lowers hormonal response while maintaining stable hemodynamics in patients undergoing CABG with sufentanil anesthesia.

Adrenergic alpha-Agonists↗
PubMed1993

Clonidine premedication for coronary artery bypass grafting under high-dose alfentanil anesthesia: intraoperative and postoperative hemodynamic study.

The purpose of this study was to assess the efficacy of clonidine in achieving perioperative hemodynamic stability in patients undergoing coronary artery bypass grafting performed under high-dose alfentanil anesthesia. Twenty-four patients with left ventricular ejection fraction greater than 0.5 were prospectively studied in a double-blind manner; those requiring emergency procedures were excluded. They were randomized to receive either oral clonidine or placebo together with their premedication. Induction of anesthesia was achieved with 10 mg of alfentanil infused over 5 minutes followed by a continuous infusion of 60 mg/h during 1 hour, or until sternotomy, and then 30 mg/h until the end of surgery. Hemodynamic responses to noxious stimuli were treated with additional alfentanil boluses and isoflurane when these were unsuccessful. Intraoperative hemodynamic profile analyses showed a continuous increase in systemic vascular resistance and mean arterial pressure in the clonidine group from the time of skin incision until the onset of bypass, whereas the cardiac output profiles remained similar in the two groups. The number of additional alfentanil boluses was similar. Isoflurane requirements (1/11 v 4/13) were not significantly different, but only a few patients required this therapy. The postbypass hemodynamic profiles were similar. Severe hemodynamic impairment occurred in the clonidine group during warming in the postoperative period: this group showed a drop in systemic vascular resistance index (1276 +/- 347 v 1757 +/- 415 dyn.sec.cm-5.m2) that could not be compensated for by an increase in cardiac output despite normal filling pressures, causing hypotension (66 +/- 10 v 79 +/- 16 mmHg). This hemodynamic status led to greater requirements for vasoactive agents and inotropics in this group.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗
PubMed2006

The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth.

The purpose of this study was to elucidate whether premedication therapy with acetaminophen-codeine or ibuprofen is able to increase the depth of anesthesia in inflamed teeth. Sixty patients with the diagnosis of irreversible pulpitis in 1 mandibular tooth requiring root canal therapy (RCT) were selected. Two other teeth in the same quadrant were selected as controls. An electric pulp tester (EPT) was used to evaluate pulp sensitivity at the baseline and after drug administration and anesthesia injection. The subjects were divided into 3 groups randomly, and in each group 1 of the 3 drugs including acetaminophen-codeine, ibuprofen, and placebo were administered 1 hour before anesthesia delivery. After 1 hour, anesthesia was injected and after a waiting period, the EPT measurement was recorded. The reversed EPT scale was used to evaluate the depth of anesthesia achieved during RCT. Data were analyzed to statistically compare the results before and after intervention in cases and controls of each group and among different groups. Significanly lower tooth sensitivity levels (TSLs) were observed after intervention in acetaminophen-codeine and ibuprofen groups, which was more significant in the ibuprofen group. The comparison of inflamed teeth TSLs in the acetaminophen-codeine group and the placebo group after anesthesia and drug administration showed significant differences (P = .001). This comparison between ibuprofen and placebo groups also showed significant differences (P approximately 0). Also, significantly lower TSL of inflamed teeth was observed in the ibuprofen group in comparison with the acetaminophen-codeine group (P = .002). This study reflected preoperative administration of ibuprofen, if not contraindicated, as a drug of choice 1 hour before local anesthesia injection as an effective method for achieving a deep anesthesia during RCT of teeth with irreversible pulpitis.

Acetaminophen↗
PubMed1996

Comparison of intranasal midazolam and sufentanil premedication in pediatric outpatients.

BACKGROUND: Intranasally administered midazolam was compared with sufentanil as a premedicant for 60 patients, aged 1/2 to 6 years, undergoing outpatient surgery of 2 hours or less. METHODS: Thirty minutes before anesthetic induction (halothane in 50% nitrous oxide/oxygen), patients were randomly assigned to receive either intranasal midazolam (0.2 mg/kg) or sufentanil (2 microg/kg). A "blinded" observer evaluated preoperative emotional state, response to premedication, induction, and emergence from anesthesia and side effects. RESULTS: Children who had not previously cried were more likely to cry when midazolam was administered compared with sufentanil (71% versus 20%, p = 0.0031). Of 31 midazolam patients, 20 experienced nasal irritation. Approximately 15 to 20 minutes after drug administration, most patients in both groups could be comfortably separated from their parents. The sufentanil group appeared to be more sedated and more cooperative during induction of anesthesia. Vital signs and oxygen saturation did not change significantly with either medication before or after surgery, although two sufentanil patients had a moderate reduction in ventilatory compliance after anesthetic induction. Sufentanil was associated with more nausea and vomiting than midazolam (34% versus 6%, p < 0.02). CONCLUSION: Both intranasal midazolam and sufentanil provide rapid, safe, and effective sedation in small children before anesthesia for ambulatory surgery. Sufentanil provided somewhat better conditions for induction and emergence. Midazolam causes more nasal irritation during instillation, and sufentanil causes more postoperative nausea and vomiting. Both drugs enabled patients to be separated from their parents with a minimum of distress. Patients in the midazolam group were discharged approximately 40 minutes earlier (p <0.005).

Adjuvants, Anesthesia↗