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PubMed2001

Premedication and parental presence revisited.

Up to 60% of all children undergoing anesthesia and surgery experience significant anxiety and distress during the perioperative period. Currently, both behavioral interventions such as parental presence during induction of anesthesia and pharmacological interventions such as sedative premedication are used to treat this clinical phenomenon. In this review, we examine the effectiveness of these interventions on clinically relevant perioperative outcomes.

Journal Article↗
PubMed2001

Origins of modern premedical education.

The author reviews the contributions of those individuals and major academic and professional organizations responsible for the development of the modern concepts of the premedical education of a physician. The late 19th century gave rise to scientifically-based medical education in U.S. medical education. It followed that this new emphasis, in medical schools, on laboratory investigation of disease processes demanded a sound introduction to the natural sciences by those who would be candidates for this type of challenging education. Starting with a vocal few, the message gradually was received throughout the country that a properly schooled physician must have the equivalent of a broad baccalaureate education in the natural sciences as well as in the traditional humanities. This essential was recognized by a small nucleus of individuals responsible for the creation of The Johns Hopkins University in 1876 and its school of medicine in 1893; the group was led by the university's first president, Daniel Coit GILMAN: Almost simultaneously other established academic institutions incorporated similar changes and a new era began.

Curriculum↗
PubMed2003

The Biomedical Humanities program: merging humanities and science in a premedical curriculum at Hiram College.

The Biomedical Humanities program at Hiram College, established in 1999, engages premedical and other qualified students in ethical and informed decision making, improves their ability to interact with persons of different backgrounds and cultures, provides them an active introduction to basic medical research and clinical practice, and coaches them in communicating across barriers, appreciating that scientists and humanists typically learn and work differently. The program offers both a major and a minor in biomedical humanities topics. The major requires the core biology and chemistry curriculum necessary for further studies in medicine as well as courses in genetics and statistics. The remainder of the major is devoted to four core areas: Communications, Relationships and Cultural Sensitivity, Ethics and Medical Humanities, and a nonacademic core area, Experiential Learning. Many of the ethics and medical humanities options are team-taught interdisciplinary courses. The Experiential Learning area requires students to take two special topics seminars, two service seminars, and two internships-one shadowing a professional in his or her area of interest and one engaging in basic biomedical research. The shadowing internship and service seminars focus not only on career exploration, but also on human interactions. Students reflect on the personal interactions they observe during their various experiences, and on their own strengths and weaknesses. Essays, designed to help students learn more about their roles in these settings, push them to deal with the sociopolitical issues involved in their service. The major, a robust and vital component of Hiram's undergraduate program, has attracted academically gifted students with a diverse array of career goals.

Bioethics↗
PubMed2002

A comparison of oral diazepam versus midazolam, administered with intravenous meperidine, as premedication to sedation for pediatric endoscopy.

OBJECTIVES: This study was performed to compare the effects of oral midazolam and oral diazepam, administered with intravenous (IV) meperidine, on pre-procedural, procedural, and post-procedural sedation and recovery in children undergoing diagnostic upper endoscopy. The costs of pre-procedure sedation were compared for the two benzodiazepines. METHODS: A randomized, double-blind study was conducted in 154 children (mean age 96.73 +/- 59.34 months, 53% male) undergoing endoscopy. Oral midazolam (0.5 mg/kg, maximum dose of 20 mg) or oral diazepam (0.3 mg/kg, maximum dose of 10 mg) was given before IV insertion, and with IV meperidine (2 mg/kg, maximum dose of 100 mg) given to all patients just before upper endoscopy. Further "rescue" midazolam doses (to a maximum cumulative dose of 5 mg) were given as needed to achieve a pre-procedure sedation score of > or =2. All patients received intravenous propofol for procedural sedation. Patients were evaluated for the efficacy and safety of pre-procedural sedation, sedation during upper endoscopy, and recovery following completion of the procedure. RESULTS: There were no significant differences between study groups for level of pre-procedural sedation, need for midazolam rescue in endoscopy, effectiveness of procedural sedation, occurrence of adverse events, and recovery parameters. CONCLUSIONS: Oral midazolam and diazepam, in conjunction with IV administration of meperidine, provide comparable, effective, and safe premedication for children undergoing upper endoscopy. The cost of midazolam was substantially higher than diazepam.

Adjuvants, Anesthesia↗
PubMed1976

Pentobarbitone premedication for anaesthesia. The influence of the preparation and route of administration on its clinical action.

Studies were carried out in the pre-operative period on patients premedicated with 100 mg pentobarbitone given by mouth or by intramuscular injection into the buttock. The injections were given by doctors using a 4 cm needle or by nurses using the needle of their choosing and two preparations were used. One was a freshly prepared aqueous solution and the other the commercially available organic solution (Nembutal) with propylene glycol, alcohol and water as solvents. An unacceptably high incidence of persistent injection site pain occurred after the use of the organic preparation but not with the aqueous solution. Otherwise no difference was detected between the effects of the two preparations. Drugs injected by doctors were, on the whole, more effective as premedicants than those injected by nurses. Oral pentobarbitone was not as effective a premedicant as the intramuscular preparation and its anxiolytic action did not differ from that of the placebo. Relief of apprehension was disappointing with all preparations of 100 mg pentobarbitone and was not as good as with diazepam. This may be attributed to the use of too small doses but larger injection volumes would have caused their own problems.

Administration, Oral↗
PubMed1980

Lorazepam as night sedation and premedication: a comparison with diazepam.

Fifty healthy female patients scheduled for surgery were randonly allocated into two groups in a double-blind study. One group received lorazepam 2.5 mg orally at 2200 h on the evening before surgery as night sedation, and again at 0800 h on the morning before surgery as premedication. The second group received diazepam 10 mg orally at the samte times. The quality of sleep the night before surgery was superior in the lorazepam group (p less than 0.02). The frequency of effective sedation produced pre-operatively was similar in both groups. Although the incidence of amnesia for visual stimuli following lorazapam was higher (p less than 0.05) than with diazepam, there was no difference in the recall of auditory and painful stimuli. The overall incidence of side effects was similar for each drug and at the dosage used no difference was found in the time to awaken from anaesthesia.

Adult↗
PubMed1981

Temazepam as premedication in day surgery.

Sixty patients scheduled for day case surgery were allocated into two groups in a double-blind study. One group received temazepam 20 mg or 30 mg orally 1 hour before surgery whilst the second group received a placebo of identical appearance. The use of temazepam was followed by a greater frequency of sedation and anxiolysis and with fewer problems at induction. The time to awaken, the level of postoperative sedation and the ability to walk unaided were similar in both groups. Postoperative sequelae were less frequent in the temazepam group. Temazepam is advocated as a suitable drug for premedication in day case surgery.

Adolescent↗
PubMed1981

Rectal premedication in children. Use of diazepam, morphine and hyoscine.

Rectal premedication with diazepam, morphine and hyoscine has been used in 20 healthy children undergoing minor surgery. Satisfactory sedation was achieved in the majority of children and the anticholinergic effects were also adequate. Peak plasma levels of diazepam and morphine were reached within 30 minutes, and the plasma levels decreased after 2 hours. No adverse effects on ventilation were seen during anaesthesia.

Anesthesia, Inhalation↗
PubMed1981

Minaxolone: an evaluation with and without premedication.

Minaxolone, a water-soluble steroid intravenous anaesthetic, has been used in clinical trials for induction and maintenance in patients presenting for minor operations. A standard induction dose of 0.5 mg/kg was given. There was a low incidence of pain on injection and venous sequelae. Excitatory effects occurred commonly at induction but these were reduced by opiate premedication. The frequency of uneventful induction was significantly greater when the 5 mg/ml solution of minaxolone was given at a rate of 6 ml/minute than at a rate of 24 ml/minute. Minaxolone has been withdrawn from clinical trials following equivocal toxicological findings in rats which require further investigation.

Adult↗
PubMed1982

Temazepam as premedication in elderly patients.

One hundred and forty-five men were randomly allocated on a double-blind basis to receive either temazepam 20 mg, diazepam 10 mg or placebo as premedication. Temazepam produced more sedation than either diazepam or placebo. Postoperative recovery was assessed by a simple visuo-motor co-ordination test and was best in the placebo group. Two hours into recovery, temazepam patients could almost match their baseline performance whereas the performance of the diazepam patients was still significantly worse than pre-operatively. Temazepam is suggested as a suitable premedicant for elderly patients undergoing minor surgery.

Aged↗
PubMed1982

Premedication with atropine or glycopyrrolate in children. Effects on heart rate and rhythm during induction and maintenance of anesthesia.

Atropine 15 micrograms/kg and glycopyrrolate 5 or 10 microgram/kg were studied as anticholinergic premedicants in groups of 20 children each. A control group of 20 children did not receive anticholinergic premedication. Both atropine and the higher dose of glycopyrrolate produced significant increases in heart rate prior to induction of anaesthesia. The subsequent increase during the process of induction was less than in those who had not received an anticholinergic drug or glycopyrrolate 5 micrograms/kg. Dysrhythmias during induction of anaesthesia occurred slightly less frequently in the patients given atropine or the higher dose of glycopyrrolate. Although the incidence was similar in these two groups, ventricular ectopic beats occurred less frequently following the use of glycopyrrolate. The control of secretions was also superior with this anticholinergic premedicant.

Adolescent↗
PubMed1983

The safety of atropine premedication in children with Down's syndrome.

Forty-five operative procedures were performed in 32 patients with Down's syndrome at the Royal Alexandra Hospital for Children, Sydney in a single year recently. Atropine premedication was administered to 25 patients with Down's syndrome on 38 occasions. Three dosage regimes of atropine were used: 20 micrograms/kg, 12 micrograms/kg, both intramuscularly, and 10 micrograms/kg intravenously. There was no statistically significant difference in the alteration of heart rate for the three dosage groups of atropine used when children with Down's syndrome were compared with weight-matched control children having similar operative procedures performed.

Adolescent↗
PubMed1984

Ketamine and military anaesthesia. The effect of heavy papaveretum premedication and Althesin induction on the incidence of emergence phenomena.

An anaesthetic technique suitable for military field anaesthesia was sought which would attenuate the psychic side effects of ketamine. Heavy premedication with 30 mg of papaveretum and induction of anaesthesia with Althesin were evaluated. A combination of the two lowered the incidence of side effects, but they still occurred frequently enough to pose problems. Ketamine sequelae are considered incompatible with the battlefield environment.

Adult↗
PubMed1985

Comparison of propofol and thiopentone for induction of anaesthesia in premedicated patients.

Thirty premedicated ASA I or II patients scheduled for minor gynaecological surgery, were randomly allocated to receive either 1.5 mg/kg or 2 mg/kg propofol of the new emulsion formulation, or 4 mg/kg thiopentone, given over 20 seconds. Anaesthesia was successfully induced in all 30 patients. The mean (SEM) induction times were for propofol 1.5 mg/kg 33.3(3.2) seconds, for 2 mg/kg 30.5(2.7) seconds and for thiopentone 34.6(2.7) seconds. The incidence of apnoea greater than 10 seconds, was respectively 60, 80 and 80%, and the mean duration of apnoea 30.8(5.3), 37.1(5.0) and 23.7(5.0) seconds. The mean systolic blood pressure decreased after propofol 1.5 mg/kg by 16.0 mmHg, after 2 mg/kg by 18.6 mmHg, and increased after thiopentone by 1 mmHg, 2 minutes after injection. Heart rate increased significantly 2 minutes after thiopentone by an average of 15.1 beats/minute, but not after propofol. Pain was not reported during or after the injection. No major adverse reactions occurred at induction or during maintenance of anaesthesia with an inhalation agent. One patient who received 2 mg/kg propofol and isoflurane vomited for 24 hours. The recovery of anaesthesia after propofol induction, was quicker than after thiopentone.

Adult↗
PubMed1985

Rectal premedication in children. Comparison of diazepam with a mixture of morphine, scopolamine and diazepam.

Two hundred and eight healthy children who were to undergo minor elective surgery during halothane, nitrous oxide, oxygen anaesthesia were studied in a double blind investigation to evaluate the sedative and anticholinergic effects of two rectal premedications. Group I received diazepam 0.75 mg/kg rectally; Group II received a mixture of diazepam 0.5 mg/kg, morphine 0.15 mg/kg and hyoscine 0.01 mg/kg rectally. No significant difference was found between the two groups in sedative or anticholinergic effects during induction of anaesthesia or in the postoperative period. No adverse effects were seen.

Adolescent↗
PubMed1985

A comparison of nalbuphine and morphine as premedication agents for minor gynaecological surgery.

Nalbuphine 10 mg and morphine 10 mg were compared in a randomised double-blind trial as intramuscular premedication in 50 patients undergoing minor gynaecological surgery. Both nalbuphine and morphine produced significant sedation without anxiolysis as assessed by patient linear analogue scales, but there were no significant differences between the two drugs. Observer ratings demonstrated that nalbuphine produced calm/sleepy patients to a greater extent than morphine. There were no differences in untoward effects produced by each drug.

Adult↗
PubMed1985

Comparison of oral slow release morphine (MST) with intramuscular morphine for premedication.

Oral morphine sulphate slow-release (MST) 40 mg and intramuscular morphine sulphate 10 mg, each administered with intramuscular atropine 0.6 mg, were compared in a randomised double-blind trial as premedication agents in 30 patients undergoing abdominal hysterectomy. Both formulations produced sedation but no anxiolysis in the anaesthetic room, as measured by 10 cm, horizontal linear analogue scales. There was no significant difference between the preparations in terms of postoperative pain, recorded either by the linear analogue scales or using a patient questionnaire. The usage of analgesics and anti-emetics postoperatively was comparable in both groups.

Administration, Oral↗