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PubMed1990

Clonidine premedication: a useful adjunct in producing deliberate hypotension.

The effect of clonidine on the dose requirements of labetalol and isoflurane for hypotension was studied in 20 adult patients undergoing middle-ear surgery. Group I (10 patients) received as premedication only pethidine 1 mg.kg-1 i.m., and Group II (10 patients) clonidine 4-5 micrograms.kg-1 p.o. in addition to pethidine. Fentanyl was used for analgesia and d-tubocurarine for muscle relaxation. The dose of labetalol required to induce hypotension to the mean arterial pressure (MAP) 50 mmHg (6.7 kPa) was 0.85 +/- 0.08 mg.kg-1 in Group I, and 0.56 +/- 0.08 mg.kg-1 in Group II (P less than 0.05). The mean isoflurane concentration in inspiratory gas for the maintenance of hypotension was 0.8 +/- 0.1 vol% in Group I, and 0.6 +/- 0.1 vol% in Group II (P less than 0.05). Before hypotension, MAP decreased significantly in Group II, and the heart rate (HR) decreased in both groups. There were no significant differences in MAP and HR between the groups during any phase. Urine flow rates (UF) were lower in Group II (0.23 +/- 0.04 ml.min-1) than in Group I (0.68 +/- 0.16 ml.min-1) before hypotension (P less than 0.05) and during hypotension (0.08 +/- 0.02 ml.min-1 vs. 0.68 +/- 0.32 ml.min-1, P less than 0.05). After anaesthesia, there was no difference in UF between the groups. The results indicate that clonidine can be used for deliberate hypotension to decrease the dose requirements of labetalol and isoflurane.

Adult↗
PubMed1991

Effects of oral clonidine premedication and postoperative i.v. infusion on haemodynamic and adrenergic responses during recovery from anaesthesia.

The effects of clonidine, a central alpha 2-adrenoreceptor agonist, on haemodynamic and catecholamine changes were assessed during emergence from anaesthesia, a period which is associated with increased sympathetic nervous discharge, hypertension and tachycardia. According to a double-blind randomized design, 32 patients received either clonidine, preoperatively given by oral route (3.5 micrograms.kg-1) and postoperatively by i.v. infusion (0.3 microgram.kg-1.h-1), or a placebo. Perioperative management was similar in both groups. Measurements were made in the recovery room, before starting clonidine or placebo infusions for evaluation of clonidine premedication, and then during infusion as follows: when core temperature reached 37 degrees C; then 2 h, and 6 h later. Prior to starting infusions, mean blood pressure (88 +/- 15 vs 103 +/- 14 mmHg) (11.7 +/- 2.0 vs 13.7 +/- 1.9 kPa), heart rate (67 +/- 8 vs 87 +/- 17 beats.min-1) and plasma norepinephrine levels (462 +/- 393 vs 615 +/- 361 pg.ml-1) were lower in the clonidine group. Only at the latest measurement (6 h after core temperature reached 37 degrees C) did clonidine elicit significant effects. The values during clonidine infusion compared to placebo were at this time: mean blood pressure (73 +/- 10 vs 86 +/- 13 mmHg) (9.7 +/- 1.3 vs 11.5 +/- 1.7 kPa), heart rate (71 +/- 6 vs 93 +/- 13 beats.min-1) and plasma norepinephrine levels (240 +/- 224 vs 451 +/- 111 pg.ml-1). Our results suggest that: 1) preoperative clonidine may improve the haemodynamic profile associated with anaesthetic discontinuation, but 2) i.v. infusion (0.3 microgram.kg-1.h-1) did not prolong this effect during the early postoperative period in the face of the sympathetic nervous discharge of recovery.

Administration, Oral↗
PubMed1991

Intramuscular dexmedetomidine, a novel alpha 2-adrenoceptor agonist, as premedication for minor gynaecological surgery.

The effects of three different doses (0.5, 1.0 and 1.5 micrograms/kg) of dexmedetomidine, a novel alpha 2-adrenoceptor agonist, on vigilance, anaesthetic requirements, haemodynamics, and plasma catecholamine levels were investigated in a double-blind placebo-controlled study in 20 healthy (ASA physical status I-II) women scheduled for uterine dilatation and curettage (UD&C). The drug was administered intramuscularly 60 min before induction of anaesthesia with thiopentone, N2O/O2 (70/30%) and thiopentone was used for maintenance. There were no significant differences between the groups in thiopentone requirements, plasma adrenaline concentrations, or subjective or objective assessment of sedation before anaesthesia and UD&C. Blood pressure, heart rate, and plasma noradrenaline levels were reduced after dexmedetomidine, with three patients receiving atropine for excessive bradycardia (less than 45 beats min-1). The haemodynamic as well as the sedative effects of dexmedetomidine after surgery lasted until the end of the observation period, 4 h after the injection of the drug, indicating that intramuscular administration of this premedication agent may result in a longer than optimal duration of pharmacological actions in connection with short surgical procedures.

Adrenergic alpha-Agonists↗
PubMed2004

'Protective premedication': an option with gabapentin and related drugs? A review of gabapentin and pregabalin in in the treatment of post-operative pain.

Substantial progress has been made during the last decades in our understanding of acute pain mechanisms, and this knowledge has encouraged the search for novel treatments. Of particular interest has been the observation that tissue injury initiates a number of modulations of both the peripheral and the central pain pathways, which convert the system from a 'physiological' to a 'pathological' mode of processing afferent information. Gabapentin, which binds to the alpha(2)delta subunit of the voltage-dependent calcium channel, is active in animal models of 'pathological' but not in models of 'physiological' pain. Consequently, attention has so far been focused on neuropathic pain as a target for the clinical use of gabapentin and analogues. Recently, several reports have indicated that gabapentin may have a place in the treatment of post-operative pain. This article presents a brief summary of the potential mechanisms of post-operative pain, and a systematic review of the available data of gabapentin and pregabalin for post-operative analgesia. It is concluded that the results with gabapentin and pregabalin in post-operative pain treatment published so far are promising. It is suggested that future studies should explore the effects of 'protective premedication' with combinations of various antihyperanalgesic and analgesic drugs for post-operative analgesia.

Amines↗
PubMed2006

Clonidine premedication effects on inhaled induction with sevoflurane in adults: a prospective, double-blind, randomized study.

BACKGROUND: The purpose of this study was to evaluate whether oral clonidine premedication becomes an alternative to N2O in terms of shortening the induction time and attenuation of the adrenergic response to tracheal intubation during inhalation induction with sevoflurane, and to evaluate the quality of anesthetic induction according to the patient's satisfaction. METHODS: We studied 84 female patients who were randomly allocated into four study groups: Groups I and II received a placebo orally, and Groups III and IV received clonidine at 150 and 300 microg, respectively, 90 min before induction of anaesthesia. Patients were anesthetized using a triple-deep-breath technique with 5% sevoflurane in Groups I, III and IV, and with 60% N2O-5% sevoflurane in group II. RESULTS: Induction time was significantly longer (P < 0.05) in Group I. Increases in mean blood pressure and heart rate after tracheal intubation were significantly suppressed in Groups III and IV but not in Group II compared with Group I. Comfort and impression of anesthesia was better in Groups III and IV than in Groups I and II. CONCLUSION: In volatile anesthetic induction, pre-anesthetic clonidine may become an alternative to N2O and may provide more comfort than with N2O.

Adult↗
PubMed2005

Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication.

BACKGROUND: Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and side effect profile. The aim of our study was to investigate and compare the efficacy of oral midazolam alone with a low-dose combination of oral midazolam and ketamine. METHODS: We performed a prospective randomized double-blind study in 100 children who were randomly allocated into two groups. Group M received 0.5 mg.kg(-1) oral midazolam and group MK received 0.25 mg.kg(-1) oral midazolam with 2.5 mg.kg(-1) oral ketamine. The preoperative sedation score, ease of parental separation and ease of mask acceptance were evaluated on a 4-point scale. The time to recovery from anesthesia and to achieve satisfactory Aldrete score was also noted. RESULTS: Uniform and acceptable sedation scores were seen in both the groups (group M 95.9%; group MK 97.96%), without any serious side effects. However, the combination offered significantly more children in an awake, calm and quiet state, who were easily separated from their parents (73.46% in MK vs 41% in group M). The induction scores were comparable between the groups. The recovery room characteristics and time to achieve satisfactory Aldrete score were also comparable between the two groups. CONCLUSIONS: Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more children in an awake, calm and quiet state who could be separated easily from parents.

Adjuvants, Anesthesia↗
PubMed1994

Oral transmucosal fentanyl citrate premedication in patients undergoing outpatient dermatologic procedures.

BACKGROUND: Oral transmucosal fentanyl citrate (OTFC) is a novel lozenge dosage form of fentanyl used for premedication. Many dermatology patients undergoing surgical procedures could benefit from such a medication. OBJECTIVE: The study compared the safety and efficacy of 400-vs 800-micrograms dosage forms for their sedative and anxiolytic effects in adults undergoing a variety of dermatologic outpatient surgical procedures. METHODS: Patients received OTFC 30 minutes before the procedure. Vital signs, oxygen saturation, sedation, and anxiety scores were measured before OTFC administration and every 15 minutes thereafter. RESULTS: Significant sedation and anxiolysis developed in both dosage groups. No clinically significant changes in respiratory rate, heart rate, or blood pressure occurred during the study period. Common drug-induced side effects included dizziness, nausea, pruritus, and vomiting. CONCLUSION: OTFC is safe and effective for outpatient dermatologic procedures; however, the risk of opioid-related side effects must be carefully weighed against the benefits when deciding to use OTFC in an outpatient setting.

Administration, Oral↗
PubMed1986

The use of oral benzodiazepines as premedications: the usefulness of temazepam.

The primary aim of premedication is to relieve the patient's anxiety/restlessness before anaesthesia and to ensure optimum quantity and quality of sleep on the night preceding surgery. With these objectives in mind, oral benzodiazepines offer a good alternative to traditional parenteral premedicants, especially as the clear anxiolytic and sedative effects of the former are of great clinical value. Oral temazepam has proven to be a valuable premedicant given on the evening before operation and/or the following morning, before surgery. Administered as a sedative in a single 20 mg oral dose the night before surgery, temazepam provided a good night's sleep in 77 percent of gynaecological surgical patients; patients slept for 7.6 hours and had no significant residual effects. As a premedicant, temazepam was as effective as parenteral diazepam or papaveretum. Temazepam's short duration of action facilitates rapid postoperative recovery in children, adults, and in the elderly. Thus, it is indicated especially for short operative procedures when rapid recovery and swift return to fitness are essential.

Anesthesia, General↗
PubMed2005

Study of the tolerance of infliximab infusions with or without betamethasone premedication in patients with active rheumatoid arthritis.

OBJECTIVES: To assess the incidence of infusion reactions in patients with rheumatoid arthritis (RA) receiving infliximab treatment with and without betamethasone premedication. To determine whether patients with an atopic diathesis had a better response to corticosteroid pretreatment than those without, and the course of patients' functional capacity and quality of life. PATIENTS AND METHODS: A prospective, multicentre, randomised, double blind phase 4 study of 355 patients with RA in two groups: group A received betamethasone and group B placebo, before a 36 week infusion treatment with infliximab. Incidence and severity of infusion reactions from infliximab treatment were assessed. RESULTS: The incidence of reactions to infliximab infusion was <5%. More infusion reactions occurred with betamethasone pretreatment than with placebo. Response to infliximab of patients with atopic backgrounds did not differ in the presence or absence of betamethasone from that of non-atopic patients. Mean Health Assessment Questionnaire score improved by 47% at week 24, quality of life assessed by Short Form-36 improved in mental and physical component subscales. CONCLUSIONS: Incidence of infusion reactions with infliximab was low and their severity generally mild, but betamethasone pretreatment did not decrease the incidence and severity of infusion reactions. Betamethasone, therefore, is not recommended as a systematic prophylactic measure, even in atopic patients.

Adult↗
PubMed1997

Effects of tiletamine/zolazepam premedication on propofol anaesthesia in dogs.

The cardiovascular and pulmonary effects of tiletamine/zolazepam, propofol and tiletamine/zolazepam plus propofol were studied in five mongrel dogs. A cannula inserted into a raised carotid artery was used to measure mean arterial pressure (MAP) and heart rate continuously and to collect arterial blood for the determination of pH, PO2, PCO2, bicarbonate and base balance. Respiratory frequency and rectal temperature were also recorded. In the two propofol groups premedication had no significant effect on the time to rejection of an endotracheal tube and the return to sternal recumbency. The MAP and heart rate increased after tiletamine/zolazepam alone and after tiletamine/zolazepam plus propofol, although propofol alone reduced MAP and transiently increased heart rate. Respiratory frequency decreased transiently in both propofol groups in association with a significant increase in PaCO2 and decrease in PaO2. The most notable change was the hypoxaemia in the tiletamine/zolazepam plus propofol group in which the PaO2 was reduced. In all the dogs given tiletamine/zolazepam alone undesirable side effects were observed, effects which also occurred during the recovery of the dogs given tiletamine/zolazepam plus propofol.

Anesthesia, Intravenous↗
PubMed2002

Effects of opipramol as an evening anaesthesiologic premedication.

To date, opipramol has not been examined within the context of evening premedication in anaesthesiology. A suitable drug for such an application should induce anxiolytic and sleep-favouring effects. Due to its pharmacological properties, one would expect opipramol to lead to these effects. In order to test this possibility, 72 female patients were randomly assigned to 50 mg opipramol, 100 mg opipramol, or placebo (n = 24 patients per group) in the evening prior to surgery in a double-blind trial. Effects were recorded in the morning prior to the operation by means of self-rating questionnaires, regarding the patients' current subjective state and their judgement of the quality of sleep during the night before. The self-rating was done by the Multidimensional Mood Inventory BSKE (EWL), by use of the Multidimensional Somatic Symptom List (MSKL), and by use of the Würzburg Sleep Questionnaire. Further dependent variables were heart rate and blood pressure. Opipramol significantly improved sleep quality. Especially the frequency of awakening at night was reduced. These effects could be observed predominantly after 100 mg opipramol. At this dosage, inner excitement was reduced as well. The autonomic variables remained uninfluenced. There were no adverse events and no hints for interactions with anaesthesiology.

Adult↗
PubMed1975

Effect of electroconvulsive therapy without anticonvulsive premedication on serum growth hormone in man.

Serum concentrations of human growth hormone (HGH) were measured in psychiatric patients during the first, third and sixth electroconvulsive therapy (ECT) without anticonvulsive premedication. Serum HGH increased 30 min after the application of current and no differences were found between responses to 1st, 3rd, or 6th ECT. Maximal increase of serum glucose was seen after the first ECT and gradual decreases after the 3rd and 6th ECT were observed

Adolescent↗
PubMed1988

Sleep effect of rectal methohexitone (10 mg/kg) in children premedicated for anaesthesia.

Methohexitone (10 mg/kg) was administered before 464 general anaesthesias for 317 children following intramuscular atropine and pethidine for various ophthalmological procedures. Approximately 70% of the children were asleep when anaesthesia was continued or started, usually with halothane in nitrous oxide and oxygen. Although the dose of methohexitone used here was smaller than that recommended in the literature, the results of the study did not greatly differ from earlier investigations in which no other premedication was given but where 20 mg/kg methohexitone was used.

Administration, Rectal↗
PubMed1982

The use of meptazinol as a premedication for surgical patients.

The acceptability of a mixture of meptazinol and hyoscine as a surgical premedication was compared with that of an Omnopon-hyoscine combination in a randomized, double-blind trial involving 101 surgical patients. Blood pressure and respiratory rate were significantly reduced to a similar extent by both premedicant combinations, and this may be interpreted as evidence of a satisfactory alleviation of anxiety by both test mixtures. The two mixtures produced a similar degree of sedation, and both were associated with a useful inhibition of salivary secretion. Side-effects were reported in 25% patients in the meptazinol group, and in 28% of those receiving Omnopon, although a number of these effects may be attributable to hyoscine. There was no difference in the pattern of post-operative analgesic requirements between the two groups, and no unfavourable interaction was noted with any of the anaesthetic agents used.

Adolescent↗
PubMed1987

Oral premedication in children.

Preoperative and postoperative sedation, postoperative analgesia and vomiting were assessed following four different oral premedications in 143 children aged 1-10 years, weighing 10-30 kg, and undergoing elective adenotonsillectomy or inguinal surgery. Diazepam, diazepam combined with droperidol, trimeprazine and trimeprazine combined with droperidol were compared in a double-blind trial in conjunction with a standardised inhalational anaesthetic technique employing an intraoperative narcotic. Trimeprazine produced significantly more preoperative sedation (P less than 0.001) and was associated with enhanced postoperative analgesia (P less than 0.01). The incidence of postoperative vomiting was significantly less in the group receiving trimeprazine (P less than 0.001). The addition of droperidol to diazepam and trimeprazine only marginally improved the performance of those drugs but significantly prolonged postoperative recovery times. This was more marked when droperidol was combined with trimeprazine.

Child↗
PubMed1987

The effect of premedication on the incidence of postoperative vomiting in children after E.N.T. surgery.

The influence of premedication and intraoperative narcotic administration on the incidence of vomiting after E.N.T. surgery was studied over a six-month period in 596 children. A high incidence of vomiting was found after intramuscular papaveretum and hyoscine and after oral diazepam. Oral trimeprazine tartrate was associated with a low incidence of vomiting and was found to have an anti-emetic effect when an opiate analgesic was administered after induction of anaesthesia.

Adolescent↗
PubMed1990

The perioperative effects of oral premedication in children.

The pre- and postoperative effects of oral diazepam (0.5 mg/kg), trimeprazine (4 mg/kg), pentobarbitone (3 mg/kg) and a placebo were compared in a randomized double-blind clinical trial in 149 children, aged one to ten years, undergoing adenotonsillectomy. The anaesthetic was standardised and each patient received intraoperative intramuscular papaveretum (0.3 mg/kg). Preoperative sedation was assessed in the ward before transfer onto the theatre trolley, on leaving the ward, on arrival on the theatre floor, on arrival in the induction room and on induction of anaesthesia. There was no significant difference in sedation between the four drug groups except for the placebo group which had a significantly greater unsatisfactory rating at the stage of induction of anaesthesia (P = 0.001). There were no differences in waking times between the diazepam, pentobarbitone and placebo groups, but the trimeprazine group's waking times were significantly prolonged (P less than 0.001). However, the trimeprazine group exhibited significantly less distress in the recovery unit (P = 0.02) and had half the incidence of vomiting (P less than 0.001) than did the other premedication groups.

Adenoidectomy↗
PubMed1986

A comparative study of diazepam with sustained-release diazepam as oral premedication in minor gynaecological surgery.

Sixty patients undergoing elective minor gynaecological surgery received oral pre-operative medication with 10 mg diazepam in either conventional tablet form on the morning of operation or as the sustained-release tablet the night before. Subjective and objective assessments of the effectiveness of premedication were made. Patients receiving sustained-release diazepam on the night before surgery experienced fewer periods of wakefulness than those who received placebo. Patients who were given diazepam on the morning of surgery felt more drowsy pre-operatively than those who received sustained-release diazepam the night before.

Adolescent↗