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At least 883 records · Page 49Linked to original sources
PubMed1992

[The effects of diazepam premedication upon atropine-induced hemodynamic changes].

Positive or negative chronotropic effects of atropine and their magnitude are known to be determined primarily by patient's age, atropine dose, anesthetic agents or techniques, and preanesthetic medication. The aim of the present study is to investigate the effects of oral diazepam upon the hemodynamic responses to intravenous atropine in awake patients. Diazepam group (n = 26) received oral diazepam, 10 mg, whereas control group (n = 20) received no premedication. The direction and magnitude of heart rate and blood pressure responses to atropine were similar between the two groups. Heart rate significantly decreased from baseline values following atropine, 2.5 micrograms.kg-1, returned to baseline values following cumulative atropine doses, 5 micrograms.kg-1, then significantly increased from baseline values following cumulative atropine dose, 10 micrograms.kg-1 in both groups. Mean blood pressure significantly decreased from baseline values following cumulative atropine dose, 2.5 and 5 micrograms.kg-1, and returned to baseline following cumulative atropine dose, 10 micrograms.kg-1, in both groups. It is concluded that oral diazepam, 10 mg, as a premedicant does not alter the hemodynamic responses to intravenous atropine in humans.

Administration, Oral↗
PubMed2005

[Effects of oral clonidine premedication on the heart rate response to intravenous atropine during propofol anesthesia].

BACKGROUND: Propofol induces suppression of the sympathetic nervous activity, and attenuates the heart rate responses to intravenous atropine. Similarly, clonidine suppresses the heart rate response to intravenous atropine under awake and enflurane-anesthetized patients. The purpose of this study is to evaluate effects of clonidine on the heart rate response to atropine under propofol anesthesia. METHODS: Thirty-two adults patients were randomly assigned to one of two groups. Clonidine group (n=16) patients received oral clonidine 5 microg x kg(-1) and famotidine 20 mg, and the control group (n=16) patients received oral famotidine alone 90 minutes before anesthesia. After tracheal intubation, anesthesia was maintained with propofol at the effect site concentration of 3 microg x ml(-1) in air and oxygen using the TCI system. All patients received incremental doses of IV atropine 5 microg x kg(-1) over 5 s at 2-min intervals until heart rate increased > 20 beats x min(-1) from baseline values or until atropine 40 microg x kg(-1) was given. RESULTS: Although heart rate response to atropine 5-25 microg kg(-1) was similar between the two groups, heart rate response to atropine 30 microg x kg(-1) in the clonidine group was smaller than that in the control group (P<0.05). When the atropine 40 microg x kg(-1) was administered, heart rate increased > 20 beats x min(-1) in all patients of the control group, but 62.5% of patients in the clonidine group (P< 0.05). CONCLUSIONS: Oral clonidine premedication attenuates the heart rate responses to IV atropine under propofol anesthesia.

Administration, Oral↗
PubMedDate not supplied

Dental premedication protocols for patients with knee and hip prostheses.

In 1997, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) published an advisory statement regarding antibiotic prophylaxis for patients with total joint replacements undergoing dental treatment. The first periodic update of these guidelines was published in 2003. Nevertheless, confusion exists among dentists and physicians as to the clinical indications for premedication in this patient population. This article serves as an overview of current recommendations for use of chemoprophylaxis in the dental treatment of patients with prosthetic joints.

American Dental Association↗
PubMedDate not supplied

Intravenous premedication with atropine and postanesthetic delirium. Report of two cases.

The authors report two cases of postanesthetic delirium in patients receiving intravenous atropine sulphate before surgery. In the first case the diagnosis of atropinic syndrome has been suggested by a cause effect relationship; in the second case the diagnosis has been supported by the prompt resolution after intravenous physostigmine salycilate administration. Since such syndrome was never observed in patients receiving atropine sulphate as i.m. premedicant, authors are prone to consider the i.m. route a safer approach to premedication with this drug.

Adult↗
PubMed1991

Pharmacokinetics and clinical response of hyoscine plus morphine premedication in connection with cardiopulmonary bypass surgery.

Plasma hyoscine and morphine levels and various pharmacodynamic responses have been examined in seven patients scheduled for a coronary-artery bypass graft. Hyoscine 0.006 mg kg-1 and morphine 0.20 mg kg-1 were administered intramuscularly as routine premedication. Surgery was performed using high-dose fentanyl anaesthesia (100 micrograms kg-1). The clinical responses followed were heart rate, blood pressure, subjective sedation and antisialogogue effect. The plasma hyoscine levels were determined by radioreceptor assay, and plasma morphine levels by liquid chromatography, both up to 24 h. The maximum levels of plasma hyoscine (6.6 micrograms l-1) and morphine (158 micrograms l-1) and the time they were reached (13.0 and 9.7 min, respectively) were comparable with the values obtained in earlier studies using young healthy subjects. After the start of cardiopulmonary bypass, significant decreases in plasma levels of both hyoscine and morphine were found. The elimination half-life of hyoscine in the plasma was 2.4 h, which is somewhat greater than obtained in earlier studies with young healthy patients under regional anaesthesia. Elimination of plasma morphine (t1/2el = 3.3 h) was not significantly altered by the procedure. The sedative and antisialogogue effects of the drugs appeared quickly and were significant, but no tachycardia or other side effects were observed. In conclusion, the kinetic properties of both hyoscine and morphine are suitable for routine use as premedicants before cardiac surgery.

Anesthesia, Intravenous↗
PubMed1991

[Effects of clonidine premedication upon hemodynamic changes associated with laryngoscopy and tracheal intubation].

The authors studied 30 patients undergoing general anesthesia in order to evaluate whether oral clonidine premedication could attenuate the hemodynamic changes associated with laryngoscopy and tracheal intubation. Patients were randomly assigned to one of two groups; clonidine group (n = 15) who received oral clonidine of approximately 5 micrograms.kg-1, or control group (n = 15) who received no clonidine. The magnitude of increases in mean blood pressure from baseline values following laryngoscopy and tracheal intubation in the clonidine group was significantly smaller as compared with that in the control group (20 +/- 12 vs. 31 +/- 14 mmHg, mean +/- SD, P less than 0.05). There was also a significant difference between the two groups in the incidence of systolic blood pressure increases above 180 mmHg following laryngoscopy and tracheal intubation (0% vs. 26%, P less than 0.05). However, no significant difference was noted between the two groups in the heart rate responses to laryngoscopy and tracheal intubation. It is concluded that oral clonidine of 5 micrograms.kg-1 as a preanesthetic medication could attenuate the pressor responses associated with laryngoscopy and tracheal intubation.

Administration, Oral↗
PubMed1990

[Premedication in children--a clinical trial of bromazepam and chloral hydrate suppositories].

We performed a study on 141 pediatric patients between 6 months and 7 years of age who underwent scheduled radical operation for inguinal hernia, to evaluate bromazepam suppository and chloral hydrate suppository as anesthetic premedication for short pediatric operations. The study was also focused on the difference of the effects of the two drugs between two age groups: younger than 5 years, and 5 years and older. The younger age group required a larger bromazepam dose compared with the older age group, and in the younger group even the larger bromazepam dose did not produce a high sedative effect as chloral hydrate. In the older group, bromazepam and chloral hydrate were equally effective. In respect to emergence from anesthesia, bromazepam delayed emergence compared with chloral hydrate after which children awoke from anesthesia very clearly. Thus, chloral hydrate suppository seemed more useful as premedicants in short pediatric operations for its high sedative effect without affecting emergence.

Anti-Anxiety Agents↗
PubMed1991

[A comparison of midazolam and diazepam in premedication using the intramuscular route].

A double blind study has been carried out on 60 women undergoing gynaecological surgery: they were divided into 2 groups who were given as premedication either midazolam: 10 mg, or diazepam: 15 mg intramuscularly. No significant differences between both groups concerning heart rate, blood pressure and respiratory rate were found. After 30 min sedation of anxiety was noted in 30 subjects (100%) after midazolam and in 20 subjects (67%) after diazepam (P less than 0.001). After 45 min good sedation was found in 19 patients (63%) after midazolam and in 4 patients (13%) afer diazepam (P less than 0.001). Amnesia related to preoperative period was more frequent in the midazolam group than in the diazepam group: 67% VS 13% (P less than 0.001). Amnesia of the immediate postoperative period was 100% in both groups. Midazolam as compared with diazepam can be regarded as a superior intramuscular premedicant. This superiority can been explained by a rapid and good resorption.

Adult↗
PubMed1990

[Anesthesia induction in children: propofol in comparison with thiopental following premedication with midazolam].

Propofol provides smooth and rapid induction of anesthesia in adults and guarantees rapid recovery. The use of propofol in adults is frequently associated with pain on injection, but this can be reduced by: (1) injection into the relatively large veins in the forearm or the antecubital fossa: (2) addition of lignocaine to the propofol; or (3) injection of an opioid (alfentanil) before propofol. Compared with experience in adults, there is very little experience with propofol in pediatric anesthesia. The aim of this random prospective study was to compare the induction characteristics of propofol and thiopentone in pediatric anesthesia. Vigilance and behavior in the postoperative period were also compared. METHOD. A total of 75 healthy children aged 3-12 years who were undergoing elective operations were studied. All the children received premedication with 0.5 mg/kg midazolam with 0.02 mg/kg atropine by the rectal route. The children were divided randomly into 3 groups and received: group A, thiopentone 3-6 mg/kg; group B, propofol 1-3 mg/kg mixed with lignocaine (10/200 mg); group C, propofol 1-3 mg/kg, followed 1 min later by alfentanil 0.01 mg/kg. The induction agent was injected over 30 s, if possible into the vein in the forearm or the antecubital fossa. The immediate reaction on vein puncture and any discomfort during the injection were noted. After intubation the anesthesia was maintained with 1 vol% halothane, nitrous oxide and oxygen (2:1). Arterial pressure was measured on arrival in the induction room, immediately after the induction of anesthesia, immediately after intubation and thereafter at 5-min intervals throughout the anesthesia. Heart rate (ECG) and arterial oxygen saturation (saO2) were measured continuously. The existence of any anterograde amnesia was tested (age over 4 years) by means of one of 6 pictures shown to each before operation. The ability to recall the picture shown was recorded 2-5 h postoperatively. The completeness of recovery was assessed at 10-min intervals up to 1 h, and thereafter at 1-h intervals. In the postoperative period a recovery test (postbox test) was performed. The incidence of side effects during the induction of anesthesia and also during recovery and the postoperative period (for 5 h) was recorded. RESULTS. There was no significant difference between the children in the 3 different groups with regard to age, body weight, type of operation, or duration of anesthesia. Among the total of 75 children, 66.7% accepted the vein puncture very well, and 24% well. In some children in each group we observed obstruction of the respiratory tract (group A, 36%; group B, 48%; group C, 64%). Apnea for 20 s was observed only in groups B and C (2 and 3 children respectively). During spontaneous respiration with room air there was a significant decrease of the arterial oxygen saturation about 1 min after induction in all groups. In children ventilated with oxygen by mask, the SaO2 remained nearly constant...

Administration, Rectal↗
PubMed1977

[Trial droperidol premedication in infants and children].

Droperidol premedication for children (0.3 to 0.5 mg/kg) was compared with pentobarbital and Dolosal--promethazine). Results are analyzed using criteria proposed by Burken and Nisbet. Droperidol compared very favourably with the order drugs. However a decrease in efficacy was noted with infants and neuw-born children, even with higher doses. The possible incidence it hypertonic seizures renders this drug unsuitable for ambulatory surgery.

Adolescent↗
PubMed1990

[Usefulness of midazolam for premedication before local anesthesia].

The optimal dose and adverse effects of midazolam for premedication were evaluated in 45 patients undergoing local anesthesia. The patients were divided into 3 groups and administered midazolam intramuscularly: group-A 0.075 mg.kg-1, group-B 0.1mg.kg-1, group-C 0.125 mg.kg-1. In this study, concerning sedative and hypnotic effects, the administration of midazolam (0.075-0.1mg.kg-1) showed satisfactory results except in conduction anesthesia of upper extremities (brachial plexus block). However, severe decrease in PaO2 was observed in relatively younger patients. Therefore, it is necessary to observe patients carefully during perioperative period.

Adolescent↗
PubMed1977

[Anaphylactoid reactions following administration of plasma substitutes in man. Prevention of this side-effect of haemaccel by premedication with H1- and H2-receptor antagonists (author's transl)].

In a randomized controlled single blind trial in 50 volunteers the problem was investigated whether a combination of dimethpyrindene (0.1 mg/kg b.w.) and cimetidine (10 mg/kg b.w.) could prevent anaphylactoid or allergoid reactions following Haemaccel infusion. In the control group 6 anaphylactoid and 9 allergoid reactions were observed, in the H1 + H2-group, however, none of those reactions occured. No single wheal could be detected. It is considered appropriate to recommend the general use premedication of an H1 + H2-blocker before all anaesthetics and operations. This mainly depends on further clinical trials with the antihistaminic drugs concerning their side-effects under various conditions.

Anaphylaxis↗
PubMed1975

The use of lorazepam as a soporific and for premedication.

An open study, in which 48 patients scheduled for elective surgery received either 1,25 mg or 2,5 mg of lorazepam (orally) as a soporific the night before surgery and as premedication immediately prior to surgery, revealed that lorazepam produced a good night's rest and a desirable calm immediately prior to surgery. Vital signs remained stable throughout the operative procedure, and vomiting and other reactions were virtually absent.

Adolescent↗
PubMed1989

Outpatient premedication: use of midazolam and opioid analgesics.

The perioperative effects of administering sedative and analgesic drugs prior to outpatient surgery were evaluated. One hundred fifty adult outpatients were randomly assigned to one of six study groups according to a double-blind protocol design. Patients were given placebo (saline) or midazolam (5 mg im) 30-60 min prior to surgery, and then either placebo, oxymorphone (1 mg iv), or fentanyl (100 micrograms iv) 3-5 min prior to a standardized anesthetic technique. Preoperatively, midazolam premedication was associated with a significantly lower anxiety level (37 +/- 29 mm vs. 50 +/- 32 mm, P less than 0.05), higher sedation level (254 +/- 136 mm vs. 145 +/- 109 mm, P less than 0.01), worsening of psychomotor skill (5 +/- 5 vs. 2 +/- 2 dots missed, P less than 0.01; midazolam vs. placebo), and impaired recall abilities. In addition, use of midazolam did not prolong the discharge time. Compared to control patients, those who received fentanyl had a decreased incidence of intraoperative airway difficulties such as coughing (28% vs. 0%, P less than 0.01). Although use of opioids increased the incidence of postoperative nausea (42% vs. 18%, P less than 0.01) and vomiting (23% vs. 2%, P less than 0.01; opioid vs. no opioid), average recovery times were not affected by opioid administration. Oxymorphone use was associated with a lower incidence of pain at home compared with that following fentanyl (46% vs. 74%, P less than 0.05). Finally, preoperative administration of both midazolam and fentanyl or oxymorphone prior to a standardized methohexital-nitrous oxide anesthetic technique did not adversely affect recovery after outpatient surgery.

Adult↗
PubMed1989

Pediatric oral premedication: changes in the patterns of administration and safety.

Fear of pain and of the unknown have long been recognized as major reasons for dental therapy avoidance. Add to this possible parental interjections of fear and avoidance of unfamiliar environments and the young patient is prepared for a difficult experience. Enter the dentist, whose trepidation for the ensuing encounter and whose possible negative feelings may lead to a breakdown of mutual confidence. Patient management is a major reason for the specialty of pediatric dentistry. The dentists that deal with pediatric and special patient populations have had increasing difficulty in providing sedative services for the individuals that need this management modality. The purpose of this article is to review the reasons for the utilization of chloral hydrate hydroxyzine as the predominant oral premedication regimen and review factors relating to the safety of its use.

Adult↗
PubMed1989

[Clinical aspects of premedication in obstetrics].

The goals of premedication in obstetric anaesthesia with particularly high risk due to high maternal morbidity and mortality are: reduction of preoperative apprehension, psychological preparation by adequate evaluation and an extensive clinical round, prevention of aspiration of gastric contents, administration of antacids, H-2-receptor-blocking and gastrokinetic agents. Due to their rapid passage across the placenta, opioids, benzodiazepines and anticholinergic drugs may influence the newborn and so arguments for and against must be considered individually. Despite all measures, the high anaesthesiological risk remains, since there is no "safe" gastric content regarding amount an pH. Anaesthetic technique and the experience of the anaesthetist play a significant role.

Anesthesia, Obstetrical↗
PubMed1989

Oral transmucosal fentanyl citrate premedication in children.

The authors evaluated the safety and efficacy of four doses of oral transmucosal fentanyl citrate (OTFC) as a premedicant in 44 children about to undergo elective operations. The patients received 5-10, 10-15, 15-20, or 20-25 micrograms.kg-1 of OTFC in the holding area and had activity (sedation) scores, vital signs (including systolic and diastolic arterial blood pressures, heart, and respiratory rates), and pulse oximetry determined oxygen saturation measured before and at 15-min intervals after premedication until they were taken to the operating room. Cooperation during anesthetic induction, and quality and speed of recovery room emergence were measured and side effects noted. OTFC was readily accepted and provided significant (dose dependent) reductions in preoperative activity starting after 30 min. Onset of sedation was related to dose of OTFC but time to peak effect was not. Vital signs remained unchanged preoperatively in all groups but patients receiving 20-25 micrograms.kg-1 had oxygen saturations that were significantly lower than patients in the other groups 30 min after beginning OTFC consumption. Three of the 12 patients receiving the highest dose of OTFC experienced transient oxygen saturation less than 90% which, however, was easily treated by commands to take a breath. Anesthetic inductions were rated good or excellent in 80% of the patients and recovery times were similar irrespective of the OTFC dose. OTFC caused dose-independent preoperative pruritus in 90% or more of patients and pruritus (33%-70%), nausea (30%-58%), and vomiting (50%-83%) postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

A new lormetazepam galenical formulation for sublingual premedication.

This study reports a double-blind evaluation of a new formulation of lormetazepam for sublingual administration, given as a premedicant in 48 female patients undergoing minor gynecological procedures. Both patient's and nurse's assessments for anxiety and sedation were recorded at different times. Anxiolysis and sedation were present 30 minutes after administration of the drug as reported by the patient with a peak effect at 45 minutes. Nurses reported significant differences in sedation only, but already present at 30 minutes after premedication. The memory test showed no persistent effect of the benzodiazepine one day after surgery.

Administration, Sublingual↗