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PubMed2006

Melatonin premedication and the induction dose of propofol.

BACKGROUND AND OBJECTIVES: Melatonin (N-acetyl-5-methoxytryptamine) is the main indolamine secreted by the pineal gland. Many studies showed that premedication with melatonin is associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills and without prolonging recovery. We hypothesized that melatonin decreases the amount of propofol required to produce an adequate depth of hypnosis at induction time. METHODS: After approval from the research committee of the anaesthesia department, informed written consent was taken from 45 adult patients undergoing different surgical procedures. They were allocated randomly into three groups according to the premedication. At 100 min preoperatively, premedication was given in the form of oral melatonin 3 mg (M3 group), oral melatonin 5 mg (M5 group) or no premedication (P group). After preoxygenation an anaesthesiologist who was blinded to the premedication injected propofol 10 mg over 5 s every 15 s until the bispectral index (BIS) score fell to 45. The total dose of propofol required to achieve a BIS score of 45 was recorded. Response to verbal commands and eyelash reflex was evaluated and correlated to the BIS score and propofol dosage. When a BIS score of 45 was reached, tracheal intubation was accomplished after administration of a narcotic and muscle relaxant. RESULTS: The mean (standard devitation (SD)) induction dose of propofol producing a BIS score of 45 was 134 (25) mg in the placebo group vs. 115 (19.5) and 114 (20.9) mg in the M3 and M5 groups, respectively (P < 0.05). The propofol dose required to achieve loss of eyelash reflex and loss of response to verbal commands was more in the placebo group. Anxiety score as assessed by visual analogue scale (VAS) scored more in the placebo group than both melatonin groups. Time spent in the recovery room did not differ between the three groups. CONCLUSION: Melatonin premedication, in an oral dose of either 3 or 5 mg, reduced the required dose of propofol to achieve a BIS score of 45, reflecting a sufficient level of hypnosis for tracheal intubation without prolongation of postoperative recovery room stay.

Adolescent↗
PubMed2000

Clonidine premedication decreases propofol consumption during bispectral index (BIS) monitored propofol-ketamine technique for office-based surgery.

BACKGROUND: Propofol-ketamine anesthesia is a room air, spontaneous ventilation (RASV), dissociative intravenous (IV) sedation technique reported to have a near-zero postoperative nausea and vomiting (PONV) rate. Clonidine premedication has been reported to control blood pressure intra- and postoperatively, as well as to reduce the requirements for hypnotic agents. The bispectral index (BIS) monitor is a reproducible, objective, observer independent, quantitative measurement of the hypnotic state. OBJECTIVE: This study was designed to compare the propofol consumption rate during BIS monitored propofol-ketamine anesthesia for office-based, elective female facial rhytidectomy in patients with and without clonidine premedication. METHODS: Six patients receiving clonidine (200 microg oral premedication administered 30-60 minutes prior to induction of anesthesia were compared with a recent, historical control group of six patients who received no premedication. A BIS of 60-70 was chosen as the standard of comparison for light hypnotic state. A dilute propofol solution was used to gradually titrate anesthesia to a BIS of 60-70 prior to the administration of ketamine. RESULTS: A statistically significant reduction in propofol consumption was observed in the clonidine premedicated female elective rhytidectomy patients compared with those not receiving the clonidine. Other than modestly increased requirements for IV fluids, there were no adverse effects observed with clonidine premedication.

Administration, Oral↗
PubMed2000

[Clonidine compared to midazolam for intravenous premedication for ambulatory procedures. A controlled double blind study in ASA 1 patients].

OBJECTIVE: Midazolam is frequently used for premedication in day-case surgical patients whereas clonidine is rarely administered for this indication. However, clonidine has several useful effects that make the drug an interesting alternative to conventional premedicants. Thus, in this randomised, double-blind, and controlled study the anxiolytic effect of midazolam was compared to that of clonidine. Furthermore, effects on postoperative complaints and minor complications, and readiness for discharge were investigated. METHODS: 100 ASA-1 patients undergoing wisdom teeth extraction on a day-case basis were included into the analysis. A further 50 patients who received no premedication served as a control group. General anaesthesia was standardised (propofol-fentanyl-isoflurane in N2O/O2). The anxiolytic effect of the premedication was assessed using the Erlanger anxiety- and tension scale (EAS). The test was applied before and after intravenous premedication with 1.5 micrograms/kg clonidine or 50 micrograms/kg midazolam and repeated once postoperatively. During recovery the incidence and severity of pain, nausea and vomiting, and shivering were recorded. The readiness for discharge was assessed using standardised discharge criteria. The recording of data was completed by a telephone interview on the day after surgery. RESULTS: The demographic data of the groups did not differ. In the two treatment groups there was a time-dependent decrease of anxiety and tension. However, postoperatively there was no difference between the levels of anxiety and inner tension between the premedicated patients and the untreated control group. Furthermore there was no difference in the incidence and severity of any postoperative complications. Time until the patients were ready for discharge did not differ between the three groups. CONCLUSION: The effects of an intravenous premedication with 1.5 micrograms/kg clonidine or 50 micrograms/kg midazolam, respectively in young ASA-1 patients undergoing minor surgical procedures on a day-case basis are restricted to decrease of anxiety and inner tension before surgery. No beneficial effects were found during the postoperative period compared with untreated control patients.

Adjuvants, Anesthesia↗
PubMed1998

The optimal test dose of epinephrine for epidural injection with lidocaine solution in awake patients premedicated with oral clonidine.

UNLABELLED: We attempted to determine the optimal test dose of epinephrine for use with epidural anesthesia in awake patients premedicated with clonidine. Eighty-eight adult patients were randomized into two groups [oral premedication with clonidine 5 microg/kg (CLON) or no premedication (CONT)]. Before induction of general anesthesia, heart rate (HR) and blood pressure (BP) were measured for 3 min after the i.v. injection of 3 mL of 1.5% lidocaine containing epinephrine (0, 1.25, 2.5, 5, 7.5, or 15 microg) in a randomized, double-blind manner. We calculated 95% confidence intervals for the peak HR and BP increases induced by each dose of epinephrine. At 7.5 microg, epinephrine induced a significantly greater increase in HR and BP in CLON than in CONT. The 95% confidence interval for the HR change induced by 7.5 microg of epinephrine in CLON was nearly the same as the accepted standard dose of epinephrine (15 microg) in CONT. We conclude that premedication with clonidine enhances HR and BP responses to the i.v. administration of epinephrine-containing epidural test solutions. Consequently, 7.5 microg of epinephrine may be sufficient to enable detection of accidental injection into a blood vessel in awake patients premedicated with clonidine 5 microg/kg. IMPLICATIONS: Clonidine, a commonly used preanesthetic medication, alters patients' cardiovascular responses to drugs such as epinephrine. Our randomized, double-blind study suggests that, in awake patients receiving oral clonidine premedication, 7.5 microg of epinephrine (half the usual dose) is adequate as an indicator of accidental injection into the epidural vessels during epidural anesthesia.

Adult↗
PubMed2004

Premedication for tracheal intubation: a prospective survey in 75 neonatal and pediatric intensive care units.

OBJECTIVE: In children, like in adults, tracheal intubation is a painful procedure that may induce hypertension, tachycardia, and other undesirable hemodynamic disorders. Although premature neonates are very sensitive to pain and vulnerable to its long-term effects, the need for sedation before tracheal intubation is still discussed in neonatal units. Our objective was to investigate the practice of premedication before tracheal intubation in neonatal and pediatric units and determine the influence of premedication on intubating conditions. DESIGN: We performed a 10-day prospective survey in 75 neonatal and pediatric intensive care units among the 98 licensed in France. A questionnaire was completed for each intubation performed in each surveyed unit. SUBJECTS: A total of 204 patients were studied: 140 neonates, 52 infants, and 12 children. MAIN RESULTS: Data on 204 tracheal intubations were collected from 223 that were performed during the study period (participation rate, 91.4%). Premedication was used before intubation for 37.1%, 67.3%, and 91.7% of neonates, infants, and children, respectively (p <.0001). In the subgroup of neonates, premedication was particularly rare for the youngest and the smallest infants. Midazolam was the principle hypnotic used in neonates, whereas propofol was mainly used in children. Opioids or muscle relaxants were used in 16.2% and 4.4% of the patients, respectively. A low success rate and a high incidence of hypoxemia and bradycardia were correlated with the inexperience of the operator. Premedication did not significantly influence either the success rate or the undesirable events associated with tracheal intubation. CONCLUSION: Use of premedication before tracheal intubation is limited in neonates and increases according to the age of the patient. Midazolam does not seem to be an accurate choice to improve intubating conditions in neonates and infants. Because tracheal intubation is a technique that requires a skill only developed by regular practice, operators who have limited experience with intubating children should be supported by senior operators.

Anesthesia↗
PubMed1992

Clinical and metabolic responses to different kinds of premedication in ASA III patients.

Clinical and metabolic responses to atropine plus pethidine and to scopolamine plus morphine premedication were studied in 45 ASA physical status III patients undergoing gynaecological procedures. Atropine 0.5 mg plus pethidine 50 mg intramuscularly (Group 1), scopolamine 0.24 mg plus morphine 8 mg (Group 2), or intramuscular placebo (Group 3) premedication were given in random, double-blind fashion. Scopolamine-morphine premedication caused a significant decrease in energy expenditure (EE) and oxygen consumption (VO2) (from 1229 +/- 193 to 1184 +/- 221 kcal/24 h, P = 0.004 and from 105 +/- 11 to 102 +/- 12 ml/min/m2, P = 0.006, respectively) simultaneously with a decrease in rate-pressure product (RPP) (P = 0.0001) and an increase in pressure-rate quotient (PRQ) (P = 0.034). Atropine-pethidine premedication induced a decrease in RPP but not in EE or VO2. In the placebo group both RPP and VO2 first increased and then slowly returned to the levels measured prior to premedication. The RPP was significantly lower in Group 2 than in Groups 1 and 3 at both 30 and 60 min. The degrees of subjective tiredness and anxiolysis were significantly greater in Groups 1 and 2 (showing good sedative and anxiolytic effect) than in Group 3. These results show that in ASA III patients, atropine-pethidine premedication does not decrease the sympathoadrenal reaction to the degree its anxiolytic and sedative effect would suggest. This may indicate neuroendocrine stress induced by atropine-pethidine.

Aged↗
PubMed1989

Interrelations among children, parents, premedication, and anaesthetists in paediatric day stay surgery.

OBJECTIVE: To investigate the incidence of difficulties associated with parental presence during the induction of anaesthesia in children and the influence of premedication with special reference to vomiting after papaveretum. DESIGN: Mixed factual and multiple choice questionnaire completed by medical and nursing staff and parents during and after admission. SETTING: Teaching hospital with regional paediatric general surgical unit where parental presence during induction of anaesthesia is long established. PATIENTS: 151 Children aged 1-14 years who had not previously undergone surgery attending with parents for day stay general surgical procedures. INTERVENTION: Children were randomly allocated to receive no premedication (group 1), oral diazepam elixir (0.3 mg/kg) (group 2), or intramuscular papaveretum with hyoscine (0.3 mg/kg with 0.006 mg/kg) (group 3). No other modification to established day stay routine was made. RESULTS: No major problems were associated with the presence of parents during the induction of anaesthesia. Only 10 of the 141 parents who accompanied their child caused some difficulty, and five became distressed. Premedication with both diazepam and papaveretum resulted in sedation but did not ease induction of anaesthesia. Papaveretum greatly reduced pain and distress immediately after the operation, pain and discomfort being observed in only 15% of children (7/48) compared with 66% (27/41) in group 1 and 49% (22/45) in group 2. Papaveretum, however, must be given intramuscularly, and nurses observed that the children preferred being given premedication orally to intramuscularly. In addition, the incidences of nausea and vomiting were significantly higher in the postoperative ward and at home with papaveretum, although no patient who had been given the drug was nauseous or vomited in the recovery area. The incidences of nausea in group 3 were 62% (31/50) and 57% (27/47) in the postoperative ward and at home, respectively, v 21% (7/33) and 14% (4/29) in group 1 and 13% (5/38) and 14% (5/37) in group 2; the incidences of vomiting in group 3 were 60% and 43% in the postoperative ward and at home, respectively, v 18% and 7% in group 1 and 11% and 11% in group 2. Finally, neither the administration or otherwise of premedication nor the drug given affected the children's or parents' perception of day care surgery. CONCLUSIONS: Difficulties with parents in anaesthetic rooms were not common or severe. Premedication provides preoperative sedation and papaveretum improves the immediate postoperative course but the incidences of nausea and vomiting after operation are higher with its use than without.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Control of gastric acidity by glycopyrrolate premedication in the parturient.

The effect of premedication with the anticholinergic quaternary ammonium compound, glycopyrrolate (0.4 mg), on gastric juice pH was investigated in 23 parturients scheduled for elective cesarean section under general anesthesia, and the results were compared to a control group of 15 nonpremedicated obstetric patients and 25 parturients premedicated with atropine (0.6 mg). In the nonpremedicated control group, the mean gastric juice pH was 2.36 (SE +/- 0.23), 66% having a pH less than the critical level of 2.5. Premedication with atropine did not significantly increase the gastric pH, while in those premedicated with glycopyrrolate, the mean pH increased to 3.7 (+/- 0.35), and the incidence of pH less than the critical level dropped to 34%. The effect of glycopyrrolate on gastric juice pH was significantly increased when the premedication-induction time was prolonged to 60 to 120 minutes. It was concluded that glycopyrrolate premedication can be used in the parturient as an additional measure to safeguard against acid-aspiration syndrome.

Anesthesia, Obstetrical↗
PubMed2004

Evaluation of the effects of premedication on gastroduodenoscopy in cats.

OBJECTIVE: To evaluate the effects of hydromorphone, hydromorphone and glycopyrrolate, medetomidine, and butorphanol premedication on the difficulty and time required to pass an endoscope into the stomach and duodenum of cats anesthetized with ketamine and isoflurane. DESIGN: Randomized complete block crossover study. ANIMALS: 8 purpose-bred adult female cats. PROCEDURES: Each cat was premedicated and anesthetized 4 times with an interval of at least 7 days between procedures. Cats were premedicated with hydromorphone, hydromorphone and glycopyrrolate, medetomidine, or butorphanol administered IM. Twenty minutes after premedication, sedation was assessed by use of a subjective ordinal scale. Cats received ketamine administered IM, and 10 minutes later a cuffed orotracheal tube was placed and anesthesia maintained with isoflurane. Cats breathed spontaneously throughout the procedure. When end-tidal isoflurane concentration was stable at 1.4% for 15 minutes, endoscopy was begun. The times required to pass the endoscope through the cardiac and pyloric sphincters were recorded, and the difficulty of endoscope passage was scored by use of a subjective ordinal scale. RESULTS: No significant differences in difficulty or time required to pass the endoscope through the cardiac and pyloric sphincters were found among premedicant groups. Premedication with medetomidine resulted in the greatest degree of sedation and longest time to return to sternal recumbency. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that hydromorphone, hydromorphone and glycopyrrolate, medetomidine, and butorphanol at the doses tested can be used satisfactorily to premedicate cats prior to general anesthesia for gastroduodenoscopy.

Analgesics↗
PubMed1999

The effect of opioid and acepromazine premedication on the anesthetic induction dose of propofol in cats.

The median effective dosage (ED50) for induction of anesthesia with propofol was determined by using the up-and-down method in 31 unpremedicated cats, in 30 cats premedicated with butorphanol, 0.4 mg/kg body weight (BW), and acepromazine, 0.1 mg/kg BW, intramuscularly, and in 30 cats premedicated with morphine, 0.2 mg/kg BW, and acepromazine, 0.1 mg/kg BW, intramuscularly. The dose required for a satisfactory anesthetic induction in 50% of unpremedicated cats (ED50) was 7.22 mg/kg BW and of premedicated cats was 5.00 mg/kg BW. The reduction in dose was statistically significant in both premedicated groups compared with no premedication. There was no significant difference in ED50 between premedication regimes. Cyanosis was the most common adverse effect observed in all groups following anesthetic induction with propofol.

Acepromazine↗
PubMed2001

Premedication with low-dose oral midazolam reduces the incidence and severity of emergence agitation in pediatric patients following sevoflurane anesthesia.

BACKGROUND: Sevoflurane is a volatile anesthetic agent with low pungency, non-irritating odor, and low blood/gas partition coefficient that makes it an attractive alternative to halothane. However, a high incidence of emergence agitation (EA) has been reported in pediatric patients after sevoflurane anesthesia. The underlying mechanism of sevoflurane-induced EA remains unclear. Rapid recovery of consciousness (emergence) from sevoflurane anesthesia has been proposed as one possible mechanism. We, therefore, hypothesized that sedatives such as midazolam may counteract sevoflurane's rapid emergence and thus reduce the incidence and the severity of sevoflurane-induced EA. METHODS: A prospective, controlled, single-blinded study was carried out in 88 ASA class I or II pediatric patients scheduled for elective outpatient surgery. Patients were assigned to receive either midazolam (oral midazolam, 0.2 mg/kg as anesthetic premedication) or saline (oral normal saline as premedication) before the conduct of anesthesia. When separation from parents was due its process was watched and evaluated. Induction of anesthesia and maintenance of anesthesia were uniform in both groups. Induction of anesthesia was made possible with 8% sevoflurane and N2O in 50% O2. Intubation was performed straight without the aid of muscle relaxant and the ventilator was set to maintain normocapnia. Anesthesia was maintained with 3% sevoflurane and N2O in 50% O2 until the surgery was over. All matters of relevant time periods were recorded (induction, surgical procedure, extubation and transportation). In the post-anesthesia care unit (PACU), adverse events, the incidence and the severity of EA, analgesic requirement, duration of PACU stay, and parental as well as PACU nurses' satisfaction were evaluated. RESULTS: A significant lower incidence and less severity of EA were noted in patients premedicated with midazolam. Less postoperaive analgesia was required in patients who had received midazolam. Although midazolam-premedicated patients remained sedated after sevoflurane anesthesia, the duration of the PACU stay was not significantly different from that of saline-treated patients. Both parents and PACU nurses were more satisfied with midazolam as premedication. No solid evidence showed that there was close correlation between the process of separation from parents and the occurrence of EA. CONCLUSIONS: Premedication with oral midazolam is safe, convenient and effective in decreasing the occurrence of sevoflurane-induced EA. It does not delay discharge from PACU and is suitable for outpatient surgery.

Anesthesia, Inhalation↗
PubMed1992

Behavioural changes in children following minor surgery--is premedication beneficial?

One hundred and twenty-three male children, aged one to ten years, were studied to determine the influence of premedication on changes in patterns of behaviour following hospitalization for repair of inguinal hernias. Four comparable groups were selected for premedication regimen: (1) A control group without premedication; (2) oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg and droperidol 0.15 mg/kg; (3) oral midazolam 0.45 mg/kg; (4) intramuscular midazolam 0.15 mg/kg. Standard inhalational anesthesia was used and caudal blocks employed for analgesia. The parents returned a questionnaire at two weeks. Changes in behaviour were reported in 78% of the children and overall, premedication showed little benefit. However, midazolam premedication was associated with a significantly lower incidence of night-time crying and awakening, compared with no premedication. Only for night-time crying and day-time toilet training did age below five years prove to be a significant contributing factor.

Anxiety, Separation↗
PubMed1989

[Rectal premedication with midazolam in children. A comparative clinical study].

Anesthetic premedication by injection is usually poorly accepted by children, especially those under 10 years of age. Less disturbing for the child is oral premedication, but this increases the risk of aspiration and must be administered 1.5-2 h before anesthetic induction. This double-blind study was performed in children to investigate the efficacy, acceptance, and general safety of midazolam given rectally. METHOD. Rectal premedication was administered to a total of 80 healthy children between 2 and 10 years of age undergoing elective operations. The children were divided randomly into two groups: group I received 0.4 mg/kg and group II 0.5 mg/kg midazolam with the addition of 0.015-0.02 mg/kg atropine. Premedication was carried out on the pediatric ward. The calculated dose was drawn from the ampule and diluted to 8-10 ml with distilled water. This dose was instilled immediately behind the anal sphincter using a suitable plastic applicator (Stanylan). The following parameters were recorded: immediate reaction to the rectal medication, sedative-hypnotic signs, and acceptance of the anesthetic mask. Heart rate and blood pressure were measured before premedication and before the induction of anesthesia. Observations were made for 5 h post-operatively. Any unusual side effects of the treatment were also noted. The existence of any anterograde amnesia was investigated in 20 children (10 in each group) between 6 and 10 years of age. RESULTS. There was no significant difference between the children allocated to the two groups with regard to age, body weight, sex, type of operation, and duration of anesthesia (Table 2). Of the total of 80 children, 66 (82.5%) accepted the rectal instillation well, 12 (15%) moderately well, and 2 (2.5%) poorly. Signs of respiratory depression or allergic reaction to midazolam were not observed in any case. The observations made before induction of anesthesia are presented in Table 3. The children in group II exhibited significantly greater (P less than 0.05) slurred speech than those in group I. A low incidence of hiccup was seen in both groups. Most of the children (27 in group I, 67.5%; 37 in group II, 92.5%: P less than 0.05) were delivered to the operating room lying down, whereas the others were sitting up in bed but showed no desire to get up. Between 10 and 55 min after the premedication, a total of 5 children (12.5%) in group I and 2 (5%) in group II were restless or crying on arrival in the induction room. Most, however, were quiet to tired/drowsy. The optimal sedative-hypnotic action was observed after 20-30 min (Fig. 1). At this time 21.7% of the children in group I were tired/drowsy, whereas 50% in group II were tired/drowsy and 9.1% were asleep but easy to arouse. This effect was significantly greater in group II (P less than 0.01). Acceptance of the mask was comparable in both groups (Table 4) and was tolerated well to very well by 92-97% of the children. (ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Rectal↗
PubMed1989

The effects of oral transmucosal fentanyl citrate premedication on preoperative behavioral responses and gastric volume and acidity in children.

The authors compared the safety, efficacy, and effects on gastric volume and pH of oral transmucosal fentanyl citrate (OTFC) premedication and of placebo lollipop and no premedication in 55 children undergoing elective operations. The patients were randomly assigned to receive no premedication (group A, N = 18); OTFC containing 15-20 micrograms/kg of fentanyl citrate (group B, N = 18); or a placebo lollipop (group C, N = 19). Activity (sedation) and anxiety scores, vital signs (including systolic and diastolic arterial blood pressures, heart and respiratory rates), and pulse oximetry determined oxygen saturation were measured before and at 10-min intervals after premedication until the patients were taken to the operating room. Gastric contents were aspirated via an orogastric tube and analyzed for volume and pH after induction of anesthesia. Quality of induction and recovery were evaluated using scoring schedules; recovery times were measured and side effects recorded. OTFC was readily accepted and provided levels of sedation and anxiolysis significantly greater after 10 min than after no premedication or the placebo lollipop. Arterial blood pressures, heart rate, and oxygen saturations were not different among the three groups. In patients given OTFC, respiratory rates were significantly lower after 10 min than they were in patients having no premedication.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1989

[Premedication. Pharmacologic preparation prior to regional or general anesthesia].

Patient safety and patient well-being are indications for premedication prior to regional or general anaesthesia. Patient well-being may be improved by anxiolytic acting premedication or analgetic premedication to patients in pain. Side-effects of premedication, as anticholinergic effects or emesis, should be avoided. In outpatient clinics it is important to avoid premedication regimens which may prolong patient recovery after the procedure. The paper discusses the principles of premedication, and includes a survey of the main drugs presently available for this purpose.

Anesthesia Recovery Period↗
PubMed1984

[Comparative clinical studies on parenteral and oral premedication in childhood with special regard to the volume and acidity of the gastric juice].

90 children of age between 1 and 10 years who were scheduled for adenotomy were randomized into 3 premedication-groups. Group 1 received no premedication, group 2 chlorprothixene 1 mg/kg i.m. and group 3 chlorprothixene 2 mg/kg orally. Prior to induction of anaesthesia 63.3% of the unpremedicated children were anxious or crying, in contrast to 23.3% of the children given oral or i.m. premedication. With respect to the reaction on venepuncture with a Butterfly G 23, there was no significant difference between the groups. The volume of gastric acid (median values) was 0.056 ml/kg in group 1, 0.063 ml/kg in group 2, and 0.068 ml/kg in group 3, with a pH of 2.0, 1.5 and 2.0 respectively. One hour after operation 44.8% of the children in group 1, 92.6% in group 2 and 84.6% in group 3 were calm or sleeping. Premedication definitively improves the pre- and postoperative management of children. We now recommend oral chlorprothixene for the premedication of children because the effect of this oral premedication is equivalent to i.m. application, and the oral route has no influence on the quantity or acidity of gastric contents.

Adenoids↗
PubMed1981

[The action of oxyfedrine on haemodynamics, inotropism and blood perfusion of the partially ischaemic myocardium after digoxin premedication. Studies on anaesthetized dogs (author's transl)].

The effect exerted on the partially ischaemic heart when administering 0.9 mg/kg L-3-(beta-hydroxy-alpha-methylphenethylamino)-3'-methoxypropiophenone (oxyfedrine, ildamen) approx. 10 min after i.v. application of 0.05 mg/kg digoxin was tested on 20 dogs previously anaesthetized with propiomazine-pentobarbital. The following parameters were studied and subsequently compound with the results of former trials of ours' without digoxin premedication: aortic pressure (ASP, ADP), left-ventricular pressure (LVSP, LVEDP), heart rate (HR), cardiac output (HMV), stroke volume (SV), dp/dtmax, dp/dtmax/IP, t-dp/dtmax, blood flow in the normal and partially ischaemic myocardium, the latter being measured with heat conductance probes and labelled microspheres. ASP and ADP show the same reduction--as compared with the control value--both after the administration of oxyfedrine with and without digoxin premedication. After digoxin premedication oxyfedrine led to a somewhat less marked reduction of LVSP; on premedication with digoxin LVEDP was slightly increased whereas it was reduced after additional administration of oxyfedrine as was also the case without digoxin pretreatment. The increase in HR after oxyfedrine is almost the same as without digoxin pretreatment. Also the increase in HMV and the SV lowering are not influenced by digoxin. By administration of oxyfedrine dp/dtmax is always increased by the same amount, starting from the already increased value after digoxin premedication, which is probably an additive effect. The same applies to the quotient dp/dtmax/IP. After oxyfedrine the time t-dp/dtmax is lowered by the same amount, irrespective of a digoxin premedication. Oxyfedrine does not produce a further increase in the heat conductance values after previous application of digoxin; when measuring the blood flow with labelled microspheres the same result was found, which means that by previous administration of digoxin the circulatory effect of oxyfedrine is obviously inhibited. Summing up one can say that by combining the active principles digoxin and oxyfedrine the function parameters of the heart can be influenced only positively.

Anesthesia↗
PubMed1993

[The effect of different types of premedication on gastric juice volume and pH].

60 pregnant women and 60 parturients treated with selected surgery were studied according to the influence of different types premedication on the gastric juice volume and pH. Parturients were divided into six groups (AI-AVI) with 10 participants in each one. Groups were comparable for a variety of signs-age, type and duration of the surgical procedure and methods of carrying out the general anaesthesia. Surgically treated patients were also divided into six groups (from B 1 to B), each group containing ten patients with similar symptoms. This makes possible comparison between them. Parturients from group AI were given each 0.007 mg/kg/body weight atropine i.v. 20 min before introduction in anaesthesia; group A II-0.014 mg/kg/body weight metacin; group AIII-0.3 mg/kg/body weight alkosin; group AIV-o.014 mg/kg/body weight metacin and 0.21 mg/kg/body weight dimidrol. Parturients from AV were given each two measure spoons Almagel A per os-an antacid drug-30 min before introduction in anesthesia and 0.007 mg/kg/body weight atropine i.v., introduced 20 min before the beginning of anesthesia. The parturients from group AVI were given each 400 mg H2 blocker (2 tabl.) per os-cimetidine-2 hours before the beginning of anesthesia and atropine 20 min before introduction in anesthesia in the same dosage as for the parturients from group AV. Surgically treated patients from group BI received as a premedication the following drugs 20 min before the beginning of anesthesia: atropine-0.007 mg/kg/body weight, fentanyl-0.001 and droperidol-0.03 mg/kg/body weight introduced i.v. Group BII-geluzil liquid-2 tea spoons 30 min before introduction in anesthesia and atropine i.v. 20 min at the beginning of anesthesia; group BIII received as a premedication dormicum-0.1 mg/kg/body weight and atropine in the same dosage as for the patients from group BII. Group BIV received as a premedication 20 ml 8.4% solution of sodium bicarbonate per os 20 min before the beginning of anesthesia and atropine in the same dosage as the patients from group BIII; BV received 0.003 mg/kg/body weight gastrodin, introduced i.v. 20 min before the beginning of anesthesia. Patients from group BVI received as a premedication for 2 hours before the beginning of anesthesia gastrozepin 2 tabl. (50 mg) per os and atropine in the same dosage as the patients from group BII. Gastric juice was taken by means of nasogastric tubing immediately before premedication, introduction in anesthesia and its end to fix its pH. The volume of gastric juice generated during the surgical procedure was determined before extubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Obstetrical↗