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[Reduction of preoperative anxiety. A study comparing music, Thalamonal and no premedication].

Ninety ASA I-II patients scheduled for a pre-planned surgical operation were randomly assigned to three groups: the first of these received no premedication, the second received 1-2 ml Thalamonal i.m., and the third were offered music from a walkman via earphones. Excluded from the study were patients under 15 and over 65 years of age, patients suffering from malignant diseases, those expecting operations of uncertain outcome, and patients whose mother tongue was not German. All 90 patients were cared for by the same investigator. She obtained informed consent on the eve of the scheduled operation and chose the music that was to be offered preceding the operation according to the patient's wishes. Each patient's history was evaluated, including the grade of anxiety and his or her attitude towards music. Of course, a physical examination was also conducted. Ninety minutes prior to the operation, psychometric tests (STAI-G-X2, STAI-G-X1, ESA-S, and BF-S) were performed. Thereafter, either music was offered or else 1-2 ml Thalamonal was injected, according to the random assignment: group 1 received neither. Fifteen minutes before entering the operating room, the tests expressing anxiety with regard to the situation were repeated as was the physical examination, and the investigator once again assessed the level of anxiety of the patients. On the evening of the day of surgery, all patients were asked to give an evaluation of the preoperative period. Trait-anxiety, as measured by the STAI-G-X2-Test, was comparable in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Induction dose-response curves for midazolam and ketamine in premedicated ASA class III and IV patients.

Using probit analysis, dose-response curves for induction of anesthesia with midazolam or ketamine were constructed in ASA class III and IV patients premedicated with morphine, 0.1 mg/kg, and glycopyrrolate, 4 micrograms/kg. For ketamine, ED50 values for abolition of the response to verbal commands, eyelash stimulation, and painful stimulation were 0.9, 1.3, and 1.3 mg/kg, respectively; corresponding ED95 values were 1.6, 2.3, and 4.3 mg/kg, which are within the range of clinically recommended doses. For midazolam, ED50 values for verbal commands, eyelash stimulation, and painful stimulation were 0.19, 0.24, and 0.36 mg/kg, significantly greater than those previously reported for unpremedicated ASA class I and II patients. The corresponding ED95 values, 0.35, 0.43, and 1.04 mg/kg exceed previously reported values and are appreciably greater than the doses used in most previous studies of midazolam induction. Midazolam decreased systolic blood pressure slightly but significantly (from 138 +/- 4 to 128 +/- 4 mm Hg, mean +/- SEM, P less than 0.005), while diastolic blood pressure and heart rate remained unchanged. In contrast, ketamine increased systolic blood pressure (from 141 +/- 4 to 164 +/- 5 mm Hg, P less than 0.005), diastolic blood pressure (from 71 +/- 3 to 88 +/- 4 mm Hg, P less than 0.005), and heart rate (from 84 +/- 2 to 102 +/- 4 beats/min, P less than 0.005). On the basis of these data, we conclude that in ASA class III and IV patients, midazolam induction allows for hemodynamic stability and avoids the significant tachycardia and hypertension associated with equipotent doses of ketamine.

Anesthesia, Inhalation↗

Evaluation of acepromazine/meperidine/atropine premedication followed by thiopental anesthesia in the cat.

Cardiopulmonary function was assessed in healthy cats premedicated with intramuscular acepromazine, meperidine, atropine combination (premix), followed by induction and maintenance with intravenous thiopental for 30 min. Cardiac output by thermodilution, heart rate, blood pressure and blood gas analysis were evaluated over 120 min. A minor degree of respiratory depression was noted in the cats. Cardiac index (cardiac output/kg) was significantly depressed following thiopental induction and for the entire 120 min studied. Stroke volume was significantly reduced after premix administration and for 90 min posthiopental induction. No significant change in heart rate, systemic vascular resistance or blood pressure was observed. Significant cardiovascular depression was produced by the premedicant, and this persisted following thiopental anesthesia.

Acepromazine↗

Efficacy of lorazepam oral fast dissolving drug formulation (FDDF) in anesthesia premedication in adults: a double-blind placebo controlled comparison.

Lorazepam 4 mg oral fast dissolving drug formulation was compared to placebo in a double-blind study as premedicant in adult anesthesia. Lorazepam induced in this trial a marked relief of anxiety after 60 minutes without changes in vital parameters nor in reflex activity or muscle tonus. Anterograde amnesia was present in about 60 percent of the patients. The clinical anesthetists rated the quality of premedication as satisfactory or better in 77 percent of lorazepam treated patients. The rating as "good" or "excellent" by patients reached 93 percent. The incidence of side effects was low. Postoperative residual effects on attention, cognitive, somatic and visceral functions were present till 5 hours postmedication. Lorazepam FDDF (fast dissolving drug formulation) appeared to be an effective and clinically safe premedicant for its good anxiolytic and amnestic effect and its high acceptance by the patients. Its use is not recommended for outpatient anesthesia because it prolongs recovery from anesthesia.

Absorption↗

A comparison of high-dose pentazocine with pethidine and diazepam in paediatric premedication.

A comparision of a high dose of pentazocine (0.9 mg/kg), and moderate doses of pethidine (1 mg/kg) and diazepam (0.2 mg/kg) as pre-anaesthetic medication was carried out in a double-blind between-patient placebo-controlled trial in 200 children. The assessment of the drugs as pre-anesthetic medication was made by comparing the sedative effect before induction, the status of the patient at induction and the patient's behaviour in the recovery room. All the active drugs were superior to the placebo at induction of anaesthesia. Postoperatively the sedative effect of the high dose of pentazocine was superior to that of the other active drugs, presumably due to the strong analgesic effect at this dose. The rate of respiration was clearly lower after pentazocine than after the other two active drugs. Other side effects or complications did not differ between the groups. It is concluded that, in spite of its favourable sedative effect, a high dose of pentazocine should be used with caution in pediatric premedication because of the possibility of slight respiratory depression.

Child, Preschool↗

[Comparative studies on premedication and general anesthesia for endoscopies of the upper airways].

Cardiovascular disorders during endoscopy of the upper respiratory tract have since long induced anaesthetists and laryngologists to find a suitable anaesthetic procedure. It was the purpose of the present study to determine the influence exerted by different kinds of premedication and different modes of anaesthesia on the cardiovascular system, pO2, and the acid-base status. The results obtained show that a hypertensive-tachycardiac response to direct laryngo-tracheoscopy could not be prevented in any of the groups under investigation. Lowest blood pressure and heart rate increases were seen in those groups of patients which received an analgetic drug (Fentanyl or nitrous oxide) in addition to hexobarbital. During endoscopy, respiratory acidosis occurred in five groups of patients. All patients were sufficiently oxygenated.

Acid-Base Equilibrium↗

[Morphine and scopolamine in premedication. A comparison of peroral and transdermal administration with intramuscular injections].

A randomized clinical study was undertaken to compare the feasibility and effectiveness of two different premedications. Thirty-eight patients admitted for elective tonsillectomy gave informed consent and were randomly assigned to two groups. One group received morphine orally and scopolamine transdermally. In the second group, the same substances were applied intramuscularly before the operation. The following parameters were evaluated: psychological state, sedation, hemodynamics, salivation, pain and side effects. General anesthesia was maintained with thiopental, fentanyl, N2O/O2, and enflurane; alcuronium was used for muscle relaxation. The results showed no significant differences between the groups for any of the parameters considered.

Administration, Oral↗

Postoperative delirium secondary to atropine premedication.

Anticholinergic agents used as preoperative medications have the ability to induce postanesthetic delirium reactions. We present a case of postanesthetic delirium secondary to premedication with atropine which was treated with intravenous physostigmine. This case is presented to alert the clinician to the possibility of this reaction occurring with the use of atropine, and to demonstrate the use of physostigmine in reversing postanesthetic delirium reactions caused by anticholinergics.

Adult↗

A combination of oral diazepam and droperidol for premedication. A double blind comparison with diazepam alone.

Oral diazepam is commonly used as a premedicant. For a given dose there is considerable between patient variation in clinical effect and plasma levels. The addition of droperidol may improve consistency and contribute antiemesis whilst avoiding the undesirable effects of droperidol alone. Ninety patients undergoing minor gynecological or minor urological surgery were given as an oral premedicant either diazepam (0.185 mg/kg) or one of two combinations of diazepam and droperidol (diazepam, 0.185 mg/kg plus droperidol, 0.09 mg/kg; or diazepam, 0.135 mg/kg plus droperidol, 0.09 mg/kg). There was no significant difference between the groups in altering mean anxiety measurements or improving consistency of action as judged by the number of patients having reduced anxiety measurements. Side effects, including nausea and vomiting, were not significantly different between the three groups. In the doses used there was no practical advantage in adding droperidol to diazepam for oral premedication.

Administration, Oral↗

Respiratory function following premedication with droperidol or diazepam.

Respiratory function was measured before and 1 hour after premedication with diazepam (10 mg IM) or droperidol (5 mg IM) in 2 groups of 14 normal patients scheduled for elective surgery. Diazepam had no significant effects on respiratory rate, tidal volume, minute ventilation, dead space, VD/VT %, alveolar ventilation, expired Po2, or Pco2, end-tidal Pco2, arterial Po2 or Pco2, or alveolar-arterial Po2 or Pco2 gradients. Droperidol was associated with statistically significant but modest reductions in tidal volume (-13.3%) and minute ventilation (-8.4%) while other respiratory functions remained unaffected.

Adult↗

Child premedication per os with lorazepam.

Our study show that lorazepam calms the child very well before his operation, as long as a minimum dose of 0.04 mg/kg is administered; if one wishes to increase the chances of provoking complete or incomplete amnesia, the dose must be increased to 0.05 mg/kg, administering a dose of 0.06 mg/kg does not increase the percentage of amnesia but provoked a side effect which is not very agreeable from the point of view of nursing and one to which our anesthetics technique has not accustomed us: sleepiness. Lastly the pre-operatory vomitting being almost certainly linked with the administration per os, an effort should be made to improve the presentation, so keeping the advantages of premedication without giving an injection to the child; furthermore as far as possible, the presentation should permit a sufficiently precise evaluation of the quantity to be administered, even though slight errors are here of no consequence due to the very large margin of security.

Administration, Oral↗

[Preoperative stress. Study of the mental behavior and parameters of physiological stress in non-premedicated patients during the preoperative period].

In 29 male patients undergoing arterial bypass operations of the lower limb, psychological and physiological stress parameters were investigated. They received no premedication. We found an increase of heart rate (HR), arterial blood pressure (BP), plasma cortisol (Cort), free fatty acids (FFA), ventricular ectopic beats (VEB) and supra-ventricular ectopic beats (SVEB) (registered with a 24 hour ECG). The physiological dynamics were different, depending on the results of the psychological tests (MMQ and ESB): Repressor had higher HR and increased significantly more than sensitizer. Depressive patients had higher Cort levels the day before surgery compared to hopeful ones, but remained at these levels, whereas hopeful patients had a significant increase of Cort immediately before operation. They had also higher BP's and HR's. Patients with sthenic affections increased significantly more with FFA levels than asthenic ones. Anxious and asthenic patients had significantly more VEB than non anxious and sthenic ones. These results can well be interpreted in terms of dynamic psychophysiological stress reactions. We propose the use of psychological and physiological stress parameters for investigations of methods for the reduction of preoperative stress.

Blood Pressure↗

A specific antihistaminic premedication anti H1 anti H2 for pediatric anesthesia.

The danger of the anaphylactoid reactions which occur during pediatric general anesthesia leads the authors to use a specific antihistaminic premedication. The association of cimetidine and hydroxizine has been proved to be adequate to avoid systemic histamine adverse effects and to diminish gastric secretion in pediatric anesthesia. The authors recommend oral administration.

Anaphylaxis↗

[Intramuscular premedication with diazepam in a fat emulsion].

10 mg of diazepam in fat emulsion was given for premedication intramuscularly to 106 patients. In 53% of the cases patients were well sedated, 33% were apprehensive, 14% anxious. Pain related to the injection was complained of by 4 patients. Plasma concentration of diazepam at induction (60 minutes after the injection) was 130 ng/ml. Compared to diazepam in propylene glycol, pain at the injection side was less frequent while the level of sedation and the plasma concentration of diazepam were similar.

Adolescent↗

[Effects of premedication, narcosis and surgery on the coagulation and fibrinolysis systems and the platelets. The influence of dextran and hydroxyethyl starch (hes) during and after operation (author's transl)].

Patients who had undergone orthopaedic surgery were investigated. The changes attributable to premedication and narcosis were characterized by a primary fibrinolysis which was accompanied by a slight hypercoagulability. This increased fibrinolytic activity was more pronounced immediately after the beginning of the operation. The post operative changes are characterized by increased ADP-induced aggregation, increased release of platelet factors 3 and 4 and hypercoagulability with reduced fibrinolysis. The reduction in platelets during the operation could be prevented due to the influence of dextran and hydroxyethyl starch (HES). It came further to a slight increase in the activity of factor VII, to an increased fibrinogen polymerization and also to an increased release of platelet factor 4.

Adenosine Diphosphate↗

Nitrous oxide and oral premedication.

Patients frequently require conscious-sedation to achieve anxiety relief in the dental office. There are specific indications, contraindications, advantages, and disadvantages to each sedation modality. Selection of the appropriate anesthetic technique should be individualized for each patient. This paper reviews two important conscious-sedation modalities: oral premedication and nitrous oxide/oxygen inhalation sedation.Pertinent drugs are reviewed and recommendations are made for their use; current researches are presented and new areas for investigation are suggested.

Anesthesia, Dental↗

[Comparative study of the oral administration of flunitrazepam with oral pentobarbital and intramuscular administration of atropine and pethidine (meperidine) as premedication].

Thirty-four patients were allocated at random to treatment with 1 mg of flunitrazepam, orally, the night before operation, and 1 mg on the morning of operation (Group 1), and another 34 to treatment with 100 mg of pentobarbital, orally, the night before operation, followed by intramuscular atropine (0.01 mg/kg)+pethidine (meperidine 1 mg/kg) on the morning of operation (Group 2). The patients in both groups slept equally well. As far as apprehension and excitement (= anxiolytic effect) just before induction of anaesthesia were concerned, oral flunitrazepam proved to be markedly better than i.m. atropine+pethidine. There were no significant differences in cardiovascular variables between the two groups. From the anaesthesiologist's point of view, atropine had beneficial antisecretory effects, but, from the patients point of view, it caused only a subjective unwanted effect (dry mouth). In our opinion, oral flunitrazepam is a useful alternative agent for routine premedication. However, when used without i.m. atropine, excessive salivary secretion in some patients may occur and be disturbing, especially during extubation.

Administration, Oral↗