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PubMed1988

Premedication with intramuscular dixyrazine: (Esucos). A controlled double-blind comparison with morphine-scopolamine and placebo.

Ninety patients scheduled for general or orthopaedic surgical procedures were randomly assigned to receive one of three i.m. premedications: dixyrazine 0.5 mg kg-1; morphine 0.15 mg kg-1 and scopolamine 0.0065 mg kg-1; or placebo. The premedication was administered and evaluated in a double-blind fashion. The patients were anaesthetized with thiopentone, fentanyl, pancuronium, and ventilated with nitrous oxide in oxygen. The three premedications had no noticeable anxiolytic effect. Although there was no difference in the frequency of observed postoperative nausea and vomiting between the three groups, premedication with dixyrazine nonetheless reduced the patients' experience of postoperative nausea as well as their need for postoperative antiemetics. Although patients in the two treatment groups were significantly more sedated immediately before induction of anaesthesia than patients receiving placebo, the degree of postoperative sedation was similar in all three groups. Morphine-scopolamine caused more postoperative dizziness than dixyrazine and placebo. Lack of recall was produced by both morphine-scopolamine and dixyrazine. It is concluded that premedication with dixyrazine is a useful alternative, especially in patients who have previously experienced postoperative nausea and vomiting.

Adult↗
PubMed1990

Medetomidine premedication in dental surgery--a double-blind cross-over study with a new alpha 2-adrenoceptor agonist.

A single 50-micrograms dose of medetomidine, a highly selective alpha 2-adrenoceptor agonist, was administered intravenously as premedication 30 min before surgical third molar extraction under local anaesthesia to ten healthy male subjects in a double-blind, placebo-controlled, cross-over study. Blood pressure, heart rate, plasma catecholamines and cortisol were measured as indicators of operation-related stress. Apprehension and pain were assessed with repeated Visual Analogue Scales. The dental surgeon rated the overall effectiveness of the premedications, and the patients reported their subjective preference. Drug-induced sedation was determined with the Critical Flicker Frequency (CFF) test. The dental surgeon rated medetomidine as significantly more effective premedication than saline placebo. Apprehension was significantly reduced by medetomidine. The patients clearly preferred medetomidine premedication. Blood pressure was lower in the medetomidine session, whereas no significant differences were seen in heart rate. Plasma noradrenaline was lower after medetomidine, but adrenaline and cortisol levels were not affected. In conclusion, medetomidine may offer a useful alternative to traditional premedications in out-patient surgery, and its clinical usefulness should also be studied in other anaesthetic paradigms.

Adrenergic alpha-Agonists↗
PubMed1992

Sublingual premedication with brotizolam.

This randomized, double-blind and double-dummy study was carried out in order to compare the perioperative sedation after premedication with either brotizolam 0.25-0.50 mg sublingually or diazepam 5-10 mg orally. Sixty-two patients aged 18-60 years scheduled for minor gynaecological surgery in general anaesthesia were included. Assessments were: 1. auditory continued response time (ACRT); 2. coma scale; 3. anxiety scale; and 4. final patient questionnaire. One hour after premedication the brotizolam group was more sedated, based on ACRT (P < 0.01) and the coma scale (P < 0.05). The final questionnaire showed (P < 0.05) that the brotizolam group was more satisfied with the effect of the premedication. Seven hours after the premedication the ACRT scores in both groups were similar to those before premedication and all the patients could walk about freely. In conclusion, as a premedicant in outpatients sublingual brotizolam appears to be a good alternative to diazepam.

Administration, Oral↗
PubMed1996

Atropine premedication attenuates heart rate variability during high thoracic epidural anesthesia.

BACKGROUND: Atropine premedication is used as it possesses an anticholinergic effect on the cardiac autonomic nervous system (CANS). The aim of this study was to investigate the effect of atropine premedication on the CANS during thoracic epidural anesthesia (TEA) by assessing power spectral analysis of heart rate (HR) variability. METHOD: Female patients (n = 28) undergoing elective mammary biopsy were randomly allocated into two groups; one received intramuscular premedication of 0.01 mg/kg of atropine 30 min before the procedure (group A: n = 14), and the other did not (group N: n = 14). Each electrocardiogram was digitally recorded before and during TEA, and played back off-line to detect R-R intervals. As a power spectrum required R-R intervals of 256 s, this was analysed before TEA and repeated thereafter for 25 min. The spectra were quantified by determining the peak areas of the spectral density by integrating low frequency (Lo: 0.04-0.15 Hz) and high frequency (Hi: 0.15-0.40 Hz) bands as they showed sympathetic and parasympathetic nervous activity in the CANS. The neural balance was assessed by calculating Hi:Lo ratio. RESULTS: Decreases in Lo and increases in Hi:Lo ratio were observed, suggesting sympathectomy and vagotonia with TEA in both groups. For 10 min after commencement, TEA maintained Hi:Lo ratios lower in group A than in group N, suggesting a vagolytic effect of premedication with atropine. With TEA, cardiac slowing was observed, which was dependent on the level of dermal analgesia. CONCLUSION: Power spectral analysis revealed that TEA had the effect of making CANS relatively vagotonic, and that atropine premedication would attenuate the effect of TEA.

Anesthesia, Epidural↗
PubMed2006

Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication.

BACKGROUND: Children undergoing anaesthesia and surgery can experience significant anxiety and distress during the peri-operative period, but whether routine premedication is necessary is currently debated. Benzodiazepines are the most frequently used drugs as premedication in paediatric anaesthesia. In the US, 50% of young children undergoing surgery receive premedication and midazolam is the most frequently used drug in this context (1). Nishina and coworkers (2) concluded in a review article in 1999 that clonidine, administered via an oral, rectal, or caudal route, is a promising adjunct to anaesthetics and analgesics to enhance quality of peri-operative management in infants and children. Later publications also support the use of clonidine for premedication (3-6). The aim of this communication is to review the use of clonidine in paediatric anaesthesia and to propose clonidine as a promising alternative to midazolam. Clonidine is associated with a number of beneficial effects in the context ofanaesthesia both in adults and children. Why clonidine is not routinely use in clinical practice despite the massive publication list is to a large extent due to the lack of marketing efforts from the pharmaceutical industry since multiplegeneric preparations are now readily available on most markets. Midazolam is also associated with a number of beneficial effects, but is far from an ideal premedicant in children, especially with regards to the amnesia, confusion and long term behavioural disturbances. Clonidine has contrary to midazolam no effect on respiration. We believe that clonidine is a good alternative to midazolam as premedication in infants and children.

Analgesics↗
PubMed2005

Premedication in children: hypnosis versus midazolam.

BACKGROUND: The main objectives of premedication in children are to facilitate the separation from the parents, to reduce preoperative anxiety, to smooth the induction of anesthesia and to lower the risk of postoperative behavioral disorders. The most common technique is sedative premedication with midazolam. Hypnosis enables a state of relaxation to be achieved and has never been evaluated as a premedication technique. The aim of the present study was to evaluate the efficacy of hypnosis on anxiety and perioperative behavioral disorders versus midazolam. METHODS: Fifty children from 2 to 11 years of age were randomized into two groups: group H received hypnosis as premedication; group M were given 0.5 mg x kg(-1) midazolam orally, 30 min before surgery. Preoperative anxiety was evaluated using the Modified Yale Preoperative Anxiety Scale (mYPAS) score when arriving in the department (T1), when entering the operating room (T2), and when fitting the facemask (T3). Postoperative behavioral disorders were evaluated using the Posthospitalization Behavioral Questionnaire (PHBQ) at days 1, 7 and 14. RESULTS: The two groups showed no significant difference preoperatively with the PHBQ: (M) 21 (17-25) vs (H) 20 (8-25) and mYPAS score: (M) 28 (23-75) vs (H) 23 (23-78). The number of anxious children was less during induction of anesthesia in the hypnosis group (T3: 39% vs 68%) (P < 0.05). Postoperatively, hypnosis reduced the frequency of behavior disorders approximately by half on day 1 (30% vs 62%) and day 7 (26% vs 59%). CONCLUSIONS: Hypnosis seems effective as premedication in children scheduled for surgery. It alleviates preoperative anxiety, especially during induction of anesthesia and reduces behavioral disorders during the first postoperative week.

Abdomen↗
PubMed1997

The effect of supplemental oxygen on the incidence of hypoxaemia after premedication in patients undergoing cardiac surgery.

Opiate premedication may cause significant respiratory depression, particularly when other sedative agents such as scopolamine or benzodiazepines are added. This can cause hypoxaemia with potential for worsening myocardial ischaemia in cardiac surgery patients. The aim of this study was to investigate the incidence of hypoxaemia (SpO2 < 90%) in elective patients undergoing cardiac surgery and to assess the efficacy of supplemental oxygen in preventing it. One hundred elective patients without significant respiratory disease or cardiac failure, who received both an opiate and a sedative premedication, were prospectively randomized to receive either oxygen via a facemask at 4 l/min or no oxygen. Continuous arterial oxygen saturation was recorded using a pulse oximeter from the time of premedication until the patient arrived in theatre. An SpO2 < 90% was recorded as a significant event and oxygen was administered to the patients. Six patients were excluded because of equipment failure or protocol violations. The patient groups were comparable with respect to patient demographics, premedication type and dose or the duration of monitoring. In patients receiving oxygen (n = 48) there were no episodes of hypoxaemia (0%). In patients not receiving oxygen (n = 46) there were 14 episodes of hypoxaemia (30%, P < 0.0001). We conclude that there is a significantly high incidence of hypoxaemia in cardiac surgery patients following combined opiate and sedative premedication and that it can be reduced by the routine administration of supplemental oxygen.

Analgesics, Opioid↗
PubMed2004

Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey.

UNLABELLED: Both parental presence during induction of anesthesia and sedative premedication are currently used to treat preoperative anxiety in children. A survey study conducted in 1995 demonstrated that most children are taken into the operating room without the benefit of either of these two interventions. In 2002 we conducted a follow-up survey study. Five thousand questionnaires were mailed to randomly selected physician members of the American Society of Anesthesiologists. Mailings were followed by a nonresponse bias assessment. Twenty-seven percent (n = 1362) returned the questionnaire after 3 mailings. We found that a significantly larger proportion of young children undergoing surgery in the United States were reported to receive sedative premedication in 2002 as compared with 1995 (50% vs 30%, P = 0.001). We also found that in 2002 there was significantly less geographical variability in the use of sedative premedication as compared with the 1995 survey (F = 8.31, P = 0.006). Similarly, we found that in 2002 parents of children undergoing surgery in the United States were allowed to be present more often during induction of anesthesia as compared with 1995 (chi(2) = 26.3, P = 0.0001). Finally, similar to our findings in the 1995 survey, midazolam was uniformly selected most often to premedicate patients before surgery. IMPLICATIONS: Over the past 7 yr there have been significant increases in the number of anesthesiologists who use preoperative sedative premedication and parental presence for children undergoing surgery.

Adult↗
PubMed2004

Oral clonidine premedication exacerbates hypotension following tourniquet deflation by inhibiting noradrenaline release.

Clonidine premedication prevents tourniquet pain and reduces sympathetic nerve activity. We evaluated hemodynamic changes and catecholamine release following tourniquet deflation during spinal anesthesia in patients who received oral clonidine premedication. The final analysis included 24 otherwise healthy patients undergoing lower-limb surgery randomly assigned to two groups: those receiving approximately 5 micrograms/kg of oral clonidine 1 hr before anesthesia (clonidine group, n = 12), and those receiving no premedication (control group, n = 12). After lumbar anesthesia, a tourniquet was applied for approximately 60 minutes to each patient. Electrocardiogram, arterial blood pressure, and consumption of butorphanol for tourniquet pain were monitored. Blood samples were obtained at different times to measure serum concentration of catecholamine. In the clonidine group, mean blood pressure decreased from 87 +/- 7 mmHg at baseline to 65 +/- 10 mmHg after tourniquet deflation (P < 0.05). This peak reduction of mean blood pressure in the clonidine group was significantly lower than in the control group. After receiving clonidine premedication, the plasma noradrenaline concentrations in the clonidine group were significantly lower than those in the control group. Noradrenaline concentration increased in the control group from 162.3 +/- 89.2 pg/mL before tourniquet deflation to 199.3 +/- 95.7 pg/mL afterward (P < 0.01), but there was no significant change in noradrenaline concentration after tourniquet deflation in the clonidine group. We conclude that oral clonidine premedication exacerbated the reduction in mean blood pressure following tourniquet deflation by inhibiting noradrenaline release.

Administration, Oral↗
PubMedDate not supplied

Two doses of oral ketamine, given with midazolam, for premedication in children.

BACKGROUND: Oral premedication is common practice in paediatric anaesthesia. The aim of this study was to assess the quality of premedication using oral ketamine, with midazolam. METHODS: Clinical randomized and blind-study on 120 patients, aged between 2 and 6 years, listed for minor surgery. Patients were divided in three groups: first group (group MK1) received midazolam and ketamine at the doses of 0.3 mgxkg-1 and 1 mgxkg-1, respectively; the second (group MK2) received 0.3 mgxkg-1 of midazolam and 2 mgxkg-1 of ketamine; the control group 0.5 mgxkg-1 of midazolam (group M). Success of premedication was assessed by assigning 1-4 points to the quality of anxiolysis and sedation every 5 min after drug administration and then at the moment of separation from parents, entrance to theatre and response to mask induction of general anaesthesia. RESULTS: More patients were successfully premedicated in the MK2 group, statistical significance was observed after 20 min (p<0.05). The MK2 group accepted separation from parents (p<0.05) and face mask for induction of anaesthesia (p<0.05) more willingly. Side effects were observed in 4 MK2 group patients (nausea, headache and diplopia), but all these effects resolved spontaneously. CONCLUSIONS: Two mgxkg-1 of ketamine given orally with midazolam improve anxiolysis and sedation and achieve more success of premedication, better acceptance of parental separation and better acceptance of face mask for induction of anaesthesia.

Adjuvants, Anesthesia↗
PubMedDate not supplied

[Oral premedication in ambulatory surgical otorhinolaryngology in children].

34 children selected into two groups due to age (patients from 4 to 7 year old were included in the 1st group, the 2nd group consisted of children, aged from 8 years to 14 years, were premedicated with dormicum, and in other 37 patients standard premedication was applied. The state of cardiovascular system was estimated by means of indices of central hemodynamics and heart rate monitoring data. Every patient was examined both before and 30 minutes after premedication. While standard premedication activates central hemodynamics, increases, especially in older children, left ventricular performance, premedication with dormicum influence neither indices of central hemodynamics nor left ventricular performance, and causes moderate sympatical activation by dormicum in dose of 0.5 mg/kg, appearing to be effective in children of any age and can be used in ambulatory surgical otorhinolaryngology in children.

Administration, Oral↗
PubMed1992

[Premedication in retrobulbar anesthesia. A blood gas analysis comparison of sublingual flunitrazepam and intravenous midazolam].

Benzodiazepines for sedation may decrease the PaO2, the arterial O2 saturation (SaO2), and the CO2 response more in the elderly than in the young. The purpose of this study was to assess changes in blood gases due to i.v. midazolam or sublingual flunitrazepam given as premedication in elderly patients for unilateral cataract surgery. METHODS. Fifty patients over 65 years of age with treated arterial hypertension and other co-existing diseases (ASA III-IV) were randomly assigned to have: (1) i.v. midazolam titrated until they became drowsy (17 patients; 2.85 +/- 0.84 mg [mean +/- SD]); (2) sublingual flunitrazepam (16 patients; 0.005 mg/kg); or (3) no sedation (17 patients; controls). On entering the operating theatre, the radial artery was cannulated and the first blood gas analysis was obtained. The premedication was then given. At 5, 10, 20, and 30 min after premedication, before and 10 min after retrobulbar block, before operation, 5 and 15 min after the beginning of the operation, 10 and 20 min after administration of 500 mg acetazolamide i.v. during the operation, and 10 and 20 min after the operation additional arterial blood samples were analysed (a total of 15 measuring points). Pulse oximetry, invasive blood pressure, and ECG were continuously monitored. All patients received oxygen 3 l/min during the operation by nasal cannula. Differences between the three groups were analysed by Student's t-test or U-test and a P value < 0.05 was considered significant. RESULTS. The patient demography, including duration of anaesthesia and operation, was similar in the three groups (Table 1). No significant differences were seen in heart rate, mean arterial pressure, PaO2, pulse-oximetric oxygen saturation (SpO2), base excess, or serum bicarbonate levels. The PaCO2 increased in patients after midazolam (P < 0.01) and flunitrazepam (P < 0.05) until the beginning of the operation compared with the control group (Fig. 3); 20 min after the operation there was still a significant difference between the midazolam group and the controls. SaO2 was significantly (P < 0.05) lower in the midazolam group 10 and 20 min after administration of premedication compared with the control group, but was within physiological limits (Fig. 5). Despite titration, 2 patients had severe respiratory insufficiency 3 min after midazolam: the SpO2 decreased below 85% and the paO2 below 55 mmHg. The paCO2 was higher (P < 0.05) in the midazolam group 10 min after acetazolamide compared with the controls. CONCLUSIONS. The results of the study show the potential hazards of i.v. midazolam in the elderly. If sedation is required for cataract surgery under local anaesthesia, we recommend sublingual flunitrazepam or the use of benzodiazepines with lower hypnogenic effects in the elderly. A thorough preoperative discussion of anaesthesia and the operation might be an adequate substitute for any premedication in high-risk patients; the best blood gas analysis results were obtained in the control group.

Administration, Sublingual↗
PubMedDate not supplied

Comparison of preparation and narcotic-sedative premedication in children undergoing surgery.

A psychological preparation program was developed for use prior to emergency surgery in children. The purpose of this study was to test the hypothesis that provision of specific information prior to an emergency operation would reduce the need for premedication to control anxiety and stress. Children were randomly assigned to either a verbally prepared group given narcotic-sedative premedication (control) or to a psychologically prepared group given only atropine as premedication. The child and parent rated their own anxiety on a Visual Analogue Scale (VAS). The children and parents were also assessed by a nurse preoperatively and postoperatively using a similar scale. The children's pulse, blood pressure, and cortisol were also measured. The results showed no significant difference between the psychologically prepared group and the premedicated group, suggesting that psychological preparation compares favorably with narcotic-sedative premedication.

Adolescent↗
PubMedDate not supplied

Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients.

BACKGROUND AND OBJECTIVES: The use of sedatives during regional anesthesia can lead to life-threatening hypoxemia. Older patients particularly are prone to enhanced effects of these drugs. We studies whether oral premedication with benzodiazepines produced hypoxemia during spinal anesthesia in elderly patients. METHODS: In a prospective, double-blind, and randomized study, we evaluated the effect of oral benzodiazepine premedication on the incidence of hypoxemia measured by pulse oximetry (arterial oxygen saturation less than 90% for 30 seconds or longer) during surgery under spinal anesthesia in 80 geriatric patients divided into four equal groups: 1, control, no premedication; 2, 1 mg flunitrazepam; 3, 1 mg lorazepam; and 4, 7.5 mg midazolam. RESULTS: The incidence of hypoxemia in the four groups was: 1, 15%; 2, 45%; 3, 20%; and 4, 60% (p = 0.0078); overall incidence was 42% in premedicated patients versus 15% in unpremedicated controls (p = 0.0304). Seventy-four percent of patients who presented drowsiness and anesthetic level above T7 had desaturation compared to only 7% of those who were awake and had lower level (p less than 0.0005). No association between hypoxemia and other factors (age, weight, ASA physical status, and position during surgery) was found. All the episodes of desaturation were easily corrected with low supplemental oxygen concentrations. CONCLUSIONS: Premedication with oral benzodiazepines may produce hypoxemia during spinal anesthesia in elderly patients. Lorazepam appeared safer than flunitrazepam and midazolam. Monitoring of arterial blood oxygen saturation and/or supplemental oxygen is mandatory in geriatric patients with high spinal anesthetic level and/or drowsiness during surgery.

Administration, Oral↗
PubMed1991

[Free fatty acids as an indicator of preoperative stress and effects of premedication with flunitrazepam, morphine and promethazine on blood fatty acid level].

We investigated the influence of different oral premedication given to 50 male and 50 female patients on the plasmaconcentration of free fatty acids (FFA) as an indicator of preoperative stress and compared them with patients given no premedication at all. FFA are measured with a gaschromatographic method. FFA were measured four times: Time 1 (t1): the first day in hospital, t2: After the anesthesiologist's visit, t3: In the morning of the operation, t4: Before starting anesthesia. The groups are: I. 20 male and 20 female patients without any premedication; II. every 10 patients of both sexes given 2 mg Flunitrazepam (p.o.) on the preoperative night; III. every 10 patients given Morphium (0.15 mg i.m.) and Promethazin (50 mg i.m.) and, last, IV. every 10 patients getting the same premedication as group II and IV. 98 patients had a significant decrease of FFA from t1 to t2. The FFA of all increased from t2 to t3. Moreover, there was an increase from t3 to t4. We conclude from this that no premedication we had investigated is able to lower the physiological and biochemical stress-response as far as shown by FFA. Apart from myristic-acid, there was no difference in the groups. However, with no statistic significance, both 'Flunitrazepam-groups' showed the lowest increase. Further, in 28 from 32 cases, females had a higher FFA-level than males (in 16 cases with statistical significance).

Adolescent↗
PubMed1991

Oral midazolam in paediatric premedication.

In a premedication study involving 135 children, aged 1-10 years, four regimens were investigated: (i) no premedication; (ii) oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg, droperidol 0.15 mg/kg (TMD); (iii) intramuscular midazolam (Dormicum; Roche) 0.15 mg/kg; and (iv) oral midazolam 0.45 mg/kg. All premedications were given 60 minutes before a standard halothane anaesthetic. No impairment of cardiovascular stability occurred but after premedication the mean oxygen saturation decreased by 1.6% and 1.1%, respectively, in the intramuscular midazolam and TMD groups. Overall, children under 5 years of age behaved less satisfactorily in the holding room and at induction, than those over 5 years (P less than 0.01). Midazolam, intramuscularly and orally, produced more satisfactory behaviour than the other two regimens (P less than 0.05) and, combined with a 70% more rapid recovery than the TMD regimen (P less than 0.05), suggests that oral midazolam is a more effective paediatric premedication agent than placebo or TMD.

Administration, Oral↗
PubMedDate not supplied

[Evaluation of the efficacy of premedication using omega potential measurement].

Spontaneous and evoked omega-potentials were registered, using high-ohm amplifier of the permanent current and non-polarized liquid minute chlorine-silver electrodes, in 40 surgical patients 40-60 min after premedication. It has been established that effective premedication in 77% of cases (29 patients) correlated with low stable (variability 1-2 mV) values of omega-potential ranging from 0 to 20 mV and an omegagram in the form of a conventionally straight line in response to the functional load. In 11 patients with ineffective premedication the functional load caused phase, smooth or uneven changes in omega-potential (variability from 5 to 27 mV), with both low (0-20 mV) and intermediate (21-40 mV) initial values. Hexenal consumption was twice lower in patients with effective than in patients with ineffective premedication. It is concluded that omegametry can be used as an effective criterion in the assessment of premedication efficacy.

Adult↗
PubMed1989

[Midazolam for premedication of infants. A comparison of the effect between oral and rectal administration].

Midazolam (M) has been successfully used in oral and rectal premedication of children of one to six years of age. The following study was designed to investigate the efficacy of both methods when used as premedication "on demand". 60 children (1-6 years) were randomly assigned to 0.3 mg/kg bw M orally and 0.5 mg/kg bw M rectally. Psychological, behavioural and physiological parameters were measured at special time intervals and special stressful events (separation from the mother or father, induction of anaesthesia). Rectally premedicated children were found to be better prepared concerning psychological and behavioural parameters. This can be due to the dosage as well as the faster absorption of M. In the postoperative period orally premedicated children experienced significantly more nausea and vomiting. This might be due to the preparation with saccharin, peppermint oil and ethanol. - In "premedication on demand" rectal Midazolam must be preferred to orally administered Midazolam in the preparation mentioned above.

Administration, Oral↗