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Oral versus intranasal midazolam premedication for infants during echocardiographic study.

Movement and anxiety during echocardiographic study may reduce the reliability and affect the quality of echocardiographic images. Thus, sedation is an essential component when it is performed in infants. This randomized, single-blinded, placebo-controlled study was undertaken to evaluate the acceptability and effectiveness of intranasal midazolam (INM) versus oral midazolam (OM) in infants during transthoracic echocardiography. Eighty patients between the ages of 6 mo and 3 y who presented for elective echocardiographic study were divided into 3 groups: the OM group received 0.4 mg/kg of injectable midazolam mixed with an equal volume of cherry juice, the INM group received 0.2 mg/kg as drops,and the control group was given oral cherry juice or intranasal serum physiologic. A blinded clinician assessed and scored the level of sedation and comfort during the procedure for each child, and a score for ease of administration was recorded by the nurse. The intranasal route was more acceptable to infants than the oral route (P<.001). No significant difference in the effects of sedation was observed between the OM group and the INM group (P=.583), but significant differences were observed between the sedated groups and the control group (P<.001). The procedure was significantly more comfortable in groups given OM and INM than in the control group (P<.001). Although no difference in sedation score was seen between the oral and nasal routes, INM was better accepted by infants than OM. Echocardiography was performed more reliably and comfortably in those given midazolam than in those in the control group.

Administration, Intranasal↗
PubMed1981

Anatomical dead space and airway resistance after glycopyrrolate or atropine premedication.

The effects of atropine and glycopyrrolate on anatomical dead space, one and three second forced expiratory volume, maximal expiratory flow rate, and total forced expiratory volume were determined in ten healthy volunteers. Using Fowler's single breath nitrogen analyzing technique, atropine was found to increase dead space by 19.2 per cent at one hour, declining to 11.02 per cent at four hours. Glycopyrrolate increased dead space by 21.57 per cent at one hour, 29.28 per cent at two hours, and 26.65 per cent at four hours. When compared to the effects of saline control injection, the dead space increases are significant. The difference between glycopyrrolate and atropine is significant only at four hours. Increases in maximal expiratory flow rate induced by atropine and glycopyrrolate were significant at one-half hour, while atropine alone induced a significant increase in one second forced expiratory volume. Three second forced expiratory volume and total forced expiratory volume were not significantly altered.

Adult↗
PubMed1982

Sodium citrate premedication in elective caesarean section patients.

The pH and volume of gastric contents from thirty-three patients undergoing elective caesarean section with thiopentone, nitrous oxide, succinylcholine anaesthesia were examined. Twenty patients received Gelusil 30 ml by mouth and thirteen patients received 30 ml of a 0.15 molar solution of sodium citrate. Following tracheal intubation, gastric fluid was sampled through an 18 French Salem sump tube place orally. Mean pH following Gelusil was 4.54 +/- 2.45 (SD) and 2.29 +/- 1.77 following sodium citrate. This difference was statistically different (P less than 0.05). There was no difference in gastric volume between the two groups. Thirty five per cent of patients receiving Gelusil had a pH less than 2.5. This low pH was more likely to occur with prolonged intervals between drug administration and sampling. Significantly more patients receiving sodium citrate had a low pH (85 per cent) and this low pH was not related to the duration of interval between administration and sampling. This study demonstrates that 30 ml of 0.15 molar sodium citrate is not a satisfactory alternative to 30 ml of Gelusil for increasing gastric pH in the paturient when given sixty minutes before operation.

Adult↗