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Premedication for elective Caesarean section.
Four coded, but otherwise unidentified, premedicants were prescribed in randomised order for 219 patients who were to undergo elective Caesarean section. Seventy-six (35%) of these patients affirmed at the pre-operative visit that they were not anxious. Diazepam 5 mg and lorazepam 1 mg appeared to be superior to the placebo and to 10-6 ml of 90% alcohol in inducing calmness and/or drowsiness, although the differences were not statistically significant. The incidence of awareness or unpleasant dreams was considerably higher in the placebo and alcohol series (6.2% and 7.5%) than in the diazepam and lorazepam series (nil and 2.1%). There was no remarkable difference in the condition of the immediate newly-born related to the premedicant received by the mother, any small differences being much less impressive than that related to the duration of the U-D interval. No notable differences were observed in the long term conditions between the infants in the placebo, alcohol and diazepam series but the incidence of "reluctance to feed". If relief from preoperative anxiety-and possibly a reduction in the likelihood of awareness-without undue effect upon the infant is considered desirable, diazepam 5 mg is the preferred choice from the four drugs investigated.
Premedication in day care surgery.
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Oral premedication for children with a droperidol, trimeprazine and methadone mixture.
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Intra-ocular pressure and premedication with oral diazepam.
Thirty patients scheduled for routine eye surgery were randomly allocated to receive either diazepam 0.2 mg/kg or ascorbic acid 100 mg orally 90 minutes pre-operatively in a double-blind fashion. Diazepam caused no significant change in intra-ocular pressure.
Recalled apprehension after premedication with lorazepam.
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Antidiuretic hormone concentrations following midazolam premedication.
Midazolam given orally the night before and on the morning of operation had a distinct subjective pre-operative sedative effect as compared with placebo. Patients receiving midazolam also experienced less apprehension and excitement before surgery, but in relation to quality of sleep, the difference between the two groups was not statistically significant. Antidiuretic hormone (ADH) concentrations were determined just before induction of anaesthesia and were significantly lower in the midazolam group (2.14 pg/ml, SD 0.96) than in the placebo group (3.07 pg/ml, SD 1.73). Our results show that midazolam is a useful sedative anxiolytic oral premedicant, which appears to prevent initiation of a stress reaction before induction of anaesthesia.
Postoperative dreaming. A comparison of the incidence following pentazocine and morphine premedication.
The incidence of postoperative dreaming following the use of morphine and pentazocine as premedicants in an otherwise standard anaesthetic sequence is compared in healthy volunteers. No statistically significant difference was demonstrated between the two drugs. The causes of psychotomimetic problems in the postoperative period and the difficulty of precise definition of hallucinations are discussed.
Intravenous premedication with diazepam. A comparison between two vehicles.
Two preparations of diazepam, Valium Roche mixed Micelles and Diazemuls, were compared as intravenous premedicants in 119 patients undergoing minor gynaecological surgery. There were no differences between the formulations with regard to anxiolytic effects and systemic tolerance. There were no symptoms typical of thrombophlebitis in the Valium Roche Mixed-Micelles group and only one case in the Diazemuls group. Acute local tolerance was similar with both trial drugs and superior to conventional diazepam preparations. Based on the favourable results of the present study it can be concluded that such vehicles should be considered for any injectable preparation with a known tendency to produce venous irritation.
Oral bromazepam in premedication. A comparison with diazepam.
Bromazepam, a relatively newly benzodiazepine with marked anxiolytic effects, was compared in a randomised, double-blind manner with diazepam for its effectiveness as an oral premedicant drug. A scoring system was used to assess sedation, relief of anxiety, nausea, and cardiovascular effects in two groups of women having gynaecological operations. No difference was demonstrated between the effectiveness of the two drugs.
Oxazepam premedication in neurosurgical patients. The use of a fast-dissolving oral preparation of oxazepam as a pre-operative anxiolytic drug in neurosurgical patients.
In a double-blind study, a new fast-dissolving formulation of oxazepam used as sole premedicant in patients undergoing neurosurgery, was assessed with particular reference to its effect on the levels of anxiety, consciousness and orientation of the patients pre- and postoperatively. The results show that when given at least one hour pre-operatively the new preparation is a highly effective anxiolytic with minimal sedative or other side-effects, is convenient to administer and has high patient acceptability.
Premedication by controlled-release morphine.
In a double-blind investigation the effect of oral controlled-release morphine (MST 30 mg) on pre-operative anxiety was assessed in 50 patients undergoing cholecystectomy. The effects on anaesthetic requirements and recovery, and postoperative pain were also studied. The patients who received morphine treatment were more sedated than those who received the placebo; however there was no significant difference in the anxiety scores for both groups of patients. During anaesthesia there were no significant differences between the groups, although the group of patients who received morphine required less anaesthetic supplement, and appeared to recover more slowly than the placebo group. One hour postoperatively, the morphine group had significantly less pain and were more sedated than the placebo group; the time to the administration of a postoperative analgesic was also significantly longer in the morphine group than the placebo group.
Premedication for children.
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Premedication in children.
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Premedication for children with oral trimeprazine and droperidol.
In 60 children aged 1-9 years, weighing under 33 kg, oral trimeprazine and oral trimeprazine plus droperidol were compared as premedicants in a controlled, double-blind clinical trial. The addition of droperidol to the trimeprazine syrup produces greater uniformity in pre-operative sedation, a low incidence of postoperative vomiting, and a reduced requirement for postoperative analgesia.
Temazepam premedication for children.
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Temazepam in fast dispensing dosage form as a premedication for children.
Forty-seven children aged between four and 11 years received temazepam 0.5 mg/kg in a novel fast dispensing dosage form. The preparation was well accepted and associated with few side-effects. Satisfactory sedation and anxiolysis was obtained in over 93% of patients. The relative merits of a variety of routes of administration of premedicant drugs for children are discussed and the advantages of buccally administered formulations for this age group are presented.
Diazepam premedication in children.
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