The premedical advisory process: attitudes of premedical advisors.
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The postanesthetic antiemetic effect of premedication with dehydrobenzperidol before ether anesthesia.
A study was performed to evaluate the antiemetic effects after ether anesthesia when dehydrobenzperidol (DHB) and pentobarbital were used for premedication and to compare these effects with halthane anesthesia when pentobarbital was used as premedication. Eighty-four patients undergoing minor surgical operations were randomly divided into three groups. The patients received ether and ether DHB 0.2 mg/kg or pentobarbital 2 mg/kg for premedication, or halothane and pentobarbital 2 mg/kg for premedication. The complaints of nausea and vomiting were recorded 24 h after anesthesia. We found that DHB compared to pentobarbital had a greater antiemetic effect after ether anesthesia, but the difference was not significant (P greater than 0.05). However, if only persistent nausea and vomiting were considered, the difference was significant (P less than 0.05). The incidence of nausea/vomiting after ether anesthesia with DHB as premedication was a little higher compared to halothane anesthesia with pentobarbital as premedication, but the difference was not significant (P greater than 0.05). However, if only persistent nausea/vomiting was considered, the incidence of complaints was equal in the two groups. It is concluded that when used for premedication to ether anesthesia DHB seems to lead to less postanesthetic nausea/vomiting than pentobarbital. Further DHB seems able to reduce the incidence of nausea/vomiting after ether anesthesia roughly to the level of that seen after pentobarbital premedication for halothane anesthesia.
Adolescent↗
[Gastroscopy in advanced age: premedication, cardiac arrhythmias].
40 not selected elderly patients (average age 79.3 years were investigated with a oesophago-gastro-duodenoscopy (OGD). For premedication the patients got 5 mg Diazemuls R and 20 mg Buscopan R i.v. With 30 patients there was taken a blood-gas-analysis before premedication and before fiberendoscopy. ECG-registration was performed before OGD und during OGD with all patients. The premedication led to a reduction of the p02 on an average of 8.9%. The average pO2 did not decrease below the age-related value. In some cases there was a great difference. With a 86-year old woman the pO2 decreased about 25% after premedication and led to a severe hypoxaemiae. Only patients (12.5%) showed a few ventricular extrasystoles, there was no serious arrhythmia. After premedication the heart-rate rose over 100 heart-beats per minute up to maximal 137 beats/minute in 9 patients. If a low dose of Diazemuls R is used, there is no need to do the OGD in elderly patients without premedication. However, there should be the possibility to give a patient oxygen via nasal insufflation to prevent severe hypoxaemia which can occur in some cases. In general, monitoring is only necessary for patients with a higher risk.
Acid-Base Equilibrium↗
[Controlled trials of premedication of fiberendoscopy (author's transl)].
In four controlled studies on 771 consecutive patients we tested the value of premedication before passing a fiberendoscope. Following local anaesthesia of the throat, 10 mgs of diazepam in patients less than 60 years and 5 mgs in those over 60 years quickly injected intravenously caused a sufficient premedication for fiberendoscopy. Premedication with diazepam is better than placebo. We fell that omission of premedication is not justifiable. Flunitrazepam, for premedication, in doses of 1-2 mgs did not prove to be suitable. 20 patients were radiologically controlled for signs of aspiration following premedication and endoskopy. They showed no signs of aspiration.
Adult↗
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↗
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↗
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↗
Effect of premedication on stress and plasma cortisol in patients bronchoscoped under local anaesthesia.
Four groups of 8 patients undergoing bronchoscopy were premedicated with either pentobarbitone 1 mg/kg i.m. followed by i.v. saline, or diazepam 10 mg and saline i.v., or diazepam 10 mg i.m. followed by diazepam 20 mg i.v. and, diazepam 20 mg i.m. and then saline i.v. Both the patients and the bronchoscopist were asked to score the premedication as excellent, satisfactory, unsatisfactory or bad. Plasma cortisol was measured before premedication and before and after bronchoscopy. Preoperatively plasma cortisol increased in every group except that given diazepam 20 mg i.m., and during bronchoscopy it rose in all except the group who received 20 mg diazepam i.v. In patients who considered the premedication unsatisfactory, the rise in plasma cortisol from before premedication until after bronchoscopy was significantly higher than in satisfied subjects. It appears that in patients undergoing bronchoscopy higher doses of diazepam (20-30 mg) gave better suppression of stress than 10 mg diazepam, or 1 mg/kg pentobarbitone.
Adult↗
Premedicating children for painful invasive procedures.
Children with cancer experience a great deal of anxiety concerning their treatment and invasive tests such as bone marrow aspirations (BMAs) and lumbar punctures (LPs). Responses of pain, fear, and anxiety are well documented and may cause regression, developmental delay, sleeping and eating problems, nausea and vomiting, nightmares, and depression. Diagnostic and treatment procedures need not cause such adverse effects if sufficient pharmacological sedation, analgesia, and anesthesia are used. However, studies show that inappropriate interventions such as underdosing and limited use of medications occur because of certain myths, beliefs, and lack of pharmacological knowledge on the part of health professionals. Studies that specifically address premedication for painful procedures in children with cancer have shown that only a small percentage of children receive premedications and that there is no clear consensus or standard for either drugs or dosages. The issue of premedicating children before procedures remains controversial and deserves further investigation. This study explored the attitudes and perceptions of oncology physicians and nurses concerning medicating children before procedures. Findings showed that most pediatric oncology specialists medicate their patients before invasive procedures and that the most common premedications used are Versed; Demerol, Phenergan, Thorazine; chloral hydrate; Ativan; fentanyl; Demerol; and Xylocaine. Most pediatric oncology specialists believe that premedication is necessary for children for BMAs and LPs.
Adolescent↗
Premedication for out-patient endoscopy of the upper gastro-intestinal tract.
Upper gastrointestinal endoscopy was performed on 342 out-patients. The patients were allocated to four groups according to premedication given. The premedication used was atropine 0.1 mg/10 kg (A), atropine 0.1 mg/10 kg and diazepam 5 mg (AD), atropine 0.1 mg/10 kg and fentanyl 0.2 mg (AF), atropine 0.1 mg/10 kg diazepam 5 mg and fentanyl 0.2 mg (ADF). Premedication was given about 30 minutes before the procedure intramuscularly; the mouth and pharynx were sprayed with 10% lidoc,ine. The patients as well as the endoscopist considered the premedication in groups A and AD to be satisfactory. From the patient's point of view there were hardly any differences between the var;ous groups, except in drowsiness, which occurred more often in groups where fentanyl had been used. From the endoscopist's point of view groups A and AD were preferred because they offered better working conditions for the procedure. The longest period of observation was required in group ADF. On the basis of these results premedication with only atropine or if desired a combination of atropine and diazepam in addition to local sprayed anaesthesia of the mouth and pharynx is sufficient, and is recommended for endoscopy of the upper gastrointestinal tract.
Aged↗
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↗
[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↗
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↗
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↗
Does opiate premedication influence postoperative analgesia? A prospective study.
The influence of opiate premedication on analgesic requirements postoperatively was investigated. Out of 98 patients with a lumbar disc prolapse 50 were premedicated with flunitrazepam orally, 48 with pethidine and triflupromazine intramuscularly. The operations were performed under inhalational anaesthesia. The average time up to the first demand for an analgesic was longer following opiate premedication (351 vs. 219 min). Only 45.8% of the patients treated with opiates demanded analgesics postoperatively, compared to 80.0% of those who had a benzodiazepine premedication (P less than 0.01). These clinical data confirm the experimental evidence that pretreatment with opiates diminishes the sustained hyperexcitation of the central nervous system caused by peripheral lesions.
Analgesia↗
The interface between premedicine and medicine: expectations of premedical advisors.
Premedical advisors can carry out many varied activities, but all require commitment, resources, and personal interest. Premedical and health career advising appear to be most successful when the task is not assigned to one individual, but is assumed as a university responsibility. Also, premedical advisors seem to be valued more and to have fewer conflicts when they are known by health professional schools and work together with them. Medical schools have a responsibility to assist and support premedical advisors more than is done at present. This need will become increasingly important if the high quality of applicants to medical school is to be maintained in an apparently shrinking applicant pool.(1)
Counseling↗
[The influence of a beta-adrenolytic premedication on cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)].
Three groups of patients with different premedications were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acid levels during esophago-gastro-duodenoscopy: Group A was premedicated with Bunitrolol, group B was premedicated with Hyoscin-N-butyl-bromide and diazepam, group C was endoscopied without premedication. The pulse rate rose significantly less in group A than in groups A and C; the same phenomenon was observed with regard to the systolic blood pressure. Premature beats occurred in all 3 groups: 32 per cent of the patients in group A, 43 per cent in group B and 60 per cent in group C had at least occasional premature beats; an accumulation of premature beats however occurred significantly less frequently in group A than in groups B or C. A drop of the ST-part of the ECG occurred with about the same frequency in each group. An increase of the plasma free fatty acids, which was noted in groups B and C, could be observed in Group A. A pre-endoscopic medication of beta blocking agents could be a useful measure in patients with labile arterial hypertension, vegatative dysregulation and a hyperkinetic heart syndrome.
Adrenergic beta-Antagonists↗
The premedication of cardiac surgical patients. A clinical comparison of four regimes.
One of four groups of patients was not premedicated; the others received diazepam 10 mg by mouth, diazepam 20 mg by mouth or a combination of pentobarbitone orally and morphine and hyoscine intramuscularly. The cardiovascular and respiratory parameters were studied before and after the premedication and any changes in sedation, apprehension and reaction to pain were noted. The ease of induction of anaesthesia in the four groups was compared. Most of the patients who received the pentobarbitone, morphine and hyoscine combination came to theatre calm, sedated and often asleep. They showed no significant cardiovascular or respiratory depression and the induction of anaesthesia was more satisfactory than in the other groups. Two of the patients who were not premedicated became very agitated in the ward and the remainder of the patients in this group were apprehensive in the anaesthetic room and during induction. The effects of diazepam in the two doses studied were intermediate between those who received the pentobarbitone, morphine and hyoscine and those who were not premedicated.
Administration, Oral↗