Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia

Title

Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia.

Mirtazapine premedication: Effect on preoperative anxiety and propofol dose requirements at different stages of hypnosis

BackgroundMirtazapine is an antidepressant drug that blocks central 5-HT2 receptors with anxiolytic and sleep-promoting effects and theoretically can be used as a premedication.MethodsSixty ASA I-II patients aged 25–50 yr were randomly allocated according to the premedication received 2 h before induction of anesthesia into two equal groups: group M patients received mirtazapine 30 mg tablet mixed with 20 ml of water and group P patients received 20 ml of plain water. Anxiety level was measured by visual analogue scale (VAS) and bispectral index (BIS) electrodes were connected before induction of anesthesia. Intravenous (i.v) infusion of propofol 1% at a rate of 300 ml h^?1 was started to induce hypnosis till a target BIS value of 45 (BIS45) is reached, and then endotracheal intubation is performed after fentanyl and cis-atracuruim being administered. Propofol dose requirements to achieve loss of response to verbal contact (RVC), loss of eyelash reflex (ELR), and a target BIS45 were recorded. Anesthesia was maintained with sevoflurane titrated to BIS value of 40–50 and oxygen/air mixture. Recovery time was recorded. In postanaesthesia care unit (PACU), VAS for pain and Ramsay sedation score were recorded. Patients were discharged from PACU when two consecutive Aldrete scores of 9 or 10 are obtained, and time of PACU stay was recorded.ResultsPreoperative anxiety by VAS and propofol doses required achieving loss of RVC and ELR, and target BIS45 were significantly lower in mirtazapine group. The two groups were comparable with regard to recovery and PACU stay times as well as postoperative pain and anxiety.ConclusionMirtazapine 30 mg oral tablets can be used as a premedication as it reduces preoperative anxiety and hypnotic dose requirements of propofol, and does not prolong recovery time.     

长托宁联合力月西应用于小儿术前给药的临床观察

目的观察长托宁联合力月西应用于小儿术前用药对镇静、情绪、心率、血压及呼吸道分泌物的影响。方法4-10岁泌尿外科患儿40例，ASAⅠ级，随机分为两组，A组20例肌注阿托品0．02mg／kg＋鲁米那钠2mg／kg；B组20例肌注长托宁0．02mg／kg＋力月西0．1mg／kg，分别记录基础值、入室、诱导、手术开始、术毕各时点的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）；观察镇静、情绪状态、与父母分离和静脉穿刺时的行为变化及在麻醉诱导时面红、口干程度、手术结束时有较多分泌物的病例数。结果长托宁联合力月西应用对患儿的心率和血压影响轻微，而抑制腺体分泌的作用较强且还具有一定的镇静和抗焦虑作用。结论长托宁联合力月西应用于小儿术前效果满意，是一种较好的小儿麻醉前用药配伍组合。     

The effect of gabapentin premedication on pain and anxiety during cataract surgery under peribulbar block

BackgroundThe principal goal of sedation during eye surgery is to keep the patient calm and comfortable without depression of the protective airway reflexes or affecting the hemodynamics. The aim of the present study was to evaluate the effect of oral gabapentin premedication on anxiety and pain during cataract surgery done under peribulbar block.Material and methodsIn this double blinded placebo controlled study, 60 patients scheduled for cataract surgery under peribulbar block were randomly allocated into two groups. In the gabapentin group (n = 30), patients were premedicated 2 h before peribulbar block by 1200 mg oral gabapentin capsules. In the placebo group (n = 30), patients were premedicated 2 h before peribulbar block by oral placebo capsules. Verbal pain score (VPS), sedation score, verbal anxiety score (VAS), respiratory rate, oxygen saturation, heart rate, blood pressure and side effects were recorded.ResultsVPS was low in the gabapentin group versus the placebo group after the block till discharge (P < 0.01). VAS for anxiety was low in the gabapentin group versus the placebo group 1 h after premedication till discharge (P < 0.01). The heart rate and blood pressure were high in the placebo group versus the gabapentin group from arrival to the operating room till discharge. No side effects were recorded.ConclusionPremedication with 1200 mg oral gabapentin reduces anxiety and pain during cataract surgery done under peribulbar block without producing side effects.     

戊乙奎醚与阿托品对幼儿术前用药时心血管稳定性的比较

目的观察戊乙奎醚和阿托品做为幼儿术前用药时心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、心电图（ECG）的变化,比较其对心血管稳定性的影响。方法幼儿择期手术40例随机分为两组,每组20例,戊乙奎醚组（A组）给予戊乙奎醚0．015mg／kg,阿托品组（B组）给予阿托品0．015ms／ks,均于术前30min肌内注射,观察记录给药前及给药后10min、20min、30min、40min时患儿HR、MAP、SpO2、ECG的变化。结果A组用药后HR、MAP、SpO2变化不明显,B组HR、MAP明显变化,SpO2变化不明显,两组均无其他心律失常。结论戊乙奎醚做为幼儿术前用药,有利于心血管稳定性的维护。     

Triazolam premedication

A randomised, double blind study, of 58 female patients undergoing laparoscopic investigation was carried out to compare triazolam 0.25 mg, lorazepam 2 mg, or placebo as oral premedication. Each patient was assessed by only one of the authors both pre- and postoperatively with regard to anxiolysis, sedation and rapidity of recovery. Triazolam and lorazepam were each associated with a significant reduction in anxiety compared to the initial assessment, whereas placebo had no anxiolytic effect. Sixty minutes after premedication, patients who had received triazolam were significantly more sleepy than patients given placebo or lorazepam. Two hours after the operation, the patients who had had triazolam or lorazepam were significantly more sleepy than those who received placebo. However, at 6 hours postoperatively there was no difference between triazolam and placebo, whilst those who had been given lorazepam were still significantly more sleepy than those given placebo. Triazolam appears to offer advantages over either lorazepam or placebo in patients who require rapid recovery, sedation and reduction in pre-operative anxiety.     

Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. We present a case of a severely autistic and violent patient scheduled for dental rehabilitation under general anesthesia. A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.     

长托宁在老年ERCP麻醉前用药的临床观察

目的：探讨长托宁作为老年患者ERCP麻醉前用药的可行性,临床效果及安全性。方法：选取2009年5月-2013年2月本院90例在静脉麻醉下行ERCP手术老年患者,随机数字表法分为三组,长托宁组30例,阿托品组30例,生理盐水组30例,三组分别以长托宁,阿托品,生理盐水作为麻醉前用药。比较三组患者在麻醉给药后不同时间点SBP、DBP、HR以及唾液分泌量的变化,并比较三组患者在术中术后出现的不良反应情况。结果：三组患者血压变化均平稳,长托宁组患者心率变化较阿托品组平稳,和生理盐水组比较变化无统计学差异,长托宁组患者唾液分泌量明显少于阿托品及生理盐水组。阿托品组患者在给药前后心率变化差异有统计学意义（P〈0.05）。结论：长托宁在应用于老年ERCP术前麻醉时,对老年患者的循环血流动力学影响小,在抗胆碱作用时比阿托品效果更持续,并能够有效的控制围术期间呼吸道分泌物,是一种更为理想的老年患者麻醉前用药。     

Released washed platelet concentrates are effective and safe in patients with a history of transfusion reactions

Background

Plasma removal by washing is an effective approach to prevent transfusion reactions by platelet concentrates (PCs). Recently, washed PCs were released by the Japanese Red Cross Society (JRCS).

咪达唑仑滴鼻用于小儿术前药的效果观察

目的观察咪达唑仑滴鼻作为小儿术前药的安全性及有效性。方法选择择期行腺样体或伴有扁桃体切除,年龄2-7岁,ASA分级Ⅰ级的小儿患者60例。随机分成咪达唑仑组（MZ组）及对照组（NS组）,每组30例,MZ组术前30 min经鼻给予咪达唑仑0.2 mg/kg（容量配至1 mL）,NS组术前30 min经鼻给予1 mL生理盐水。记录患儿的基础情绪及给药后鼻腔不适感的发生情况,同时监测给药即刻至入手术室前患儿的脉搏（HR）、血压（BP）、血氧饱和度（SpO2）,记录患儿给药后30 min的镇静评分、情绪评分、与父母分离抵抗评分、静脉穿刺抵抗评分、面罩抵抗评分及不良反应发生情况。术中记录患儿的HR、BP、SpO2、手术时间、拔管时间及术后恶心呕吐、嗜睡等不良反应的发生情况。结果 MZ组的镇静评分、情绪评分、与父母分离评分、静脉穿刺抵抗评分、面罩抵抗评分分别为3、3、3、3、4分,均高于NS组的2分,差异有统计学意义（U=170.5、179、131、197、169.5;Z=-4.81、-4.45、-5.21、-4.01、-4.30;P〈0.05）,两组患儿给药后至麻醉诱导前、术中以及苏醒期血流动力学、血氧饱和度波动和不良反应发生情况比较差异无统计学意义（P〉0.05）。结论经鼻应用咪达唑仑对小儿术前有镇静作用,且对循环呼吸无影响,不延长拔管时间。