Melperon premedication for cataract surgery

Given as a peroral premedicant for geriatric patients having cataract surgery under regional block, a butyrophenone neuroleptic melperon (15–30 mg, n = 50) ranked equally with diazepam (4–10 mg, n = 50), assessed using a qualitative subjective estimation of the patients' anxiety. The patients treated with melperon needed significantly fewer supplementations with intravenous drugs, to withstand the surgery, compared to those medicated with diazepam. Melperon is a compatible alternative, but its possible propensity to cause occasional arterial hypotension must be noticed.     

Oral lormetazepam in premedication. A comparison with diazepam

Lormetazepam, a relatively new benzodiazepine was compared in a randomised, double blind trial with diazepam for its effectiveness as an oral premedicant drug. A scoring system was used to assess sedation, relief of anxiety, nausea, dizziness and cardiovascular effects in two groups of patients having orthopaedic operations. Some statistical indication that lormetazepam has a greater anxiolytic effect than diazepam was found, but in assessing total effect using a known scoring system, no difference was demonstrated between the two drugs.     

A comparison of triazolam and diazepam as premedication agents for minor gynaecological surgery

Triazolam 0.25 mg, diazepam 10 mg and placebo were compared in a randomized double-blind trial of oral premedication in 90 patients undergoing minor gynaecological surgery. Both triazolam and diazepam produced a significant sedative effect as measured by patient self assessment linear analogue scales but only diazepam was more anxiolytic than placebo. Psychomotor performance assessed by the letter-search test at 3 and 6 hours after awakening showed a decrement in performance in patients receiving triazolam at 3 hours compared with the two other groups. Triazolam was shown to have a pronounced amnesic effect and whilst it might be used for premedication, its lack of anxiolysis coupled with a significant impairment of psychomotor performance at 3 hours after awakening, render the drug unsuitable for premedication in the short stay patient.     

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.     

Lorazepam as night sedation and premedication: a comparison with diazepam

Fifty healthy female patients scheduled for surgery were randonly allocated into two groups in a double-blind study. One group received lorazepam 2.5 mg orally at 2200 h on the evening before surgery as night sedation, and again at 0800 h on the morning before surgery as premedication. The second group received diazepam 10 mg orally at the samte times. The quality of sleep the night before surgery was superior in the lorazepam group (p less than 0.02). The frequency of effective sedation produced pre-operatively was similar in both groups. Although the incidence of amnesia for visual stimuli following lorazapam was higher (p less than 0.05) than with diazepam, there was no difference in the recall of auditory and painful stimuli. The overall incidence of side effects was similar for each drug and at the dosage used no difference was found in the time to awaken from anaesthesia.     

A randomized comparison of midazolam and diazepam injectable emulsion in cataract surgery

The purpose of this study was to compare the psychomotor recovery of patients sedated with either midazolam or Diazemuls using the digit symbol substitution test and the Trieger test. Sixty patients were allocated in random double-blind fashion to receive either midazolam or diazepam in oil emulsion (Diazemuls) as intravenous sedation for cataract surgery. Both groups received fentanyl 0.5 μg· kg^?1 IV. Tests of cognition were performed by the patients prior to sedation and at half-hourly intervals for three hours after cataract surgery. In a dose ratio of 1:4, midazolam was found to produce better sedation but more prolonged recovery than Diazemuls. Anterograde amnesia was comparable in the two groups, while more patients in the Diazemuls group developed episodes of apnoea and venous irritation.     

Intravenous sedation for cataract surgery

Fifty-five unpremedicated outpatients scheduled for cataract surgery were randomly allocated to receive either a fixed dose of nalbuphine and methohexitone or fentanyl and diazepam administered in a dose adjusted to produce the required sedative effect. Statistical analysis revealed no difference between groups with regard to immediate side effects, intra-ocular pressure or postoperative nausea or vomiting. Recovery time from administration of the sedative until compliance with simple commands was significantly longer in the nalbuphine/morphine group (89 vs 196 seconds) but this was not felt to be of clinical importance. This combination was better in terms of sedation at the time of insertion of the nerve blocks, lack of recall of insertion of the nerve block, incidence of intra-operative complications, surgeon's assessment of operating conditions and patient acceptability. This fixed dose by weight drug combination for intravenous sedation should be applied widely.     

A combination of oral diazepam and droperidol for premedication. A double blind comparison with diazepam alone

Oral diazepam is commonly used as a premedicant. For a given dose there is considerable between patient variation in clinical effect and plasma levels. The addition of droperidol may improve consistency and contribute antiemesis whilst avoiding the undesirable effects of droperidol alone. Ninety patients undergoing minor gynecological or minor urological surgery were given as an oral premedicant either diazepam (0.185 mg/kg) or one of two combinations of diazepam and droperidol (diazepam, 0.185 mg/kg plus droperidol, 0.09 mg/kg; or diazepam, 0.135 mg/kg plus droperidol, 0.09 mg/kg). There was no significant difference between the groups in altering mean anxiety measurements or improving consistency of action as judged by the number of patients having reduced anxiety measurements. Side effects, including nausea and vomiting, were not significantly different between the three groups. In the doses used there was no practical advantage in adding droperidol to diazepam for oral premedication.     

Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA

BACKGROUND: Because of its pain-attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations. METHODS: One hundred children between 10 and 15 kg of body weight scheduled for day-case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 microg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1-9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well-being at home. RESULTS: The children of the K-groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D-groups; stridor scores > or = 6 were seen in one child of the D-groups (DS) and in six children of the K-groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home. CONCLUSION: Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.     

Flumazenil used for antagonizing the central effects of midazolam and diazepam in outpatients

In a double-blind, randomized trial, the efficacy and safety of flumazenil, a benzodiazepine antagonist, was evaluated in patients after gastroscopy under midazolam or diazepam sedation. The criteria of efficacy were the degree of sedation and anterograde amnesia. Flumazenil significantly reduced the degree of sedation in both groups without significant intergroup differences. No sign of resedation was found during the observation period of 3 h. The anterograde amnesia was effectively antagonized in both groups. Flumazenil was well tolerated. Flumazenil is a safe and effective benzodiazepine antagonist which makes it possible to reduce the recovery period in outpatients sedated sufficiently with benzodiazepines for gastroscopy.     

Bromazepam as oral premedication. A comparison with lorazepam

A double-blind trial of bromazepam 6 mg versus lorazepam 2 mg as oral premedicant agents was undertaken. A total of 153 patients were studied; 78 received bromazepam and 75 lorazepam. Objective and subjective assessments of sedation, amnesia, nausea and vomiting were performed. No significant difference between the two groups was found. It was concluded that bromazepam 6 mg and lorazepam 2 mg were equally satisfactory as premedicant drugs.     

A comparison of high-dose pentazocine with pethidine and diazepam in paediatric premedication.

A comparision of a high dose of pentazocine (0.9 mg/kg), and moderate doses of pethidine (1 mg/kg) and diazepam (0.2 mg/kg) as pre-anaesthetic medication was carried out in a double-blind between-patient placebo-controlled trial in 200 children. The assessment of the drugs as pre-anesthetic medication was made by comparing the sedative effect before induction, the status of the patient at induction and the patient's behaviour in the recovery room. All the active drugs were superior to the placebo at induction of anaesthesia. Postoperatively the sedative effect of the high dose of pentazocine was superior to that of the other active drugs, presumably due to the strong analgesic effect at this dose. The rate of respiration was clearly lower after pentazocine than after the other two active drugs. Other side effects or complications did not differ between the groups. It is concluded that, in spite of its favourable sedative effect, a high dose of pentazocine should be used with caution in pediatric premedication because of the possibility of slight respiratory depression.     

Comparison of triazolam v. diazepam as an oral preanaesthetic medication for outpatient paediatric surgery

Diazepam, in combination with pethidine and atropine, has proved to be an effective oral pre-anaesthetic medication for paediatric outpatient surgery. Triazolam is a benzodiazepine with a short half-life and rapid oral absorption, and causes amnesia and sedation. The results of a prospective, randomized, double-blind study substituting triazolam for diazepam in this regimen are described. One hundred and nineteen healthy paediatric outpatients older than 1 year of age were randomized to receive either our routine oral outpatient premedication (pethidine 1.5 mg·kg^-1, diazepam 0.15 mg·kg^-1 and atropine 0.02 mg·kg^-1), an oral premedicant where triazolam (0.005 mg·kg^-1) was substituted for diazepam or an oral premedicant containing pethidine and atropine only. Children given triazolam had a more rapid onset of pre-anaesthetic medication effect (change in state of consciousness) compared with patients in the other two groups (P < 0.01). Patients receiving traizolam showed more evidence of sedation within 45 min of receiving the oral premedication (P < 0.003). There were no other differences between the three groups.     

A comparison of midazolam and diazepam for intravenous sedation in dentistry

In a randomised cross-over trial, midazolam, a new water soluble benzodiazepine was compared with the conventional diazepam preparation (Valium) in 34 patients aged 16-45 years who were undergoing outpatient conservation dentistry. Midazolam hydrochloride (0.17 mg/kg) was virtually free of venous complications and showed advantages over diazepam (0.32 mg/kg) in providing a faster onset of action, higher incidence of amnesia and more rapid recovery. Midazolam produced a higher incidence of respiratory side effects hiccough (17.6% compared with 2.9%), brief apnoea following induction (11.8% compared with 5.8%), and airway obstruction during maintenance (8.8% compared with 0%). These may be related to the greater potency of midazolam as suggested by the smaller total dose required. Cardiovascular changes and operating conditions were similar.     

A comparison of nalbuphine and morphine as premedication agents for minor gynaecological surgery

Nalbuphine 10 mg and morphine 10 mg were compared in a randomised double-blind trial as intramuscular premedication in 50 patients undergoing minor gynaecological surgery. Both nalbuphine and morphine produced significant sedation without anxiolysis as assessed by patient linear analogue scales, but there were no significant differences between the two drugs. Observer ratings demonstrated that nalbuphine produced calm/sleepy patients to a greater extent than morphine. There were no differences in untoward effects produced by each drug.     

Glycopyrrolate during ketamine/diazepam anaesthesia A double-blind comparison with atropine

In a double-blind study, the effects of atropine and glycopyrrolate (dosage ratio 2:1) following i.m. and i.v. administration were compared with respect to salivation, heart rate, and blood pressure before, during and after i.v. infusion anaesthesia with ketamine and diazepam for alloplastic hip or knee surgery in 30 patients above the age of 50 years. Given with the premedicant, the two drugs were equally effective in reducing salivation. A slight increase in heart rate was seen after atropine only (P less than 0.005). Increases in heart rate and blood pressure during induction of anaesthesia were similar in the two groups. A second dose of the test drug was given with neostigmine for reversal of neuromuscular blockade. Again, there were no statistically significant differences with respect to salivation, blood pressure, heart rate, nausea and/or vomiting, unpleasant dreams and arousal time.     

Midazolam-droperidol premedication for cardiac surgery A comparison with papaveretum and hyoscine

A combination of midazolam and droperidol given intramuscularly was compared with papaveretum and hyoscine for premedication of patients about to undergo cardiac surgery. Midazolam and droperidol proved to be a very satisfactory combination, producing superior sedation and anxiolysis with good cardiovascular stability.     

Oral transmucosal fentanyl citrate for preanaesthetic medication of paediatric cardiac surgery patients

The safety and efficacy of oral transmucosal fentanyl citrate (OTFC) as a preanaesthetic medication were evaluated in 42 children aged two to twelve years scheduled to undergo general anaesthesia for open cardiac surgery. Patients were randomly assigned to receive either a placebo lozenge or a lozenge of 15–20 μg·kg^?1) OTFC 45 min preoperatively and were managed in a double-blinded manner. Heart rate, respiratory rate (RR), blood pressure, and digital pulse oximetry (Spo₂) were monitored throughout the study. Scoring systems were utilized to evaluate sedation, anxiety, cooperation, and ease and quality of parental separation and anaesthetic induction. Adverse effects were noted. Preoperatively, sedation was observed in both groups, but children receiving OTFC had significantly less distress at time of separation from parents. Clinically significant decreases in RR and Spo₂ were observed more frequently in children in the OTFC group than in the placebo group. The authors conclude that, in paediatric cardiac surgical patients, OTFC induces preoperative sedation and facilitates separation of the patients from their parents, but is associated with decreases in respiratory rate and Spo₂ that may be of clinical importance.