Flunitrazepam Versus Placebo Premedication for Minor Surgery

The clinical effects of oral flunitrazepam (2 mg on the night before operation followed by 2 mg on the morning of operation) and placebo as premedicants were tested in a double-blind study in 81 gynaecological patients. The separate or total concentrations of flunitrazepam and its demethylated metabolite in plasma (measured by gas chromatography) were correlated with the clinical effects of flunitrapam premedication, assessed both sugjectively and objectively. In most parameters tested (sleep on the night before operation, sedation, apprehension, headache, pulse rate), there was a positive, significant difference between the flunitrazepam group (n = 44) and the placebo group (n = 37). No significant difference was found between the two groups in emetic effect, excitement, systolic blood pressure increase, and vene-puncture, but the patients receiving flunitrazepam felt significantly more dizziness. The temperature of the left forefinger before, during and after the anaesthesia did not vary significantly between the two groups. There was no correlation between the plasma concentration of flunitrazepam and its demethylated metabolite (separate or total concentrations) and any of the parameters tested before induction of anaesthesia. Flunitrazepam is a new oral premedicant with prominent sedative and anxiolytic actions. When the drug is given as a sedative on the night before operation, followed by a second dose on the morning of operation, the beneficial effects last for at least 8 hours after the second dose.     

An Alternative Access Technique Under Direct Vision for Preperitoneoscopic Pelvic Surgery: Easier for the Beginners

Background  We present an alternative access technique to facilitate preperitoneoscopic (extraperitoneal laparoscopic) approach for radical prostatectomy, herniorrhaphy, and other pelvic procedures. Methods  A 0° telescope was mounted into a Visiport Optical Trocar (Visiport), and via a periumbilical incision it was advanced under direct vision at first vertically through different layers of the anterior abdominal wall. Immediately before the posterior rectus sheath, it was redirected caudally and horizontally toward the symphysis pubis. The Visiport was withdrawn and replaced by a dissection balloon that was inflated for developing the working space, then it was substituted with a 12-mm trocar to begin the pneumo-extraperitoneum. The surgical procedures are detailed in the attached video. Results  This technique was used in 168 of 179 patients undergoing preperitoneoscopic surgery (97 radical prostatectomies, 80 totally extraperitoneal herniorrhaphies, and 2 urinary bladder diverticulectomies). Operative parameters were compared with 11 preceding patients approached with the open Hasson technique. All of the procedures to create the preperitoneoscopic space were successfully with no complications. For radical prostatectomy, there was a significantly faster access to the preperitoneal space (38 ± 12 vs 540 ± 69 seconds) and a faster setup of the whole operative space (15 ± 5 vs 29 ± 9 minutes, both P < .05) with the new technique. Less pericannular CO₂ leakage was experienced during the preperitoneoscopy with our technique. Conclusion  This alternative technique offers a simple, safe, quick, and effective access for creating a preperitonescopic working space. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Psychosedation With Dexmedetomidine Hydrochloride During Minor Oral Surgery

We performed intravenous sedation with dexmedetomidine hydrochloride during minor oral surgery and compared this agent with propofol. Patients were randomly divided into 2 groups: dexmedetomidine hydrochloride (D) and propofol (P) groups. In Group D, systolic blood pressure (SBP) increased immediately after the start of initial loading, although no significant differences were noted. Both SBP and diastolic blood pressure (DBP) gradually decreased during maintenance administration and were significantly lower than pretreatment values. The heart rate decreased immediately after the start of administration and was significantly lower during both initial loading and maintenance administration; the heart rate was also significantly lower than that in Group P. In Group D, arterial blood oxygen saturation (SpO₂) significantly decreased after the sedation level reached an optimum level until the end of administration. The bispectral index (BIS) value gradually decreased during initial loading. At the optimal sedation level, it decreased to 80 to 85. During maintenance administration, marked changes were observed in this parameter. No marked differences in amnestic effects and comfort were noted between the 2 groups. If the sedation level can be evaluated accurately via another objective method, intravenous sedation with dexmedetomidine hydrochloride may be useful in dental treatment.