Diazepam premedication in children

Oral diazepam 0.25 mg/kg or 0.5 mg/kg was employed as premedication in one hundred and one children undergoing elective surgery. The drug failed to modify the rise in cardiorespiratory indices of preanaesthetic anxiety compared with control values, and there was no difference between the two doses assessed by a sedation scoring system. 0.25 mg/kg diazepam produced less sedation in children under 5 years old, compared with those 5 years and older, whereas 0.5 mg/kg produced no difference between the older and younger age groups. The plasma levels of diazepam were greater postoperatively in the 0.5 mg/kg group. There was no relationship between plasma diazepam and recall at induction, and pre-anaesthetic amnesia was not enhanced with the higher premedication dose.     

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.     

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.     

Effect of metoprolol and diazepam on pre-operative anxiety

A double-blind study of 98 patients who underwent elective hysterectomy or orthopaedic surgery was conducted to evaluate the effect of metoprolol or placebo combined with diazepam given 1-3 hours before surgery. Evaluation was by anaesthetists and by visual analogue scoring by the patients. The anaesthetists found that patients who received metoprolol were significantly less anxious (p less than 0.005) and better sedated (p less than 0.001) before induction of anaesthesia. The patients who received metoprolol found themselves more calm compared with placebo patients. Arterial blood pressure and heart rate were reduced by metoprolol compared to placebo. Metoprolol may be a valuable drug for premedication.     

Haemodynamic changes during induction of anaesthesia with midazolam and diazepam (Valium) in patients undergoing coronary artery bypass surgery

Midazolam 0.3 mg/kg and diazepam 0.5 mg/kg were used for induction of anaesthesia in two groups of 10 patients each undergoing coronary artery bypass surgery. Haemodynamic variables were measured during induction of anaesthesia, after pancuronium and following tracheal intubation. Haemodynamic indices were derived from these measurements using standard formulae. The induction of anaesthesia with midazolam produced a slight but significant increase in heart rate. There was a significant fall in systemic arterial pressure and pulmonary artery pressure following both drugs. Despite the fall in systemic arterial pressure, the cardiac index was maintained in patients who received midazolam. The cardio-stimulatory effect of laryngoscopy and tracheal intubation was not prevented by either of the benzodiazepines and morphine in the dosage used. Midazolam is a suitable alternative to diazepam as part of an intravenous induction regimen in patients with ischaemic heart disease.     

Forum Aminophylline reversal of diazepam sedation

A double-blind randomised study was performed to investigate whether aminophylline reversed the sedative effect of diazepam. Thirty-two patients undergoing genito-urinary surgery with spinal or topical anaesthesia were given diazepam to maintain a state of deep sedation. Postoperatively patients received either aminophylline (60-120 mg) or physiological saline intravenously. The aminophylline group showed a rapid reversal of sedation, which persisted throughout the observation period of 2 hours. No such effect was seen in the patients who received saline and the difference was still obvious after 2 hours. It is concluded that aminophylline is a potent antagonist to the sedative effect of diazepam.     

Benzodiazepine premedication may attenuate the stress response in daycase anesthesia: a pilot study

PURPOSE: Patients undergoing daycase surgery suffer from varying degrees of fear and anxiety. There is conflicting evidence in the literature regarding the benefit of benzodiazepine premedication in daycase surgery. We carried out a prospective, double-blind, randomized pilot study investigating the effect of benzodiazepine premedication on the stress response in patients undergoing daycase anesthesia and surgery. METHODS: Group I (n = 16) received diazepam 0.1 mg*kg(-1) orally 60 min preoperatively; Group II (n = 15) received diazepam 0.1 mg*kg(-1) orally 90 min preoperatively; Group III (n = 30) received a placebo. The stress response was measured by analyzing urinary catecholamine and cortisol levels and by scoring anxiety levels using state-trait anxiety inventory (STAI) scores and visual analogue scores (VAS). RESULTS: Anxiety scores (VAS and STAI scores) were not different between groups. We found a statistically significant reduction in urinary cortisol and noradrenaline levels in the groups receiving diazepam vs placebo. DISCUSSION: The reduction in stress hormones following diazepam premedication, in patients undergoing daycase surgery may support the role for benzodiazepine premedication in this setting. However, further studies are warranted to determine the clinical significance of these findings.     

Rectal premedication in children

Two hundred and eight healthy children who were to undergo minor elective surgery during halothane, nitrous oxide, oxygen anaesthesia were studied in a double blind investigation to evaluate the sedative and anticholinergic effects of two rectal premedications. Group I received diazepam 0.75 mg/kg rectally; Group II received a mixture of diazepam 0.5 mg/kg, morphine 0.15 mg/kg and hyoscine 0.01 mg/kg rectally. No significant difference was found between the two groups in sedative or anticholinergic effects during induction of anaesthesia or in the postoperative period. No adverse effects were seen.     

肝细胞肝癌术后大量腹水预测评分体系的建立

目的 通过对肝细胞肝癌患者术后大量腹水形成相关因素的分析,建立一套预测术后大量腹水形成的评分体系.方法 回顾性分析2005年1月至2010年1月收治的324例肝细胞肝癌患者的术后腹水发生情况,男性282例,女性42例,年龄17～84岁,中位年龄54岁.根据腹水量的多少,将患者分为两组:大量腹水组(n=78)和少量腹水组(n=246).通过统计学分析筛选出与术后腹水形成密切相关的术前、术中及术后因素,并建立评分系统.结果 单因素分析显示,大量腹水组患者有无肝硬化、凝血功能、血小板计数、血浆白蛋白及天冬氨酸转氨酶等术前指标,以及手术时间、术中出血量、术中输血浆量、术中输红细胞量、半肝(含半肝)以上切除等因素,与少量腹水组相比差异有统计学意义(P＜0.05).多因素回归分析显示,术前血小板计数、天冬氨酸转氨酶、是否行半肝以上(含半肝)切除、术中输注血浆量、术后第1天尿量及术后第1天引流量是术后产生大量腹水的独立相关因素.依据多因素回归分析结果建立的评分系统,预测腹水产生的敏感度为83.3%,特异度为86.2%.结论 肝细胞肝癌术后腹水生成与术前、术中及术后多种因素有关,本研究建立的评分系统可较准确地预测术后大量腹水的生成.     

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.     

Diazepam Adsorption to Infusion Sets and Plastic Syringes

The adsorption of diazepam to infusion sets and plastic syringes was studied. Infusion solutions consisting of diazepam injection (Valium®) in glucose 5.5%, diazepam emulsion (Diazemuls®) in glucose 5.5%, or diazepam emulsion in a lipid emulsion (Intralipid® 10%) were infused through two different infusion sets (Transcodan L-74 and Cutter IL). It was found that, when an infusion solution with a low diazepam concentration (0.04 mg/ml) was infused slowly (4 ml/h), the diazepam adsorption was more than 80%. At a higher diazepam concentration (0.1 mg/ml) and increased infusion rate (20 ml/h) the adsorption decreased. Diazepam injection in glucose 5.5% was adsorbed to a higher degree (40–75%) than diazepam emulsion in glucose 5.5% (15–35%). When diazepam emulsion was diluted with the lipid emulsion, no diazepam adsorption to the infusion set occurred at this concentration and infusion rate. No significant difference between the two infusion sets could be found. The miscibility of diazepam emulsion with glucose 5.5%, glucose 10%, or sodium chloride 0.9% was examined. Diazepam emulsion proved to be miscible with glucose 5.5% and glucose 10%, but sodium chloride should not be used to dilute diazepam emulsion. The effect on the diazepam concentration of storing diazepam injection and diazepam emulsion in plastic syringes for up to 4h was also studied. It was found that the diazepam concentration remained unchanged during this time.     

Flumazenil attenuates development of tolerance to diazepam after chronic treatment of mice with either isoflurane or diazepam

In an effort to clarify the mechanism of action of isoflurane, we studied the effect of flumazenil on mice chronically treated with isoflurane or diazepam. Mice were pretreated with diazepam, isoflurane, or saline, with and without flumazenil. After 2 wk, responses to isoflurane and diazepam were assessed, and central benzodiazepine receptor (CBR) binding characteristics were assayed. Mice pretreated with isoflurane failed the horizontal wire test at a larger isoflurane concentration (0.5%) compared with saline-pretreated mice (0.4%) (P < 0.05). These differences did not occur when flumazenil was added to the pretreatment. After the administration of diazepam, 20% of diazepam- and 11% of isoflurane-pretreated mice failed the horizontal wire test, versus 50% and 44% when flumazenil was added to either drug (P < 0.002) and 80% and 100% in the saline and saline plus flumazenil-treated mice. The increased CBR density due to flumazenil was attenuated by the coadministration of isoflurane or diazepam. Flumazenil attenuated the development of tolerance to diazepam after chronic treatment with diazepam or isoflurane and attenuated the development of tolerance to isoflurane. Isoflurane, like diazepam, attenuated the effect of flumazenil on CBR ligand binding. These findings suggest that isoflurane shares a mechanism of action with diazepam, probably via the gamma-aminobutyric acid system, most probably the CBR. IMPLICATIONS: Flumazenil attenuates the development of tolerance to isoflurane and diazepam after chronic isoflurane pretreatment. Isoflurane, like diazepam, attenuates the increase in central benzodiazepine receptor (CBR) density caused by flumazenil. These findings suggest that isoflurane and diazepam share a mechanism of action, most probably via the gamma-aminobutyric acid system and the CBR.     

Midazolam and Fat-Emulsion Diazepam as Intramuscular Premedication A Double-Blind Clinical Trial

Sixty female patients were given, in random order, under double-blind conditions, either midazolam or fat-emulsion diazepam, intramuscularly, as premedication, 1 h before general anaesthesia. The dose of midazolam used was 0.13 mg/kg and that of diazepam 0.17 mg/kg. The degree of sedation, mood of the patient, and time at which onset of effect was perceptible were assessed before induction of anaesthesia, together with skin temperature and concentrations of midazolam or diazepam in plasma. Patients were interviewed postoperatively to discover their subjective evaluation of the premedication and to assess its amnesic effects. Midazolam was significantly superior (P less than 0.05) to diazepam as regards sedation. There were no differences in effects on mood of the patients between the two groups. Sixteen patients in the diazepam group and four in the midazolam group had no perception of onset of effect. The difference is significant (P less than 0.01). The skin temperature was, on average, 2 degrees C higher in the midazolam group than in the diazepam group (P less than 0.005). The mean plasma concentration was 67.8 +/- 24.5 micrograms/l in the midazolam group and 44.8 +/- 25.7 micrograms/l in the diazepam group. In only two cases was the concentration of diazepam above 100 micrograms/l (arbitrarily defined as the minimum sedative concentration). Subjective evaluation of efficacy significantly (P less than 0.002) favoured midazolam. Local pain was evident in two patients in the diazepam group, and three patients experienced nausea immediately after administration of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)     

加压交锁髓内钉固定加植骨治疗胫骨骨不连的临床研究

目的:探讨加压交锁髓内钉内固定加交锁髓内钉开口处取骨植骨治疗胫骨骨不连的临床疗效。方法:回顾性分析自2008年2月至2010年10月采用加压交锁髓内定内固定加髓内针开口处取骨植骨治疗18例胫骨骨干骨不连,男12例,女6例;年龄31～67岁,平均42岁。受伤至手术时间6～18个月,平均8个月。骨折不愈合11例,延迟愈合7例。术后根据HSS评分系统评价膝功能,采用Tenny和Wiss评分系统评估疗效。结果:术后随访12～36个月,平均18个月,患者切口愈合良好,无感染,无皮肤坏死。全部患者未见骨不愈合、感染、畸形及再骨折发生。骨性愈合时间4～8个月,平均6个月。患者术后1年膝关节功能HSS评分平均(89.97±3.21)分。术后根据Tenny和Wiss评分系统评估疗效,优16例,良2例。结论:采用加压交锁髓内钉内固定加交锁髓内钉开口处取骨植骨治疗胫骨骨折不愈合及延迟愈合,能提高骨折愈合率,避免髂骨取骨带来的并发症,减少患者医疗费用。     

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.     

Influence of premedication with diazepam or morphine on the induction dose of eltanolone

Background : This study examined the influence of premedication with morphine or diazepam on the dose of eltanolone, a steroidal intravenous anaesthetic agent, required to induce anaesthesia.
Methods : Two hundred and sixteen patients, aged 18 to 65 years, were randomly assigned to receive premedication with diazepam 10 mg orally, morphine 10 mg intramuscularly, or placebo. The double-dummy technique was used to maintain blinding. Eltanolone 0.16-0.75 mg·kg^-1 was given intravenously over 20 s. At the commencement of injection patients were instructed to begin counting; if the patient ceased counting within 120 s and failed to respond to commands to continue, anaesthesia was considered to have been induced. The dose required to anaesthetise 50% of patients (ED₅₀) was determined by logistic regression.
Results : The ED₅₀ (95% confidence interval) of eltanolone in patients who received placebo premedication was 0.31 (0.27-0.34) mg · kg^-1. It was reduced slightly and nonsignificantly by premedication with diazepam, to 0.27 (0.24-0.30) mg · kg^-1, or morphine, to 0.26 (0.23-0.29) mg · kg^-1. Involuntary movement occurred in 65% of placebo premedicated patients. Its incidence was not significantly reduced by diazepam (57%), but was significantly ( P <0.001) reduced by morphine (37%). Morphine premedication was, however, associated with a significant ( P <0.01) increase in the incidence of apnoea (21%) compared to placebo premedicated patients (4%).
Conclusion : Premedication with diazepam or morphine had little influence on the dose of eltanolone required to induce anaesthesia.     

Sedation for outpatient conservative dentistry

Pentazocine 30 mg. or 15 mg or a placebo, was administered randomly to forty-nine patients undergoing conservative dental treatment in combination with a local analgesic block and intravenous diazepam. Simple cardiorespiratory measurements were made throughout the treatment period. Patients in the 30 mg pentazocine group required some 6 mg diazepam less than the placebo (control) group (P less than 0.05). Patients receiving 15 mg pentazocine also required less diazepam compared to the control group, but this difference was not statistically significant. There were no significant differences between the three groups either in recovery times or the cardiorespiratory measurements.     

白蛋白和Ⅳ型胶原及脾长径评分系统对慢性乙型肝炎肝纤维化分期的诊断意义

目的从常用的非创伤性指标中筛选出与肝纤维化分期相关的指标,并进一步建立评分系统用于慢性乙型肝炎肝纤维化的诊断。方法收集208例慢性乙型肝炎患者的33项非创伤性指标值,分析这些指标与纤维化分期的关系,筛选与肝纤维化分期相关的指标,继续用Bayes逐步判别并分析筛选出具有判别作用的指标,从中选取代表性较强的指标以建立评分系统用于肝纤维化分期的诊断,并验证此评分系统的敏感性及特异性。结果通过相关分析,共筛选出20项与肝纤维化分期相关的指标,继续用Bayes逐步判别分析并筛选出白蛋白、Ⅳ型胶原及脾长径建立评分系统,取总分4分为诊断截断值,以该评分系统区分S0～2及S3～4纤维化的符合率为70.9%,诊断S3～4纤维化组的灵敏度和特异度分别为69.7%和71.7%。结论白蛋白、Ⅳ型胶原及脾长径3项指标组成的评分系统可以较好地区分S1～2及S3～4肝纤维化,符合率为70.9%。     

Evoked potentials following diazepam or fentanyl

The effects of fentanyl or diazepam on somatosensory, visual and brainstem auditory evoked potentials were studied in 13 healthy patients scheduled for elective surgery. Following control recordings of evoked potentials, either diazepam 20 mg or fentanyl 200 micrograms was administered intravenously. Evoked potentials were then recorded twice in the subsequent hour. No significant changes occurred in the latency or amplitude of somatosensory, visual or brainstem auditory evoked potentials. Although dose-related changes in evoked potential latencies and amplitudes have been demonstrated with both the inhalational and intravenous anaesthetics, these changes did not occur with diazepam or fentanyl used alone. An anaesthetic technique based on these two drugs would be suitable when intra-operative evoked potential monitoring is required to assess ischaemia and preservation of evoked responses.     

Ketamine sequelae

The ability of a number of drugs to abolish the emergence delirium and unpleasant dreams which follow anaesthesia induced with 2 mg/kg ketamine was studied. These included three benzodiazepines, droperidol and 'neurolept' combinations and four commonly-used premedicants. When given intravenously 10 min before induction of anaesthesia flunitrazepam and lorazepam gave best results. In a subsequent study, these two benzodiazepines and diazepam were given intravenously 30-40 min before induction of anaesthesia. There was no doubt that 4 mg lorazepam gave the greatest protection and is worthy of further study in this respect.