Oral midazolam in children: effect of time and adjunctive therapy.

The purpose of this study was to determine the influence of timing and concomitant administration of atropine and/or meperidine on the perioperative effects of oral midazolam in children. In 154 healthy children, 1-8 yr old, we studied six oral preanesthetic medication regimens according to a randomized, double-blind protocol. Group A (placebo) received 5 mL of apple juice. The other five groups received medication with apple juice to a total volume of 5 mL, 20-60 min before induction of anesthesia. Group B received atropine (0.02 mg/kg); group C received midazolam (0.5 mg/kg); group D received midazolam (0.5 mg/kg) and atropine (0.02 mg/kg); group E received meperidine (1.5 mg/kg) and atropine (0.02 mg/kg); and group F received meperidine (1.5 mg/kg), atropine (0.02 mg/kg), and midazolam (0.5 mg/kg). The sedative effect of midazolam was maximal 30 min after oral administration. Ninety-five percent of the children who were separated from their parents within 45 min after oral midazolam administration (with or without atropine) had satisfactory separation scores (vs 66% of those separated after 45 min; P less than 0.02). Midazolam-treated patients were more cooperative with a mask induction of anesthesia compared with non-midazolam-treated children (83% vs 56%). Neither atropine nor meperidine appeared to significantly improve the effectiveness of oral midazolam. No preoperative changes in heart rate, respiratory rate, or hemoglobin oxygen saturation were noted in any of the treatment groups. Finally, oral midazolam did not prolong recovery even after outpatient procedures lasting less than 30 min. In conclusion, midazolam (0.5 mg/kg) given orally 30-45 min before induction of anesthesia is safe and effective without delaying recovery after ambulatory surgery.     

Oral midazolam in paediatric premedication

In a premedication study involving 135 children, aged 1-10 years, four regimens were investigated: (i) no premedication; (ii) oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg, droperidol 0.15 mg/kg (TMD); (iii) intramuscular midazolam (Dormicum; Roche) 0.15 mg/kg; and (iv) oral midazolam 0.45 mg/kg. All premedications were given 60 minutes before a standard halothane anaesthetic. No impairment of cardiovascular stability occurred but after premedication the mean oxygen saturation decreased by 1.6% and 1.1%, respectively, in the intramuscular midazolam and TMD groups. Overall, children under 5 years of age behaved less satisfactorily in the holding room and at induction, than those over 5 years (P less than 0.01). Midazolam, intramuscularly and orally, produced more satisfactory behaviour than the other two regimens (P less than 0.05) and, combined with a 70% more rapid recovery than the TMD regimen (P less than 0.05), suggests that oral midazolam is a more effective paediatric premedication agent than placebo or TMD.     

A double blind randomized comparison of oral trimeprazine-methadone and ketamine-midazolam for sedation of pediatric dental patients for oral surgical procedures.

The safety and efficacy of an oral sedation technique for children having minor oral surgical procedures under local anesthesia were studied. One hundred healthy children between the ages of 2 and 7 yr received either a combination of midazolam (0.35 mg/kg) and ketamine (5 mg/kg) (Group A), or a combination of trimeprazine (3 mg/kg) and methadone (0.2 mg/kg) (Group B) 30 min preoperatively. Hemodynamic parameters, adverse reactions, postoperative recovery, and behavior were evaluated. More children were asleep, but rousable to verbal commands, 30 min after drug administration in Group A (40%) than in Group B (8%). Immediately before the dental procedure, 46% of children in Group A were asleep in contrast to 8% of children in group B. Significantly more children in Group A were awake, coughing, crying, and moving purposefully 30 and 60 min after admission to the recovery room. Two children (4%) in Group A vomited. Ten (20%) children in Group A hallucinated compared to none in Group B. The surgeon rated the procedure as good or very good in 94% of children in Group A compared to 78% in Group B. Our results show that the combination of midazolam and ketamine, administered orally, is a safe, effective, and practical approach to managing children for minor oral surgical procedures under local anesthesia.     

Midazolam and amnesia in pediatric premedication

One hundred and twenty-eight children aged three to ten years, were studied to determine the effect of premedication on amnesia for the preanesthetic period. Four comparable groups were used: A control group, no premedication; oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg plus droperidol 0.15 mg/kg (T.M.D.); oral midazolam 0.45 mg/kg; intramuscular midazolam 0.15 mg/kg. Amnesia was tested for four pictorial facts, and for induction of anesthesia. For pictorial facts, both routes of midazolam administration gave a sixty percent incidence of amnesia compared with sixteen percent in the control group (p less than 0.001). The T.M.D. premedication provided a forty-three percent incidence, also better than the control group (p less than 0.05). Induction was remembered by fifty percent of the midazolam children compared with sixty-six percent of the T.M.D. group (p greater than 0.05) and eight-one percent of the control group (p less than 0.05). The potential advantages of amnesia in pediatric premedication are discussed.     

Oral midazolam is an effective premedication for children having day-stay anaesthesia.

The effect of oral premedication was studied in a double-blind, randomised trial of 200 children undergoing day-stay anaesthesia. Midazolam 0.25 mg/kg, midazolam 0.5 mg/kg, diazepam 0.5 mg/kg or a placebo was given orally one hour prior to anaesthesia. Patient state was assessed at nine stages, from administration of the premedication up to and including induction of anaesthesia, using a four-point behavioural scale. Patient state was also assessed postoperatively in the recovery area and the day-stay ward. There was no difference between the four groups until induction of anaesthesia. At this stage 82% of children were either asleep or awake and calm. Patients who received midazolam 0.5 mg/kg were more likely to be asleep or awake and calm at induction rather than other groups (P = 0.05). Children receiving midazolam 0.5 mg/kg or diazepam 0.5 mg/kg slept longest in the post anaesthetic recovery room (P less than 0.005), and spent most time there (P less than .005). There was no difference between groups in the length of time spent in the day-stay ward or in the number of overnight admissions. The study shows that a high proportion of unsedated children are calm at induction of anaesthesia and that oral midazolam is an effective premedication in children for day-stay anaesthesia.     

Obliterative lesions in small airways in an immunosuppressed porcine heterotopic bronchial allograft model

Abstract We have recently developed a heterotopic large-animal model for research into obliterative lesions in small airways caused by allograft rejection. In this model, the small airways of subcutaneously implanted allografts gradually obliterate, whereas autografts remain patent. Twenty lung fragments and 20 segments of bronchi were implanted in domestic pigs weighing 20 kg from non-related donors. The histology of five animals receiving daily cyclosporine A (CsA) (10 mg/kg), azathioprine (2 mg/kg) and methylprednisolone (20 mg), Group C, was compared with that of six animals without immunosuppression, Group A. Four animals received monotherapy with CsA (10 mg/kg) or methylprednisolone (3 mg/kg). The histological findings were graded from 0 to 3 on the basis of implants harvested repeatedly over 3 months. Epithelial destruction and bronchial obliteration was rapid and permanent in all the allografts. Inflammation and fibrosis of the bronchial wall was less prominent in Group C than in Group A and the onset of fibrosis was delayed. Cartilage degeneration and pericartilagineous inflammation were significantly less severe in Group C ( P < 0.05). Monotherapy was less potent than triple therapy. This large-animal model is useful for studying the effects of immunosuppressive drugs on obliterative airway disease.     

Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children.

We studied the effect of oral premedication with midazolam on the recovery characteristics of sevoflurane anesthesia in small children. In a randomized, double-blinded study, 60 children (1-3 yr, ASA physical status I or II) undergoing ambulatory adenoidectomy received either midazolam 0.5 mg/kg (Group M) or placebo (Group P) PO approximately 30 min before the induction of anesthesia. All children received atropine 0.01 mg/kg IV and alfentanil 10 microg/kg IV before the induction of anesthesia with sevoflurane up to 8 vol% inspired concentration in N2O 67% in O2. Tracheal intubation was facilitated with mivacurium 0.2 mg/kg. Anesthesia was continued with sevoflurane adjusted to maintain hemodynamic stability. In the postanesthesia care unit, predetermined recovery end points (emergence, recovery, discharge) were recorded. A pain/ discomfort scale was used to determine the quality of recovery. A postoperative questionnaire was used to evaluate the well-being of the patient at home 24 h after surgery. Emergence (spontaneous eye opening), recovery (full points on the modified Aldrete scale), and discharge were achieved later in Group M than in Group P (15+/-6 vs. 11+/-3 min [P = 0.002], 25+/-17 vs. 16+/-6 min [P = 0.01], and 80+/-23 vs. 70+/-23 min [P = 0.03]). Side effects, postanesthetic excitement, and analgesic treatment did not differ significantly between groups. At home, more children in Group P (30%) experienced disturbed sleep during the night compared with those in Group M (4%) (P = 0.007). IMPLICATIONS: In this randomized, double-blinded, placebo-controlled study, premedication with midazolam 0.5 mg/kg PO delayed recovery in children 1-3 yr of age after brief (<30 min) sevoflurane anesthesia. Except for more peaceful sleep at home, premedication did not affect the quality of recovery.     

Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging

BACKGROUND: The purpose of this study was to compare the safety and efficacy of oral midazolam and midazolam-diphenhydramine combination to sedate children undergoing magnetic resonance imaging (MRI). METHODS: We performed a prospective randomized double-blind study in 96 children who were randomly allocated into two groups. Group D received oral diphenhydramine (1.25 mg x kg(-1)) with midazolam (0.5 mg x kg(-1)), and Group P received oral placebo with midazolam (0.5 mg x kg(-1)) alone. Sedation scores, onset and duration of sleep were evaluated. Adverse effects, including hypoxemia, failed sedation, and the return of baseline activity, were documented. RESULTS: Diphenhydramine facilitated an earlier onset of midazolam sedation (P < 0.01), and higher sedation scores (P < 0.01). In children who received midazolam alone, 20 (41%) were inadequately sedated, compared with 9 (18%) children who received midazolam and diphenhydramine combination (P < 0.01). Time to complete recovery was not significantly different between the two groups. CONCLUSIONS: Our study indicates that the combination of oral diphenhydramine with oral midazolam resulted in safe and effective sedation for children undergoing MRI. The use of this combination might be more advantageous compared with midazolam alone, resulting in less sedation failure during MRI.     

Experience of iron saccharate supplementation in haemodialysis patients treated with erythropoietin

We assessed the efficacy of intravenous (i.v.) iron saccharate (VENOFER) vs oral iron supplementation in haemodialysis patients treated with low-dose erythropoietin (EPO). Twenty haemodialysis patients with serum ferritin >200 ng/mL and transferrin saturation >30% were assigned to one of the two groups. In Group 1, 10 were given i.v. iron saccharate (100 mg i.v. twice weekly) post dialysis. In Group 2, oral ferrous sulphate 200 mg was given thrice daily. In both groups, subcutaneous EPO 25 units/kg body weight (BW) was started simultaneously, twice weekly. After 3 months (study completion) the mean haemoglobin and haematocrit was significantly increased in Group 1 than in Group 2 (Hb 11.60±0.64 G/dL vs 10.5 G/dL±1.14 P <0.01). The final mean EPO dose was 25% lower in Group 1 than in Group 2 (3400±1356 U/week vs 4600±1356 U/week P =0.10) and the mean serum ferritin was higher in the i.v. iron group than the oral group (671 ng/mL±388 vs 367 ng/mL±238 P =NS). The same was also observed with transferrin saturation (44.6%±19.8 in Group 1 vs. 29%±11.0 in Group 2 P =NS). No adverse effects were seen during the study. In conclusion, we observed that regular use of i.v. iron had a significantly enhanced haemoglobin response, better maintained serum ferritin and lower EPO dosage requirement than the oral iron group.     

右美托咪定用于1岁以内先天性心脏病患儿放射学检查补救镇静的疗效分析

目的 与传统镇静药物比较,评估1岁以内(1个月～1岁)先天性心脏病(congenital heart disease,CHD)患儿放射学检查时,右美托咪定(dexmedetomidine,Dex)作为首剂口服水合氯醛镇静失败后补救用药的疗效及安全性. 方法 根据意向性治疗原则,前瞻性、随机、单盲临床随机对照试验分析2016年3月29日～6月2日于我院行心血管放射学检查且需镇静的患儿225例,采用随机均衡分组法分为3组(每组75例):A组(5 mg/kg苯巴比妥肌内注射)、B组(25 mg/kg水合氯醛口服)、C组(1 μg/kg Dex滴鼻).比较首剂口服水合氯醛失败后3组补救镇静的成功率及副作用发生情况,同时分析家属满意度,比较起效时间、苏醒时间及总镇静时间,评估给药前(T0)、给药后5 min(T1)、给药后10 min(T2)、给药后20 min(T3)、起效时(T4)、检查结束时(T5)、苏醒时(T6)患儿SpO2及HR的变化. 结果 A组、B组及C组放射学检查补救镇痛成功率分别为75.8％、83.3％、90.7％,C组与A组成功率比较,差异有统计学意义(P＜0.05).分层研究后发现,C组右向左分流型CHD患儿放射学检查成功率较A组高(P＜0.05).C组起效时间与B组比较,差异有统计学意义(P＜0.05).C组苏醒时间及总镇静时间与A组及B组比较,差异有统计学意义(P＜0.05).A组、B组及C组副作用发生率分别为3.2％、7.6％、4.0％,差异无统计学意义(P＞0.05).3组HR及SpO2变化差异无统计学意义(P＞0.05). 结论 1μg/kg Dex滴鼻可以有效用于CHD患儿放射学检查补救镇静,具有起效快,效果持久的特点,其对右向左分流的紫绀型CHD患儿镇静效果较苯巴比妥更好,且不增加CHD患儿副作用的发生率.     

Microendoscopic discectomy, a less traumatic procedure for lumbar disk herniation

OBJECTIVE: To investigate the change of serum levels of interleukin-6 (IL-6), C-reactive protein (CRP) and creatine kinase (CK) in patients undergoing microendoscopic discectomy (MED) and open discectomy. METHODS: Forty-four patients with single level lumbar disk herniation were treated, either by MED (Group A, n equal to 22) or open discectomy (Group B, n equal to 22). Peripheral venous blood samples were taken before surgery and at 24 and 48 hours postoperatively. The operating time, intraoperative blood loss, postoperative hospital stay were recorded. The pain severity of incision was evaluated by visual analog scale after operation and the clinical outcome was evaluated by Oswestry disability index. Statistical comparison was performed by the analysis of variance and Student's t test. RESULTS: The data showed that patients in Group A had a less intraoperative blood loss (P < 0.05), shorter operating length (P < 0.05), shorter postoperative hospital stay (P < 0.05) and less postoperative pain of incision than those in Group B. Serum levels of IL-6 (mean, 31.60 ng/L +/- 9.88 ng/L vs 39.16 ng/L +/- 11.14 ng/L, P < 0.05) and CK (mean, 167.91 U/L +/- 51.85 U/L vs 401.55 U/L +/- 108.86 U/L, P < 0.05) all get to the peak at 24 hours after operation and Group A with the response statistically less than Group B. Serum level of CRP peaked at 24 hours in Group A (mean, 12.68 mg/L +/- 7.10 mg/L vs 20.82 mg/L +/- 8.79 mg/L, P less than 0.05)and peaked at 48 hours after surgery in Group B (mean, 10.77 mg/L +/- 5.25 mg/L vs 29.95 mg/L +/- 14.85 mg/L, P < 0.05). The clinical outcomes of both groups were the same at 6 months after surgery. CONCLUSIONS: Both MED and open discectomy have made good clinical outcomes, however, the less change of IL-6, CRP and CK after operation proves that MED procedure is less traumatic to patients than open discectomy.     

Respiratory Effects of Premedication during Enflurane N2O Anaesthesia in Children

The influence of premedication on induction characteristics and respiration was studied in 40 children breathing spontaneously during enflurane-nitrous oxide anaesthesia. Two different premedications were used. Twenty children (Group DA) received a rectal solution containing diazepam 0.25 mg kg-1 and atropine 0.015 mg kg-1 and 20 (Group DMS) received a rectal solution of diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and scopolamine 0.01 mg kg-1. The children in Group DMS had a significantly higher preoperative sedative score (P less than 0.01), faster induction of anaesthesia (P less than 0.01), lower occurrence of airway problems during induction and a smoother intubation (P less than 0.05) than the children in Group DA. However, the end-tidal carbon dioxide tensions were higher and the occurrence of apnoea was more common in Group DMS than in Group DA. Thus it was concluded that if the more sedative premedication (DMS) is to be used for enflurane anaesthesia in children, controlled ventilation would be preferable.     

The neuromuscular response of infants to a continuous infusion of succinylcholine

The response of the adductor of the thumb to ulnar nerve stimulation (0.1 Hz) was evaluated during continuous infusion of succinylcholine (SCh) in 20 infants anesthetized with halothane (1%) and N2O2/O2. Train-of-four stimulation (2 Hz for 2 s) was used to differentiate between phase I and phase II block. Some infants were very resistant to the neuromuscular effects of SCh. These infants (Group 1) were younger in age, 57 +/- 15 days (mean +/- SE) and required 24.6 +/- 3.3 mg X kg-1h-1 SCh to achieve more than 90% depression of the twitch. Older infants (Group 2), 188 +/- 33 days, required significantly less (P less than 0.001) SCh (8.7 +/- 0.5 mg X kg-1h-1) to achieve the same degree of twitch suppression. Group 1 infants recovered from the effects of SCh very rapidly. After 10 mg/kg SCh, the train-of-four ratio in Group 1 infants recovered to 75% in 4.7 +/- 0.6 min, whereas it took 34 +/- 10 min in Group 2 infants (P less than 0.01). Tachyphylaxis developed in infants after 3.6 +/- 0.3 mg/kg (mean +/- SE) and phase II block after 5.3 +/- 0.7 mg/kg (P less than 0.05) SCh. Combining the data of infants with that of children from a previous study conducted in a similar fashion resulted in significant correlation (P less than 0.001) between the log age and SCh requirement. The rate of administration of a continuous infusion of SCh in infants should be based upon the response of infants and not on a fixed dose (mg X kg-1 X h-1).     

Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children

BACKGROUND AND OBJECTIVE: Sedation is commonly used to facilitate diagnostic procedures in children. The aim of our study was to investigate sedation in children using propofol alone or combined with fentanyl or midazolam with regard to efficacy, adverse reactions or side-effects related to the drugs, ease of operation for the endoscopist, and time to discharge from the post-anaesthesia care unit. METHODS: We prospectively studied 240 children, aged 1-12 yr of age, undergoing endoscopic procedures of the upper gastrointestinal tract. The patients were given an oral premedication with midazolam (0.5 mg kg(-1)) and were then randomly allocated to one of the three study groups: propofol alone (Group P), propofol with fentanyl 1 mug kg-1 (Group PF) or propofol with midazolam 0.1 mg kg(-1) (Group PM). Additional doses of propofol given during the procedure were recorded. Adequacy of sedation and ease of procedure (easy, adequate, impossible) were evaluated by the endoscopist, who was blinded as to the drugs used. RESULTS: The duration of the procedure and the recovery period were similar in the three groups. The number of patients requiring supplemental doses of propofol to permit safe completion of gastroscopy was 31 in Group P (=39%; eight of these required two additional doses), 14 in Group PM (=18%), and 11 in Group PF (=13%) (P < 0.05). There was a lower incidence of adverse events in Group PM and in Group PF than in Group P (P < 0.05). CONCLUSIONS: Propofol in combination with fentanyl or midazolam gives better sedation and ease of endoscopy than propofol alone.     

Intra-ocular pressure changes during rapid sequence induction of anaesthesia

The changes in intra-ocular pressure associated with two different anaesthetic induction and tracheal intubation techniques were compared (n = 30). After pre-oxygenation, Group A received thiopentone (5 mg/kg) followed by suxamethonium (1.5 mg/kg), both within 25 seconds, and Group B atracurium (0.5 mg/kg) followed by thiopentone (5 mg/kg) again both within 25 seconds. Tracheal intubation occurred after one minute in Group A and 2 minutes in Group B to allow for full paralysis. In Group A intra-ocular pressure did not alter significantly from baseline and the maximum increase was only 0.93 mmHg. The statistical type II error risk was consistently below 55% and all 95% confidence limits included negative values. Intra-ocular pressure in Group B was consistently lower than baseline (p less than 0.05) but with a longer induction-intubation interval. These results therefore provide valuable information about the 'balance of risks' when choosing a muscle relaxant for an inadequately starved patient with a penetrating eye injury.     

Effects of protease inhibitors on coagulation abnormalities in acute canine pancreatitis

Coagulation abnormalities associated with severe pancreatitis were studied in 24 dogs. Group I consists of six control subjects who had duodenotomy alone. Group II consists of six dogs with pancreatitis induced by bile injection ( lcm3 /kg) into the pancreatic duct. The six dogs in Group III and the six in Group IV were given aprotinin (trasylol) 1.0 mg/kg and S-2441 (10mg/kg), a new synthetic protease inhibitor, respectively. These were given over 10 minutes by intravenous infusion, 20 minutes after bile induced pancreatitis. Blood was drawn for amylase, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and platelets, in addition to markers for hypercoagulation, fibrinopeptide A, antithrombin III, and markers for fibrinolysis, B beta 15-42 immunoreactive peptides and alpha 2 antiplasmin at baseline, 30 minutes, 1 hour, 3 hours, 6 hours, and daily for 3 days after injection of bile or duodenotomy. There was no significant difference in PT, platelets, antithrombin III, and fibrinopeptide A among the four groups. Fibrinogen levels and PTT were minimally elevated in animals with bile induced pancreatitis, but these changes reached significance only at 24 hours and 48 hours, respectively (P less than 0.05). Immunoreactive B beta 15-42 became elevated at 30 minutes indicating fibrinolysis in animals with pancreatitis, and these changes were significant compared with Group I control subjects (P less than 0.05) throughout the study. Levels of alpha 2 antiplasmin were decreased in Group II animals with pancreatitis, which also suggests fibrinolysis. Amylase was elevated in Group II animals with pancreatitis (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of dimethyl PGE2 on canine pancreatic autograft exocrine secretion

This study was designed to evaluate the effect of 16,16-dimethyl prostaglandin E2 (dimethyl PGE2) on exocrine secretion in autografted animals with pancreaticocystostomies. The rates of secretion of urinary (autograft) amylase (units/min) and bicarbonate (mmole/min), over a 5-hr interval, were determined in the basal state (Group A, N = 5), after a bolus injection of 1 microgram/kg of dimethyl PGE2 (Group B, N = 5), during an OP-CCK infusion at 125 ng/kg/hr (Group C, N = 5), and during an OP-CCK infusion plus a bolus injection of 1 microgram/kg (Group D, N = 5) or 18 micrograms/kg (Group E, N = 5) of dimethyl PGE2 at the end of the second hour. Basal secretion of amylase and bicarbonate were decreased 1 hr after 1 microgram/kg of dimethyl PGE2, with the bicarbonate inhibition being statistically significant (Group A = 0.073 +/- 0.04 vs Group B = 0.001 +/- 0.00; P less than 0.05). When compared to Group C (128.3 +/- 28.0), an immediate and significant inhibition of OP-CCK-stimulated amylase release was demonstrated in both Group D (36.3 +/- 11.1; P less than 0.02) and Group E (57.3 +/- 13.4; P less than 0.05). One and two hours post-dimethyl PGE2, amylase releases were 37.7 +/- 8.6 and 64.7 +/- 6.8 in Group D and 0.92 +/- 0.3 and 8.28 +/- 2.6 in Group E, compared to 140.3 +/- 23.3 and 104.9 +/- 31.8 in Group C, indicating a dose-related, prolonged inhibition of autograft amylase secretion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experience of iron saccharate supplementation in haemodialysis patients treated with erythropoietin

SUMMARY: We assessed the efficacy of intravenous (i.v.) iron saccharate (VENOFER) vs oral iron supplementation in haemodialysis patients treated with low-dose erythropoietin (EPO). Twenty haemodialysis patients with serum ferritin >200 ng/mL and transferrin saturation >30% were assigned to one of the two groups. In Group 1, 10 were given i.v. iron saccharate (100 mg i.v. twice weekly) post dialysis. In Group 2, oral ferrous sulphate 200 mg was given thrice daily. In both groups, subcutaneous EPO 25 units/kg body weight (BW) was started simultaneously, twice weekly. After 3 months (study completion) the mean haemoglobin and haematocrit was significantly increased in Group 1 than in Group 2 (Hb 11.60 ± 0.64 G/ dL vs 10.5 G/dL ± 1.14 P <0.01). the final mean EPO dose was 25% lower in Group 1 than in Group 2 (3400 ± 1356 U/week vs 4600 ± 1356 U/week P =0.10) and the mean serum ferritin was higher in the i.v. iron group than the oral group (671 ng/mL ± 388 vs 367 ng/mL ± 238 P =NS). the same was also observed with transferrin saturation (44.6%± 19.8 in Group 1 vs. 29%± 11.0 in Group 2 P =NS). No adverse effects were seen during the study. In conclusion, we observed that regular use of i.v. iron had a significantly enhanced haemoglobin response, better maintained serum ferritin and lower EPO dosage requirement than the oral iron group.     

Oral clonidine premedication for elderly patients undergoing intraocular surgery.

In a randomized double-blind study, the effects of clonidine premedication as a sedative, anxiolytic, analgesic and oculohypotensive agent were studied in 100 elderly patients (62 to 65 +/- 10 years, ASA grade I-II) undergoing elective intraocular surgery under local anaesthesia. The control group (Group A, n = 50) received oral diazepam 0.15 mg/kg 120 min before surgery and Group B (n = 50) received oral clonidine 300 micrograms 120 min before surgery. Two hours after the premedication, there was significantly more sedation (P less than 0.05) and less subjective anxiety (P less than 0.05) in the clonidine group than in the control group. There was a significant fall in intraocular pressure (IOP) from 20 +/- 0.5 to 13 +/- 0.5 mmHg (P less than 0.05) and significant reduction in systolic and diastolic blood pressure (BP) and heart rate (HR) (P less than 0.05) in the clonidine group as compared to the control group. Perioperatively, significantly more supplementation with i.v. diazepam was given in the control group than in the clonidine group (P less than 0.01). The incidence of intra-operative hypertension (P less than 0.01) and tachycardia (P less than 0.05) was significantly greater in the control group than in the clonidine group. A significantly larger number of patients in the clonidine group scored a Post-Anaesthesia Recovery (PAR) score of 10 as compared to the control group (P less than 0.01). There was no statistical difference in the postoperative Visual Analogue Scale (VAS) scores for pain, number of analgesic requests and emesis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Piroxicam inhibits the growth of an adenocarcinoma isograft in Fischer rats

The effect of piroxicam, a nonsteroidal anti-inflammatory drug, on a transplantable adenocarcinoma in Fischer rats was studied. Forty male Fischer rats were injected with 1 X 10(6) DMH-F317 adenocarcinoma cells, and after 2 weeks were assigned to be treated with piroxicam or carrier solution. The groups were as follows: Group 1, control; Group 2, 4.0 mg/kg piroxicam; Group 3, 6.0 mg/kg piroxicam; and Group 4, 8.0 mg/kg piroxicam. Thirty-nine of forty rats developed measurable tumors during this study. At the conclusion, 60% (6/10) of the rats in Group 2 were tumor free compared to 0/10 controls, 0/10 Group 3 rats, and 1/8 Group 4 rats. (P less than 0.005, chi 2). Mean tumor volumes (mm3) were calculated for each group and converted to log10. At Week 6, the mean log10 tumor volume (+/- SEM) for Group 2 was 1.5 +/- 0.6 vs 4.1 +/- 0.1 for Group 1 (P less than 0.05). The mean log10 volume for Group 3 was 3.8 +/- 0.1 (P less than 0.05 vs Group 2). The mean log10 volume for Group 4 was 3.4 +/- 0.05 and was not significantly different from that for Group 2 (P greater than 0.05). Plasma PGE2 levels for each treatment group were determined at the conclusion of the study and no statistical difference between treatment groups was found. It is concluded that piroxicam inhibits tumor growth in this model, and may have a role as a biological response modifier in cancer therapy.