Comparison of various physiologic and psychomotor parameters in patients sedated with intravenous lorazepam, diazepam, or midazolam during oral surgery

Intravenously administered lorazepam (0.05 mg/kg), diazepam (0.25 mg/kg), and midazolam (0.1 mg/kg) were compared for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that all three drugs provide satisfactory sedation. Average mean arterial pressures, however, decreased significantly with midazolam and diazepam. Statistically significantly higher heart rates during the entire procedure were also found for lorazepam when compared with diazepam and midazolam. At the postblock stage, the midazolam group had respiratory rates that were significantly higher than those of the other two drug groups. Patients in the diazepam and midazolam groups took significantly longer to complete the pegboard test at the preblock stage than those in the lorzepam group. At 1, 1.5, and 2 hours after arrival in the recovery room, an inversion of groups took place, with the lorazepam group taking significantly longer for their tests than the other two groups. Significantly more improvement in anxiety levels was found at 10 minutes postdrug for the patients who had received diazepam and this tended to remain so on arrival in the recovery room. When compared with the other two groups, significantly more patients in the lorazepam group reported giddiness/dizziness and significantly more in the diazepam group reported pain on injection.     

New intravenous sedative combinations in oral surgery: a comparative study of nalbuphine or pentazocine with midazolam

A randomised, double blind study was conducted to compare the efficacy and safety of nalbuphine or pentazocine with midazolam in patients undergoing minor oral surgery under local analgesia. Forty patients, aged between 17 and 48 years and in American Society of Anesthesiologists A.S.A. Class I participated. The results confirmed that the use of either nalbuphine (0.2 mg/kg) or pentazocine (0.5 mg/kg) allowed for a significant reduction in the mean dosage of midazolam required to produce satisfactory sedation when compared with trials where midazolam was used alone. Thus a mean midazolam, 0.087 mg/kg (nalbuphine group) or 0.081 mg/kg (pentazocine group) was required compared with 0.17 mg/kg (Aun et al., 1984) and 0.19 mg/kg (Skelley et al., 1984). Inadvertent overdosage with midazolam is prevented as the onset of sedation and its end-point are more obvious. No adverse cardiovascular or respiratory side effects were noted. The recovery rate for both groups was similar. Ninety-five per cent (39 of 40) of patients were able to walk unaided at 2 h post operation. At this time significantly more patients in the nalbuphine group were pain free (p less than 0.001). Both combinations provided excellent operating conditions with a high degree of safety and high patient acceptability. As the nalbuphine group enjoyed a more comfortable post-operative period this combination is favoured.     

咪达唑仑作为口腔颌面外科麻醉前用药的探讨

目的研究咪达唑仑用于口腔颌面外科麻醉前用药的效果。方法60例患者随机等分为Ⅰ、Ⅱ、Ⅲ组,麻醉前30min分别肌肉注射咪达唑仑0.06mg/kg、地西泮0.12mg/kg、苯巴比妥钠3mg/kg,观察镇静和抗焦虑作用、对循环和呼吸的影响以及不良反应。结果Ⅰ组用药后5min始出现BIS明显下降、Ramsay镇静评分明显增大,用药后30min时AVAT和SAI数值明显降低(P<0.05),Ⅱ组和Ⅲ组无明显改变;3组的循环和呼吸功能无明显变化,也未见明显不良反应。结论咪达唑仑作为麻醉前用药,镇静和抗焦虑作用确切,无明显不良反应,值得推广应用。     

Evaluation of ketorolac (Toradol) with varying amounts of codeine for postoperative extraction pain control

This study analyzes the combination of oral ketorolac 10 mg with varying amounts of codeine phosphate, and the postoperative pain relief that developed from these combinations. Five groups of patients were administered the codeine/ketorolac combinations. Variations of the combinations were analyzed to ascertain if an optimal analgesic ratio existed. All controllable variables involved with the surgical procedure were held constant to allow for better evaluation of postoperative pain. Results obtained from 67 patients indicated that the best pain relief was achieved with a combination of 10 mg ketorolac and 15 mg codeine phosphate. Codeine alone provided adequate analgesia, but the addition of ketorolac reduced the patients' perceived side effects. The presence of codeine in the analgesic combination was also shown to reduce the number of days that the patient required the medication postoperatively. Reducing the duration of medication use postoperatively may also minimize the possible side effects of ketorolac and codeine, which could develop with extended periods of use.     

Evaluation by thoracic impedance cardiography of diazepam, placebo, and two drug combinations for intravenous sedation of dental outpatients

The cardiovascular and respiratory effects of three common intravenous premedicants were examined noninvasively in a population of 20 dental outpatients scheduled for surgical removal of third-molars. Two third molars from one side of the mouth were removed at each appointment. Group 1 received a diazepam titration (mean dose = 25.6 mgs) at one appointment and placebo at the other appointment. Group 2 received a combination of diazepam (12.5 mg), fentanyl (0.1 mg), and methohexital (mean dose = 18.0 mg) at one appointment and the combination of diazepam (15.0 mg) and methohexital (mean dose = 27.0 mg) at the other appointment. Noninvasive measurement of cardiac output revealed little change during intravenous drug administration, but a significant increase was seen in all groups following local anesthesia and during surgery. Heart rate was elevated and stroke volume decreased during administration of the two-drug combinations. Oxygen saturation was greatly decreased following the combination of diazepam, fentanyl, and methohexital. These findings indicate that the combination of diazepam, fentanyl, and methohexital results in decreased oxygen saturation, a transient decrease in stroke volume, and an elevated heart rate when used as an intravenous premedicant for dental outpatients.     

A comparison of chloral hydrate and diazepam sedation in young children

The purpose of this study was to compare a high and low dose of diazepam with chloral hydrate in the sedation of young children. Thirty healthy children between the ages of 20 and 48 months, with a mean age of 33.5 months, participated in the study. All children exhibited negative behavior during a screening visit and required at least two restorative appointments with the use of sedation. A dose of either 0.3 mg/kg or 0.6 mg/kg of diazepam at one visit and 50 mg/kg of chloral hydrate at another visit was administered in a double-blind manner. All children were restrained in a Papoose Board with auxiliary head restraint and received 50% nitrous oxide/oxygen during treatment. The degree of sleep, body movement, crying, pulse rate, respiratory rate, and blood oxygen saturation were monitored before and during the operative procedures. Vital signs remained essentially unchanged during treatment, except for transitory elevations of the pulse during periods of stimulation. There were no statistically significant differences among the three drug regimens with regard to movement and crying. Significantly more patients who received chloral hydrate were asleep than when either dose of diazepam was given during the first 60 min of treatment. The only side effect found was vomiting in one patient with both chloral hydrate and diazepam. It is concluded that the sedative effects of chloral hydrate and diazepam are similar when young children are sedated for dental treatment. The use of diazepam might be more advantageous because chloral hydrate produces more sleep during the first hour of treatment.     

Paracetamol versus paracetamol-codeine in the treatment of post-operative dental pain: a randomized,double-blind,prospective trial

BACKGROUND: Codeine is frequently added to paracetamol to treat post-operative dento-alveolar pain; studies have shown effectiveness in relief of post-operative pain at high doses but at the expense of central nervous and gastrointestinal side effects. There has been no trial to compare the efficacy and safety of paracetamol 1000 mg with paracetamol 1000 mg combined with codeine 30 mg. METHOD: A randomized, single centre, double-blind prospective parallel group trial was performed to compare paracetamol 1000 mg with paracetamol 1000 mg with codeine 30 mg for the relief of pain following surgical removal of impacted third molars, and analysed on an intention-to-treat (ITT) basis. Eighty-two patients were assigned randomly to receive either drug for a maximum of three doses. Patients recorded their pain intensity one hour after surgery and hourly thereafter for 12 hours. RESULTS: The average increase in pain intensity over 12 hours was significantly less in patients receiving paracetamol plus codeine than in those receiving paracetamol alone (p=0.03) -1.81 cm/h compared with 0.45 cm/h - a difference of 1.13 cm/h (95 per cent CI: 0.18 to 2.08). Of the patients who received the paracetamol codeine combination, 62 per cent used escape medication compared with 75 per cent of those on paracetamol alone (p=0.20). There was no significant difference between the two groups in the proportion of patients experiencing adverse events (p=0.5). CONCLUSION: A combination of 1000 mg paracetamol and 30 mg codeine was significantly more effective in controlling pain for 12 hours following third molar removal, with no significant difference of side effects during the 12 hour period studied.     

长托宁在小儿唇腭裂手术麻醉前用药的临床观察

目的比较长托宁、阿托品及东莨菪碱术前肌注对唇腭裂手术全麻患者的效果。方法选择在气管插管全麻下行唇腭裂手术的120例患者为研究对象,将其随机分为长托宁组、阿托品组、东莨菪碱组,每组40例患者。3组患者术前分别肌注长托宁0.01 mg/kg、阿托品0.01 mg/kg、东莨菪碱0.006 mg/kg,观察并记录给药前、给药后15 min、给药后30 min、插管后及术毕拔管时患者的心率、体温、血压及呼吸道分泌物等指标。结果长托宁组患者用药后心率、体温、血压无明显变化（P>0.05）;阿托品组、东莨菪碱组患者用药后心率明显加快、体温升高（P<0.05）,血压无明显变化（P>0.05）。术毕拔管时,长托宁组患者的分泌物较阿托品组、东莨菪碱组明显减少（P<0.05）。结论长托宁作为小儿唇腭裂手术前用药对心率、体温、血压无明显影响,对呼吸道腺体分泌有持久的抑制作用,优于阿托品与东莨菪碱。     

丙泊酚与氢吗啡酮联合用于口腔颌面外科术后留置气管导管患者的临床研究

目的:探讨丙泊酚与氢吗啡酮联合用于口腔颌面外科术后留置气管导管患者镇静及镇痛的作用。方法:将口腔颌面外科术后留置气管导管患者40例患者按照随机原则分为丙泊酚-氢吗啡酮组(P-H组,20例)、丙泊酚-右美托咪定(P-D组,20例)。P-H组以异丙酚0.5～1mg/Kg·h^-1持续泵注复合氢吗啡酮4～8μg/kg·h^-1持续泵注;P-D组以异丙酚0.5～1mg/Kg·h^-1持续泵注复合右美托咪定0.2～0.6μg/kg·h^-1持续泵注。比较2组患者的Ramsay评分、心率、血压、呼吸等变化。采用SPSS16.0软件包对数据进行统计学处理。结果:在拔管前2组的动脉血pH值、氧分压、二氧化碳分压无显著差异;2组间各时点SPO2、MAP、RR、RAMSAY比较无显著差异,2组间HR在T2、T5、T6时点比较有显著差异(P<0.05)。结论:静脉泵注丙泊酚-氢吗啡酮可以取得静脉泵注丙泊酚-右美托咪定类似的临床疗效,且无减慢心率的作用。     

Estrogen and progesterone improve scopolamine-induced impairment of spatial memory

This study was conducted to investigate the effects of estrogen and progesterone on spatial memory in ovariectomized female rats, specifically, on memory impaired by the cholinergic antagonist scopolamine. Forty-one female rats were divided into five groups: ovariectomized (OVX), estrogen-treated after ovariectomy (OE), progesterone-treated after ovariectomy (OP), estrogen-progesterone-treated after ovariectomy (OEP), and the sham control group (Control). The animals were trained on an eight-arm radial maze with four arms baited to assess both working and reference memory performances. The OE and OEP groups showed significant improvement in the ability to perform a spatial memory task over the OVX group (P<0.05). Spatial memory in the OP group did not differ from that in the OVX group. After thirty-two trials were conducted and all rats learned the eight-radial maze task, scopolamine hydrobromide (0.2 mg/kg i.p.) was administered prior to retesting. After scopolamine injection, the OVX group showed an increased number of working memory errors, reference memory errors than the other groups (P<0.05). The OE, OEP and OP groups showed significant improvement in spatial impairment induced by scopolamine. These findings suggest progesterone alone or in combination with estrogen, improved scopolamine-induced impairment of working memory and reference memory as effectively as estrogen supplementation.     

Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective, randomized, double-blind trial in Swedish children aged 1.5-3.5 years.

The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect, treatment acceptance, and amnesia. Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale (Wilton). The children's acceptance of procedures was assessed using another behavioral scale (Holst) during administration of the sedative, application of topical anesthesia, injection of a local anesthesia, and extraction. Amnesia was evaluated by the parents on the following day, with the child being asked standardized questions. Parental ratings of the child's and their own distress during and after treatment were made on a visual analog scale (VAS). No differences were found between the sedatives concerning level of sedation during treatment, acceptance of procedures, or amnesia. At discharge, 60 min after administration of the sedative, the children receiving diazepam were significantly more agitated (P=0.006). Parental rating on a VAS of the child's discomfort after treatment was significantly higher in the diazepam group (P=0.006). There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment. In conclusion, the present results, in combination with known pharmacological advantages, indicate that midazolam is preferable in outpatients when sedation is needed and amnesia is desirable.     

A comparison of two oral ketamine-diazepam regimens for the sedation of anxious pediatric dental patients.

PURPOSE: This study compared 2 oral ketamine-diazepam regimens (8 mg/kg and 10 mg/kg of ketamine in combination with 0.1 mg/kg diazepam) in preschool age children with respect to physiological, behavioral and amnestic parameters. METHODS: Twenty-five children completed the double-blind, crossover design. Physiologic, behavioral and amnestic effects were evaluated. RESULTS: ANOVA demonstrated significant changes in systolic blood pressures and heart rates in both the 8 mg/kg group and 10 mg/kg group (P < 0.05), as well as significant changes in diastolic blood pressures in the 10 mg/kg group (P < 0.05). However, these changes were not clinically significant. Success rates were 28% for the 8 mg/kg dosage and 44% for the 10 mg/kg dosage. There was a cumulative vomiting rate of 50% and a psychic phenomena rate of 10%. There were no statistically significant differences between the two dosages with regard to success rates, postoperative vomiting, or psychic phenomena using McNemar's test. CONCLUSIONS: There is no advantage of 10 mg/kg dose of ketamine over the 8 mg/kg dose. Ketamine did not demonstrate amnestic effects in this study. There were statistically but no clinically significant changes in physiological parameters in either group. This study does not support the use of either 8 mg/kg or 10 mg/kg oral ketamine for the sedation of uncooperative children.     

Propofol alone and combined with dexamethasone for the prevention of postoperative nausea and vomiting in adult Japanese patients having third molars extracted

We did a prospective, randomised, double-blind study to evaluate the efficacy and safety of a small dose of propofol alone, and propofol combined with dexamethasone, for the prevention of postoperative nausea and vomiting in adult Japanese patients listed for third molars extractions. One hundred and twenty patients, 55 men and 65 women aged 17-48 years, were given placebo, propofol 0.5mg/kg, or propofol 0.5mg/kg plus dexamethasone 8 mg intravenously at the end of the operation. A standard general anaesthestic was used, including sevoflurane and nitrous oxide in oxygen. Patients' characteristics were comparable in all three groups. The numbers of patients who developed postoperative nausea and vomiting during the 24h after anaesthesia were 8 with propofol (p=0.04), 2 with propofol plus dexamethasone (p=0.001), and 16 with placebo. The antiemetic efficacy of propofol combined with dexamethasone was superior to that of propofol alone (p=0.04). There were no clinically important adverse events. We conclude that a small dose (0.5mg/kg) of propofol combined with dexamethasone 8 mg was more effective than propofol alone for the prevention of postoperative nausea and vomiting in adult Japanese patients having general anaesthesia for extractions of third molars.     

Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective,randomized, double-blind trial in Swedish children aged 1.5-3.5 years

The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect, treatment acceptance, and amnesia. Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale (Wilton). The children's acceptance of procedures was assessed using another behavioral scale (Holst) during administration of the sedative, application of topical anesthesia, injection of a local anesthesia, and extraction. Amnesia was evaluated by the parents on the following day, with the child being asked standardized questions. Parental ratings of the child's and their own distress during and after treatment were made on a visual analog scale (VAS). No differences were found between the sedatives concerning level of sedation during treatment, acceptance of procedures, or amnesia. At discharge, 60 min after administration of the sedative, the children receiving diazepam were significantly more agitated (P = 0.006). Parental rating on a VAS of the child's discomfort after treatment was significantly higher in the diazepam group (P = 0.006). There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment. In conclusion, the present results, in combination with known pharmacological advantages, indicate that midazolam is preferable in outpatients when sedation is needed and amnesia is desirable.     

Serum antimuscarinic activity after a single dose of oral scopolamine hydrobromide solution measured by radioreceptor assay

Radioreceptor assay (RRA) was used to evaluate serum antimuscarinic activity in 10 healthy volunteers after a single dose of scopolamine hydrobromide (ScHBr) solution, 0.02 mg/kg, by a new oral administration method. Cardiac, antisialogogue, and subjective effects of the drug were also recorded. Although clinically useful antisialogogue and sedative effects were obtained 40 to 60 minutes after the administration of ScHBr, no reliable antimuscarinic activity was evaluated in serum samples for up to 3 hours. Clinically useful sedative and antisialogogue effects can be reached by gastrointestinal absorption of ScHBr solution.     

Effect of diazepam on temporomandibular joints in rats with increased occlusal vertical dimension

Anxiolytic agents, mainly benzodiazepines, have been used to treat symptomatic disorders of the temporomandibular joint (TMJ). Our aim was to evaluate the effect of diazepam on the TMJ of rats with increased occlusal vertical dimension (iOVD). Forty male rats were randomly assigned to 4 groups: control rats were given sham iOVD plus saline solution daily for 7 days. The first experimental group was given sham iOVD plus diazepam 2.5 mg/kg/intramuscularly daily for 7 days (diazepam alone group); the second had iOVD induced in molars for 7 days plus saline daily for 7 days (iOVD alone group); and the third had iOVD induced in molars for 7 days plus diazepam 2.5 mg/kg/intramuscularly daily for 7 days (iOVD plus diazepam group). At the end of each experiment the animals were killed and their bilateral TMJs were removed, randomly stained with haematoxylin and eosin and sirius-red, and immunoassayed. The thickness of condylar cartilage and of fibrous, proliferating, mature, and hypertrophic layers, number of collagen fibres, and the articular area were measured. Proinflammatory cytokines (interleukin (IL)-1α, IL-1β, IL-6, and tumour necrosis factor (TNF)-α) were also measured. ANOVA and Tukey's tests or the Kruskal–Wallis test were used to compare data among groups (α = 5%). Condylar cartilage was thicker in the control group than in the other groups, the diazepam alone group being thicker than the other 2 experimental groups. There were fewer collagen fibres in the 2 groups given diazepam than in the other 2 groups, and there were no significant differences in the area of cartilage among groups. The controls had lower concentrations of all cytokines (p < 0.05) than the 3 experimental groups, except for IL-6. Both iOVD groups had higher concentrations of IL-1α, IL-1β, and IL-6 than the diazepam alone group. Diazepam alone was associated with increased concentrations of all cytokines except IL-6. We conclude that both iOVD and diazepam induced significant changes in rats’ articular cartilage.     

A comparison of ketorolac tromethamine and acetaminophen codeine in the management of acute apical periodontitis.

Effective management of severe endodontic pain is often a major problem. The analgesic effect of ketorolac tromethamine (Toradol, 10 mg p.o.) was compared with acetaminophen codeine (325 mg/15 mg p.o.) in patients with severe pain due to acute apical periodontitis in a double-blind clinical study. A total of 66 patients presenting with severe pain (defined as 7 cm and more using a visual analog scale) were randomly assigned to receive either ketorolac tromethamine or acetaminophen codeine (33 patients in each group), and recorded their pain score once every 10 min for 90 min after administration. Results indicate that patients in the ketorolac group had significantly less pain than those who received acetaminophen codeine (p = 0.005).     

Comparison of the effectiveness of oral diazepam and midazolam for the sedation of autistic patients during dental treatment

PURPOSE: This study was undertaken to compare the effectiveness of oral diazepam and midazolam in sedating autistic patients during dental treatment. METHODS: The treatment regimen consisted of nitrous oxide/oxygen inhalation in conjunction with oral administration of either diazepam 0.3 mg/kg or midazolam 0.5 mg/kg in a cross-over design study of 13 subjects aged 5.8 to 14.7 years. A drug was classified as being effective when over 70% of the patients taking the drug were judged as "success" in all 3 behavioral criteria: (1) sleeping; (2) body movement; and (3) crying behaviors. The study was observed by an independent clinician with an intraexaminer reliability of 88%. RESULTS: For sleeping behavior, midazolam was found to be significantly more effective than diazepam as the duration of stimulation increased (P<.05). For the movement and crying behaviors, midazolam also proved to be significantly more effective from the start of treatment through the 35- and 40-min markers, respectively (P<.05). For the remainder of treatment, however, there was no statistically significant difference in these behaviors between the trials (P>.05). Diazepam and midazolam were rated as 77% and 100% successful, according to the overall behavior evaluation criteria (P=.02). CONCLUSIONS: Both diazepam and midazolam were shown to be effective sedative agents, successfully and safely used to sedate autistic patients for dental treatment. Midazolam was significantly more effective than diazepam in those portions of the procedure with increased stimulation.     

Comparison of hemodynamic effects of morphine, butorphanol, buprenorphine and pentazocine on ICU patients

Morphine and narcotic agonist-antagonists have been used to assist ICU patients in adapting to mechanical ventilation. In this study, 10 mg of morphine and the equipotent doses of synthetic analgesics, 2 mg of butorphanol, 0.6 mg of buprenorphine or 30 mg of pentazocine were administered intravenously to 29 patients requiring a ventilator. Hemodynamic effects on the heart rate, mean arterial pressure (MAP), cardiac index, stroke index, left ventricular stroke work index, mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP) and systemic and pulmonary vascular resistance (PVR) were measured. The hemodynamic effects of the four drugs were mild and not statistically significant except for the reduction in PCWP and the increase in PVR after morphine and the increase in MAP and MPAP after pentazocine administration. These doses of the four drugs could be given safely even in critically ill patients. The hemodynamic effects of these analgesics showed a similarity between the administration of butorphanol and morphine, and between buprenorphine and pentazocine. This study demonstrates that morphine and butorphanol are preferred to the cases with hypertension, increased pulmonary arterial pressure or wedge pressure and that pentazocine and buprenorphine are more suitable for the cases with hypotension or hypovolemia.