Premedication

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Premedication with clonidine is superior to benzodiazepines.

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
A meta analysis of published studies
Background: Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an ,2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines. Methods: A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed. Results: Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post-operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post-operative nausea and vomiting (PONV). Discussion: Premedication with clonidine is superior to midazolam in producing sedation, decreasing post-operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result. [source]


Comparison between intubation and the laryngeal mask airway in moderately obese adults

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009
M. ZOREMBA
Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30 head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P<0.05. Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function. [source]


Measurement of Antiplatelet Inhibition during Neurointerventional Procedures: The Effect of Antithrombotic Duration and Loading Dose

JOURNAL OF NEUROIMAGING, Issue 1 2010
DJ Pandya MD
ABSTRACT BACKGROUND/OBJECTIVE Symptomatic thromboembolic events are the most common complications associated with aneurysm coiling, and carotid and intracranial stenting. Our objective is to assess the effect of aspirin (ASA) and clopidogrel dose and duration on platelet inhibition using a point of care assay in neurointerventional (NI) suite. METHOD The dose, duration, and point of care platelet function assay data for clopidogrel and aspirin therapy were prospectively collected between February 2006 and November 2007. Inadequate platelet inhibition for ASA was defined as ,550 ASA reaction units (ARU), and for clopidogrel was defined as ,50% inhibition of the P2Y12/ADP receptor RESULTS We collected data from 216 consecutive patients. Inadequate platelet inhibition was noted in 13% of patients on aspirin and 66% of patients on clopidogrel (P -value < .0001). Patients taking clopidogrel 75 mg for ,7 days, 300 mg for 24 hours, and 600 mg same day load had a mean P2Y12/ADP inhibition of 45%, 35% (P- value = .09), and 16%, respectively (P -value = .005). CONCLUSION Premedication with clopidogrel, in contrast to aspirin, does not achieve adequate platelet inhibition in about two-third of the patients. Same day antiplatelet loading may be insufficient to achieve adequate platelet inhibition and should be avoided if clinically feasible. J Neuroimaging 2010;20:64-69. [source]


Comparison of perioperative spirometric data following spinal or general anaesthesia in normal-weight and overweight gynaecological patients

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2005
B. S. Von Ungern-Sternberg
Background:, There is limited data comparing the impact of spinal anaesthesia (SA) and general anaesthesia (GA) on perioperative lung function. Here we assessed the differences of these two anaesthetic techniques on perioperative lung volumes in normal-weight (BMI < 25) and overweight (BMI 25,30) patients using spirometry. Methods:, We prospectively studied 84 consenting patients having operations in the vaginal region receiving either GA (n = 41) or SA (n = 43). Both groups (GA and SA) were further divided into two subgroups each (normal-weight vs. overweight). We measured vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), midexpiratory (MEF25-75) and peak expiratory flow rates (PEFR) at the preoperative assessment (baseline), after premedication, after effective SA, and 20 min, 1 h, 2 h and 3 h after the operation (last measurement after patient mobilization). Results:, Premedication was associated with a small but significant decrease in lung volumes in direct correlation with BMI (,5%). Spinal anaesthesia resulted in a significant reduction in lung volumes in overweight as opposed to normal-weight patients. Postoperatively, lung volumes were significantly more reduced following GA than SA as indicated by differences in mean VC (SD) of ,12 (6)% vs. ,6 (5)% 20 min after the end of the operation in the normal-weight and ,18 (5)% vs. ,10 (5)% in the overweight patients. There was a significant impact of BMI on postoperative respiratory function, which was significantly more important in the GA group than in the SA group, and recovery of lung volumes was more rapid in the normal-weight patients than in the overweight patients, particularly in the SA group. Conclusion:, In gynaecological patients undergoing vaginal surgery, the impact of anaesthesia on postoperative lung function as assessed by spirometry was significantly less after SA than GA, particularly in overweight patients. [source]


Efficacy of oral rofecoxib versus intravenous ketoprofen as an adjuvant to PCA morphine after urologic surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2004
M. C. Cabrera
Background:, Adjunctive use of nonsteroidal anti-inflammatory drugs has become increasingly popular in the perioperative period because of their opioid-sparing effects. This randomized, controlled, double-dummy study was designed to evaluate the cost-effectiveness of using oral rofecoxib as an alternative to intravenous ketoprofen for pain management in patients undergoing urologic surgery. Methods:, Seventy patients were randomly assigned to receive either a placebo (Control) or rofecoxib 50 mg po (Rofecoxib) 1 h prior to surgery. After a standardized spinal anesthetic, patients in the Control group received ketoprofen 100 mg IV q 8 h for 24 h, while the Rofecoxib group received an equivolume of saline at 8-h intervals for 24 h. Both groups were allowed to self-administer morphine (1 mg IV boluses) using a PCA delivery system. The need for ,rescue' analgesic medication, as well as pain scores [using an 11-point verbal rating scale (VRS) (0 = none to 10-severe)], were recorded at 1, 2, 6, 12, and 24-h intervals after surgery. In addition, the incidences of side-effects were recorded at the end of the study period. Results:, Total amount of morphine required in the initial 24-h postoperative period was nonsignificantly reduced in the Rofecoxib group (29 2 vs. 37 4 mg). More importantly, the percentage of patients reporting moderate-to-severe pain (VRS score ,4) during the study period was lower in the Rofecoxib group (12 vs. 22%, P < 0.05). The daily cost of rofecoxib (USD 1.14 for 50-mg dose) was also significantly less than ketoprofen (USD 3.06 for three 100-mg doses). Conclusion:, Premedication with oral rofecoxib (50 mg) is a cost-effective alternative to the parenteral nonselective NSAID, ketoprofen (100 mg q 8 h), when used as an adjuvant to PCA morphine for pain management after urologic surgery. [source]


Premedication with melatonin vs midazolam in anxious children

PEDIATRIC ANESTHESIA, Issue 7 2008
BERRIN ISIK MD
Summary Aim:, Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N2O/O2) sedation for dental treatment. Methods:, In a randomized study, 60 children received either 3 mg of melatonin [Melatonina (3 mg) 60 min before the procedure (n = 15); group I], 0.5 mgkg,1 melatonin 60 min before the procedure (n = 15; group II), 0.75 mgkg,1 midazolam [Dormicum (15 mg/3 ml ) 15 min before the procedure (n = 15); group III] or 3 ml of 0.09 NaCl 15 min (n = 7) or 60 min before the procedure (n = 8; group IV) orally. The children were sedated with 40/60% N2O/O2 inhalation. The heart rate and O2 saturation were monitored during the treatment period. The level of sedation was assessed according to the Ramsay Sedation Scale. The children's sedation success during dental treatment was classified. The sedation success and other sedation-related events recorded. Comparisons among the four groups were made using one-way anova or Kruskal,Wallis test, and if any significant differences were noted, the Tukey's HSD or Mann,Whitney U -test were used for intergroup comparisons. All differences were considered significant at P < 0.05. Results:, The evaluation of sedation success was as follows: group I: satisfactory (n = 1), average satisfactory (n = 4), and unsatisfactory (n = 10); group II: satisfactory (n = 2), average satisfactory (n = 3), and unsatisfactory (n = 10); group III: satisfactory (n = 9), average satisfactory (n = 6); and group IV: satisfactory (n = 1), average satisfactory (n = 3), and unsatisfactory (n = 11). Conclusion:, In these doses and clinical conditions, melatonin was similar to that of placebo and did not contribute to N2O/O2 sedation of anxious children. [source]


Anaesthesia for magnetoencephalography in children with intractable seizures

PEDIATRIC ANESTHESIA, Issue 9 2003
Peter Szmuk MD
Summary Background Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported. Methods We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty-one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia. Results There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane. Conclusions In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain. [source]


Survey on small animal anaesthesia

AUSTRALIAN VETERINARY JOURNAL, Issue 9 2001
A NICHOLSON
Objective To ascertain anaesthetic practices used currently for dogs and cats in Australia. Methods A questionnaire was distributed to 4800 veterinarians throughout Australia, seeking data on numbers of dogs and cats anaesthetised per week; drug preferences for anaesthetic premedication, induction and maintenance; use of tracheal intubation, supplemental O2, nitrous oxide and anaesthetic antagonists; and types of vaporisers, breathing systems and anaesthetic monitoring devices used or available. Additional questions concerned proportions of different animal types seen in the practice, and the respondent's university and year of graduation. Results The response rate was 19%; 95% of respondents graduated from Australian universities, about half since 1985. Most responses (79%) came from mainly small animal practices. On average 16 dogs and 12 cats were anaesthetised each week. Premedication was used more often in dogs than cats, with acepromazine and atropine most favoured in both species. For anaesthetic induction, thiopentone was most preferred in dogs and alphaxalone/alphadolone in cats. Inhaled agents, especially halothane, were preferred for maintenance in both species. Most respondents usually employed tracheal intubation when using inhalational anaesthetic maintenance, but intubation rates were lower during injectable anaesthetic maintenance and a minority of respondents provided supplemental O2. Nitrous oxide was administered regularly by 13% of respondents. The agents most frequently used to speed recovery from anaesthesia were doxapram and yohimbine. The most widely used vaporisers were the Fluotec Mark III and the Stephens machine. Most (95%) respondents used a rebreathing circuit for large dogs and a non-rebreathing system was used for small dogs by 68% of respondents. Most respondents (93%) indicated some form of aid was available to monitor general anaesthesia: the three most mentioned were an apnoea alarm, oesophageal stethoscope and electrocardiogram. Conclusion Diverse approaches were evident, but there appeared to be less variation in anaesthetising dogs: premedication was more frequent and less varied in type, while thiobarbituates dominated for induction and inhalants for maintenance. Injectable maintenance techniques had substantial use in cats, but little in dogs. Evident disparity between vaporisers available and circuits used suggested either confusion in terminology or incorrect use of some vaporisers in-circuit. While most respondents used monitoring equipment or a dedicated observer to invigilate anaesthesia, the common reliance on apnoea alarms is of concern, because of unproven reliability and accuracy. [source]


A randomized study of docetaxel and dexamethasone with low- or high-dose estramustine for patients with advanced hormone-refractory prostate cancer

BJU INTERNATIONAL, Issue 3 2006
THOMAS NELIUS
OBJECTIVE To test the combination of docetaxel with two different doses of estramustine in patients with hormone-refractory prostate cancer (HRPC), to improve response rates and to lower side-effects, as docetaxel-based chemotherapy is an increasing option for men with advanced HRPC, and alone or combined with estramustine, docetaxel improves median survival. PATIENTS AND METHODS In all, 72 patients with metastatic HRPC were randomly assigned to receive docetaxel (70 mg/m2 intravenously, on day 2 every 21 days) and estramustine (3 280 mg/day oral starting 1 day before docetaxel, for 5 consecutive days) for arm A, or estramustine (3 140 mg/day oral starting 1 day before docetaxel, for 3 consecutive days) for arm B. Premedication with oral dexamethasone at a total daily dose of 16 mg, in divided doses twice a day was administered in arm A on day 1,5 and in arm B on day 1,3. Initially, six cycles were administered. Chemotherapy was restarted after a significant increase in prostate-specific antigen (PSA) level. Patients were monitored for any measurable PSA response and toxicity. RESULTS Between the arms there was no statistically significant difference in time to progression and overall survival. However, treatment B had less treatment-related toxicity than A. Independent prognostic variables were baseline factors like PSA level, haemoglobin level, Eastern Cooperative Oncology Group performance status, and bone pain at presentation. CONCLUSIONS In this randomized phase II study the combination of docetaxel and estramustine had substantial activity in HRPC, with a significant incidence of severe toxicity, both haematological and not. Nevertheless, treatment-related toxicity was predictable and manageable. There was no better effect with a higher dose of estramustine with docetaxel than for a lower dose. There was a slight tendency to higher toxicity for high-dose estramustine but this was not statistically significant. The present results support the assertion that estramustine is not necessary in docetaxel-based treatment regimens. [source]


Follicular Unit Transplantation: The Option of Beard Construction in Eunuchoid Men

DERMATOLOGIC SURGERY, Issue 9 2002
Kayihan, ahinoglu MD
background. Psychosocial problems are very common in eunuchoids and may be related to the impact of underlying disorders on the physical appearance which makes them unable to overcome the sense of inferiority of childhood. A beardless patient treated with follicular unit transplantation (FUT) is reported here. objective. Such patients desire to get rid of a boyish appearance and want to achieve a masculine appearance. One of the easiest methods to achieve this goal is FUT. methods. By using an 18-gauge needle, the recipient bed was prepared under local anesthesia after premedication, and 1200 one- or two-hair micrografts were transplanted to the perioral (goatee) and its extensions to the sideburns. results. After completion of the procedure to the planned area, we achieved restoration of a masculine appearance which made the patient seem quite satisfied. conclusion. The process of beard reconstruction is time consuming and tedious, but highly effective. [source]


Premedication with clonidine is superior to benzodiazepines.

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
A meta analysis of published studies
Background: Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an ,2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines. Methods: A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed. Results: Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post-operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post-operative nausea and vomiting (PONV). Discussion: Premedication with clonidine is superior to midazolam in producing sedation, decreasing post-operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result. [source]


Adverse drug reactions to biologics

JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 6 2010
Kathrin Scherer
Summary The use of biologics has rapidly expanded since the introduction of the first diagnostic antibodies; they are now widely employed in oncology, autoimmune disorders, inflammatory diseases and transplantation medicine. Their widespread use has resulted in an increase in adverse drug reactions. Adverse effects result from both direct pharmacological actions and immunological actions, as well as through induction of a specific immune response. The nomenclature, particularly of the monoclonal antibodies, identifies the target structure and organ as well as the species of origin, which then helps predict their effects and antigenic properties. Depending on the extent of foreign protein, anti-allotypic or anti-idiotypic antibodies with or without neutralizing properties may be induced. Adverse drug reactions from biologics often depend on the target and may be explained by activation or inhibition of particular cytokine pathways. Adverse drug reactions are classified by their pathomechanism, which enhances understanding of the pathogenesis and facilitates both allergologic diagnostic measures and planning of premedication in future treatments. This review emphasizes immunostimulatory and hypersensitivity reactions. [source]


Vascular endothelial growth factor reduces Fas-mediated acute liver injury in mice

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt2 2008
Yoichi Tanaka
Abstract Background and Aim:, Fulminant hepatitis is still a fatal liver disease, and no specific treatment for it has been available. Vascular endothelial growth factor (VEGF) is the focus of attention because of its various actions. We investigated the effect of vascular endothelial growth factor (VEGF) on Fas-induced fulminant hepatic failure (FHF). Method:, Male Balb/c mice were treated with an intraperitoneal injection of an anti-Fas antibody (Jo-2 Ab) with or without premedication with intraperitoneally administered human recombinant VEGF. Results:, The serum level of alanine aminotransferase (ALT) was up to 300 times higher that of normal mice following the Jo-2 Ab injection, and histological analysis revealed hepatic injury and massive hepatocyte apoptosis. The VEGF significantly suppressed an elevation in serum ALT levels and hepatocyte apoptosis. Immunohistochemically, VEGF-treated mice showed that Bcl-xL in hepatocytes was strongly expressed. Conclusions:, Since hepatocytes do not express VEGF receptors, we speculated that VEGF acts on sinusoidal endothelial cells (SECs) and promotes production of cytokines such as hepatocyte growth factor in SECs, resulting in reducing apoptosis through an increase expression of Bcl-xL in hepatocytes. We suggest that VEGF has a potent antiapoptotic effect on hepatocytes through cell,cell interaction between SECs and hepatocytes. [source]


Does pethidine affect the cardiovascular and sedative effects of dexmedetomidine in dogs?

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 2 2009
N. J. Grint
Objectives: To investigate pethidine's effects on sedation and cardiovascular variables in dogs premedicated with dexmedetomidine. Methods: Sixty American Society of Anesthesiologists (ASA) I dogs were presented for routine neutering. Heart rate was measured at admission. Dogs were randomly assigned to one of the five groups to decide premedication; group D5+P (dexmedetomidine 5 ,g/kg plus pethidine 5 mg/kg), D10+P (dexmedetomidine 10 ,g/kg plus pethidine 5 mg/kg) with three control groups, D5 (dexmedetomidine 5 ,g/kg), D10 (dexmedetomidine 10 ,g/kg) or P (pethidine 5 mg/kg). Heart rate was measured at 3, 5, 10 and 20 minutes after preanaesthetic medication. Simple descriptive scores for sedation were assigned after 20 minutes. Anaesthesia was induced using propofol and maintained using isoflurane in oxygen. Heart rate was recorded throughout anaesthesia. Results: Sedation scores after preanaesthetic medication were significantly higher (P<0001) in groups D5+P and D10+P compared with the other three groups. D5+P and D10+P groups tended to have lower heart rates in dogs at all time points after premedication compared with groups containing only pethidine or dexmedetomidine at the relevant dose. Clinical Significance: Greater sedation is achieved using combinations of dexmedetomidine and pethidine compared with each drug alone. Pethidine does not attenuate the alpha-2 adrenergic-induced bradycardia. [source]


Parental presence during induction enhances the effect of oral midazolam on emergence behavior of children undergoing general anesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2007
Y.-C. P. Arai
Background:, Pre-anesthetic anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Thus, sedative premedication and parental presence during induction of anesthesia (PPIA) are used to treat pre-anesthetic anxiety in children. The aim of the present study was to test if a combination of mother presence and midazolam premedication is effective for improving emergence condition in children undergoing general anesthesia. Methods:, Sixty children were allocated to one of three groups: a sedative group (0.5 mg/kg oral midazolam), a PPIA group or a sedative and PPIA group. When anesthesia was induced with 7% sevoflurane in 100% oxygen, qualities of mask induction were rated. Anesthesia was maintained with sevoflurane (1.5,2.5%) in 60% oxygen and intravenous fentanyl 4 ,g/kg. During emergence from anesthesia, the score of the child's emergence behavior was rated. Results:, The children in the midazolam group showed a better quality of mask induction compared with those in the PPIA group, the addition of parental presence to oral midazolam did not provide additional improvement of mask induction. In contrast, the children in the midazolam + PPIA group were less agitated than those in the other groups at emergence from anesthesia. Conclusion:, Parental presence during induction of anesthesia enhanced the effect of oral midazolam on emergence behavior of children undergoing general anesthesia. [source]


Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2006
P. Hannemann
Background:, For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. Methods:, In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results:, The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2,3 h before anaesthesia. Solid food was permitted up to 6,8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. Conclusion:, In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome. [source]


Influence of Isoflurane General Anesthesia or Anesthesia and Surgery on Thyroid Function Tests in Dogs

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2009
M.A. Wood
Background: Anesthesia and surgery affect thyroid function tests in humans but have not been studied in dogs. Hypothesis: Anesthesia and anesthesia with surgery will affect thyroid function tests in dogs. Animals: Fifteen euthyroid dogs. Methods: Prospective, controlled, interventional study. Dogs were assigned to one of 3 groups: control, general anesthesia, and general anesthesia plus abdominal exploratory surgery. Dogs in the anesthesia and surgery groups were premedicated with acepromazine and morphine, induced with propofol, and maintained on isoflurane. Samples for measurement of serum thyroxine (T4), free T4 (fT4) by equilibrium dialysis, triiodothyronine (T3), reverse T3 (rT3), and thyroid-stimulating hormone concentrations were collected from each dog immediately before premedication, at multiple times during anesthesia, surgery, 4, 8, 12, 24, 36, and 48 hours after anesthesia, once daily for an additional 5 days, and once 14 days after anesthesia. Sampling was performed at identical times in the control group. Results: Serum T4 decreased significantly from baseline in the surgery and anesthesia groups compared with the control group at 0.33 (P= 0.043) and 1 hour (P= 0.018), and 2 (P= 0.031) and 4 hours (P= 0.037), respectively, then increased significantly in the surgery group compared with the control group at 24 hours (P= 0.005). Serum T3 decreased significantly from baseline in the anesthesia group compared with the control group at 1 hour (P= 0.034). Serum rT3 increased significantly from baseline in the surgery group compared with the control and anesthesia groups at 8 (P= 0.026) and 24 hours (P= 0.0001) and anesthesia group at 8, 12, 24, and 36 hours (P= 0.004, P= 0.016, P= 0.004, and P= 0.014, respectively). Serum fT4 increased significantly from baseline in the surgery group compared to the control at 24 hours (P= 0.006) and at day 7 (P= 0.037) and anesthesia group at 48 hours (P= 0.023). Conclusions and Clinical Importance: Surgery and anesthesia have a significant effect on thyroid function tests in dogs. [source]


Influence of antibiotic therapy on serum levels of reactive oxygen species in ovariectomized bitches

JOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2008
M. MUTINATI
This study was conducted on 60 ovariectomized bitches. The objectives were to measure the mean reactive oxygen species (ROS) concentrations before, during and after surgery, and to investigate the effect of the administration of five different antibiotic treatments: amoxicillin, benzylpenicillin/dihydrostreptomycin, sulfametazine/sulfamerazine/sulfathiazole, enrofloxacin, lincomycin/spectinomycin. The first value recorded represented the mean ROS concentration in anestral bitches and constitutes a reference level with which to compare the subsequent measurements. After premedication, induction of anesthesia and during maintenance and surgery, ROS serum concentrations showed constant values until the end of surgery. After surgery and during antibiotic administration, an increase in ROS concentration occurred, which differed among the five groups in relation to the antibiotics employed. The lowest increases occurred in the groups treated with the combination of lincomycin/spectinomycin, and with amoxicillin; whereas the highest increases were detected in the group treated with enrofloxacin. The three other antibiotics showed an intermediate level of influence on oxidative status. [source]


Dexmedetomidine or medetomidine premedication before propofol,desflurane anaesthesia in dogs

JOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2006
R. J. GMEZ-VILLAMANDOS
The objective of this study was to evaluate dexmedetomidine as a premedicant in dogs prior to propofol,desflurane anaesthesia, and to compare it with medetomidine. Six healthy dogs were anaesthetized. Each dog received intravenously (i.v.) five preanaesthetic protocols: D1 (dexmedetomidine, 1 ,g/kg, i.v.), D2 (dexmedetomidine, 2 ,g/kg, i.v.), M1 (medetomidine, 1 ,g/kg, i.v.), M2 (medetomidine, 2 ,g/kg, i.v.), or M4 (medetomidine, 4 ,g/kg, i.v.). Anaesthesia was induced with propofol (2.3,3.3 mg/kg) and maintained with desflurane. The following variables were studied: heart rate (HR), mean arterial pressure, systolic arterial pressure, diastolic arterial pressure, respiratory rate (RR), arterial oxygen saturation, end-tidal CO2, end-tidal concentration of desflurane (EtDES) required for maintenance of anaesthesia and tidal volume. Arterial blood pH (pHa) and arterial blood gas tensions (PaO2, PaCO2) were measured during anaesthesia. Time to extubation, time to sternal recumbency and time to standing were also recorded. HR and RR decreased significantly during sedation in all protocols. Cardiorespiratory variables during anaesthesia were statistically similar for all protocols. EtDES was significantly different between D1 (8.1%) and D2 (7.5%), and between all doses of medetomidine. Desflurane requirements were similar for D1 and M2, and for D2 and M4 protocols. No statistical differences were observed in recovery times. The combination of dexmedetomidine, propofol and desflurane appears to be effective for induction and maintenance of general anaesthesia in healthy dogs. [source]


Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2006
H. Bergendahl
Background:, Children undergoing anaesthesia and surgery can experience significant anxiety and distress during the peri-operative period, but whether routine premedication is necessary is currently debated. Benzodiazepines are the most frequently used drugs as premedication in paediatric anaesthesia. In the US, 50% of young children undergoing surgery receive premedication and midazolam is the most frequently used drug in this context (1). Nishina and coworkers (2) concluded in a review article in 1999 that clonidine, administered via an oral, rectal, or caudal route, is a promising adjunct to anaesthetics and analgesics to enhance quality of peri-operative management in infants and children. Later publications also support the use of clonidine for premedication (3,6). The aim of this communication is to review the use of clonidine in paediatric anaesthesia and to propose clonidine as a promising alternative to midazolam. Clonidine is associated with a number of beneficial effects in the context ofanaesthesia both in adults and children. Why clonidine is not routinely use in clinical practice despite the massive publication list is to a large extent due to the lack of marketing efforts from the pharmaceutical industry since multiplegeneric preparations are now readily available on most markets. Midazolam is also associated with a number of beneficial effects, but is far from an ideal premedicant in children, especially with regards to the amnesia, confusion and long term behavioural disturbances. Clonidine has contrary to midazolam no effect on respiration. We believe that clonidine is a good alternative to midazolam as premedication in infants and children. [source]


Comparison of perioperative spirometric data following spinal or general anaesthesia in normal-weight and overweight gynaecological patients

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2005
B. S. Von Ungern-Sternberg
Background:, There is limited data comparing the impact of spinal anaesthesia (SA) and general anaesthesia (GA) on perioperative lung function. Here we assessed the differences of these two anaesthetic techniques on perioperative lung volumes in normal-weight (BMI < 25) and overweight (BMI 25,30) patients using spirometry. Methods:, We prospectively studied 84 consenting patients having operations in the vaginal region receiving either GA (n = 41) or SA (n = 43). Both groups (GA and SA) were further divided into two subgroups each (normal-weight vs. overweight). We measured vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), midexpiratory (MEF25-75) and peak expiratory flow rates (PEFR) at the preoperative assessment (baseline), after premedication, after effective SA, and 20 min, 1 h, 2 h and 3 h after the operation (last measurement after patient mobilization). Results:, Premedication was associated with a small but significant decrease in lung volumes in direct correlation with BMI (,5%). Spinal anaesthesia resulted in a significant reduction in lung volumes in overweight as opposed to normal-weight patients. Postoperatively, lung volumes were significantly more reduced following GA than SA as indicated by differences in mean VC (SD) of ,12 (6)% vs. ,6 (5)% 20 min after the end of the operation in the normal-weight and ,18 (5)% vs. ,10 (5)% in the overweight patients. There was a significant impact of BMI on postoperative respiratory function, which was significantly more important in the GA group than in the SA group, and recovery of lung volumes was more rapid in the normal-weight patients than in the overweight patients, particularly in the SA group. Conclusion:, In gynaecological patients undergoing vaginal surgery, the impact of anaesthesia on postoperative lung function as assessed by spirometry was significantly less after SA than GA, particularly in overweight patients. [source]


Comparison of a combination of midazolam and diazepam and midazolam alone as oral premedication on preanesthetic and emergence condition in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2005
Y-C. P. Arai
Background:, Preanesthetic anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Thus, midazolam has been used as premedication for children. However, midazolam alone is not effective for emergence agitation. The present study tested the effect of a combination of midazolam and diazepam on the preanesthetic condition and emergence behavior in children. Methods:, Forty-two children were allocated to one of three groups: the NoPre group received no premedication; the Mi group received midazolam 0.5 mg kg,1 orally; and the Mi + Di group received midazolam 0.25 mg kg,1 and diazepam 0.25 mg kg,1 orally. When anesthesia was induced with 7% sevoflurane in 100% oxygen, qualities of mask induction and sedation were rated. Anesthesia was maintained with sevoflurane (3,5%) in 100% oxygen. During emergence from anesthesia, the score of the child's emergence behavior was rated. Results:, Children in the Mi and Mi + Di groups were more sedated than those in the NoPre group. A combination of midazolam and diazepam provided a better quality of mask induction, when compared with no premedication. Also, the children in the Mi + Di group were less agitated than those in the other groups during the emergence. Conclusion:, Children in the Mi + Di group were significantly more sedated at induction of anesthesia and less agitated during emergence from anesthesia. [source]


Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedication

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2004
W. Malmgren
Background:, Sevoflurane is a rapid-acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator-blinded study was designed to evaluate whether premedication with an opioid might reduce non-divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane. Methods:, Ninety-two healthy two to six year-old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg,1 together with either morphine 0.15 mg kg,1 or midazolam 0.30 mg kg,1 approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre- and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS. Results:, There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward. Conclusion:, In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia. [source]


The place of premedication in pediatric practice

PEDIATRIC ANESTHESIA, Issue 9 2009
ABRAHAM ROSENBAUM MD
Summary Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital-related distress begins at the start of the patient's journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro,con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective. [source]


Use of premedication for intubation in tertiary neonatal units in the United Kingdom

PEDIATRIC ANESTHESIA, Issue 7 2009
RAJIV CHAUDHARY MBBS MRCPCH
Summary Background:, Endotracheal intubation and laryngoscopy are frequently performed procedures in neonatal intensive care. These procedures represent profoundly painful stimuli and have been associated with laryngospasm, bronchospasm, hemodynamic changes, raised intracranial pressure and an increased risk of intracranial hemorrhage. These adverse changes can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication. Aims:, To evaluate current practices for premedication use prior to elective intubation in UK tertiary neonatal units. Methods:, Telephone questionnaire survey of all 50 tertiary neonatal units in the UK. Results:, Ninety percent of units report the routine use of sedation prior to intubation and 82% of units routinely use a muscle relaxant. Morphine was the most commonly used sedative and suxamethonium was the most commonly used muscle relaxant. Approximately half of the units also used atropine during intubation. Seventy seven percent of units had a written policy for premedication. Ten percent of the units did not routinely use any sedatives or muscle relaxants for elective intubation. Conclusions:, In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose. [source]


Premedication with melatonin vs midazolam in anxious children

PEDIATRIC ANESTHESIA, Issue 7 2008
BERRIN ISIK MD
Summary Aim:, Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N2O/O2) sedation for dental treatment. Methods:, In a randomized study, 60 children received either 3 mg of melatonin [Melatonina (3 mg) 60 min before the procedure (n = 15); group I], 0.5 mgkg,1 melatonin 60 min before the procedure (n = 15; group II), 0.75 mgkg,1 midazolam [Dormicum (15 mg/3 ml ) 15 min before the procedure (n = 15); group III] or 3 ml of 0.09 NaCl 15 min (n = 7) or 60 min before the procedure (n = 8; group IV) orally. The children were sedated with 40/60% N2O/O2 inhalation. The heart rate and O2 saturation were monitored during the treatment period. The level of sedation was assessed according to the Ramsay Sedation Scale. The children's sedation success during dental treatment was classified. The sedation success and other sedation-related events recorded. Comparisons among the four groups were made using one-way anova or Kruskal,Wallis test, and if any significant differences were noted, the Tukey's HSD or Mann,Whitney U -test were used for intergroup comparisons. All differences were considered significant at P < 0.05. Results:, The evaluation of sedation success was as follows: group I: satisfactory (n = 1), average satisfactory (n = 4), and unsatisfactory (n = 10); group II: satisfactory (n = 2), average satisfactory (n = 3), and unsatisfactory (n = 10); group III: satisfactory (n = 9), average satisfactory (n = 6); and group IV: satisfactory (n = 1), average satisfactory (n = 3), and unsatisfactory (n = 11). Conclusion:, In these doses and clinical conditions, melatonin was similar to that of placebo and did not contribute to N2O/O2 sedation of anxious children. [source]


Midazolam as premedication: is the emperor naked or just half-dressed?

PEDIATRIC ANESTHESIA, Issue 4 2007
Frederic A. Berry MD
No abstract is available for this article. [source]


Midazolam as premedication: Is the emperor naked or just half-dressed?

PEDIATRIC ANESTHESIA, Issue 4 2005
PER-ARNE LNNQVIST MD PhD
No abstract is available for this article. [source]


Anaesthesia for magnetoencephalography in children with intractable seizures

PEDIATRIC ANESTHESIA, Issue 9 2003
Peter Szmuk MD
Summary Background Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported. Methods We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty-one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia. Results There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane. Conclusions In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain. [source]


Preparation of parents by teaching of distraction techniques does not reduce child anxiety at anaesthetic induction.

PEDIATRIC ANESTHESIA, Issue 9 2002
A. Watson
Introduction For those children having surgery, induction of anaesthesia is one of the most stressful procedures the child experiences perioperatively. Current work has failed to show a benefit of parental presence at induction of anaesthesia for all children. The reasons for lack of effect may include the high anxiety levels of some parents and also that the role for parents at their child's induction is not delineated. The main aim of this study was to see if parental preparation by teaching of distraction techniques could reduce their child's anxiety during intravenous induction of anaesthesia. Methods After ethics committee approval 40 children aged 2,10 years old, ASA status I or II undergoing daycase surgery under general anaesthesia were enrolled into the study. To avoid possible confounding factors children with a history of previous, surgery, chronic illness or developmental delay were excluded form participation. No children were given sedative premedication. After written informed consent by the parent, each child and parent was randomly assigned to an intervention or control group. Parents in the intervention group received preparation from a play specialist working on the children's surgical ward. It involved preparation for events in the anaesthetic room and instruction on methods of distraction for their child during induction using novel toys, books or blowing bubbles appropriate to the child's age. Preoperative information collected included demographic and baseline data. The temperament of the child was measured using the EASI (Emotionality, Activity, Sociability, Impulsivity) instrument of child temperament(l). In the anaesthetic room all children were planned to have intravenous induction of anaesthesia after prior application of EMLA cream. Anxiety of the child was measured by the modified Yale Preoperative Anxiety Scale (mYPAS)(2) by a blinded independent observer at three time points: entrance to the anaesthetic room, intravenous cannulation and at anaesthesia induction. Cooperation of the child was measured by the Induction Compliance Checklist (ICC) by the same observer (3). Postoperative data collected included parental satisfaction and anxiety scores measured by the Stait Trait Anxiety Inventory (STAI)(4) and at one week the behaviour of the child was measured Using the Posthospitalisation Behavioural Questionnaire (PHBQ)(5). Normally distributed data were analysed by a two-sample t-test, categorical data by Pearson's Chi-squared test and non-parametric data by the Wilcoxon rank-sum test. Results One parent withdrew after enrolment. This left 22 children in the control group and 17 in the intervention group. There were no significant differences in demographic and baseline data of the children between the two groups including ethnic origin, number of siblings, birth order of the child, recent stressful events in the child's life, previous hospital admissions and the temperament of the child. Parent demographics were also similar between groups including parent's age, sex, relationship to child and level of education. There were no significant differences in child anxiety or cooperation during induction measured by mYPAS and ICC between the control and intervention groups. More parents in the preparation group distracted their child than those without preparation but this did not reach significance. Parental anxiety immediately postinduction was similar between groups as was the level of parental satisfaction. The incidence of development of new negative postoperative behaviour of the child at one week was not significantly different between groups. Discussion This study shows that giving an active role for parents in the induction room, particularly by instructing them on distracting techniques for their child, does not reduce their child's anxiety compared to conventional parental presence. We conclude resources should not be directed at this type of parental preparation. Further work should examine the usefulness of distraction by nursing staff or play specialists during anaesthetic induction. [source]