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Biomedical subjects

S Galloon

Publications and source records attributed to S Galloon.

16 recordsLinked to original sources

Sublingual lorazepam: a better premedication?

The efficacy of a sublingual preparation of lorazepam was compared with an i.m. injection of lorazepam as premedication for 150 patients undergoing minor gynaecological surgery. Anxiety, arousability and recall of auditory, visual and tactile stimuli were used as measurements of the degree and rate of onset of the effects. Anxiety scores decreased in both groups after medication. Patients who received the drug sublingually showed less recall, an earlier onset of sedation, more drowsiness and a longer recovery time than those who received the drug i.m. It is concluded that lorazepam given by the sublingual route is superior to that given i.m. because of more rapid absorption resulting in earlier drowsiness and more amnesia. An additional advantage is the absence of the discomfort of an injection.

Administration, Oral↗

A randomized evaluation of the reversal of ketamine by physostigmine.

One hundred and eleven patients undergoing ketamine anaesthesia for therapeutic abortion were studied in a double-blind trial of the reversal of ketamine by physostigmine administered postoperatively. The results demonstrate that physostigmine does not shorten recovery time or reduce the occurrence of ketamine emergence phenomena such as hallucinations, restlessness and dreams. In fact, the recovery course was prolonged in patients given physostigmine immediately upon termination of anaesthesia as compared with controls. By contrast, when physostigmine was given 30 minutes after the last dose of ketamine, the recovery was not prolonged as compared with that of the placebo-treated controls. These findings suggest some synergism between the effects of ketamine and physostigmine and should discourage the use of physostigmine as a ketamine antidote.

Abortion, Therapeutic↗

Comparison of lorazepam and diazepam as premedicants.

A double-blind random study compared lorazepam with diazepam as i.m. premedicants in 84 healthy women undergoing uterine curettage. Anxiety, assessed by a self-rating test by the patient and by a trained observer, was reduced 90 min after both lorazepam (P less than 0.001) and diazepam (P less than 0.01). There was more sedation and a longer recovery time after lorazepam than after diazepam. Amnesia at 24 h after operation (lack of recall rather than lack of recognition) was greater after lorazepam. There was transient local discomfort at the site of the injection in most patients in both groups, but no serious effects. Local erythema was present in 12 patients who received lorazepam and 10 who received diazepam 90 min after the injection, disappearing after 24 h in the former group but remaining in the latter. The incidence of nausea, vomiting and headache in both groups was small and similar, but there was more restlessness and dizziness after diazepam in the early recovery period.

Adult↗

The measurement of anxiety in the pre-surgical patient.

Sixty-nine female patients were assessed for anxiety before receiving premedication. Thirty-three were given lorazepam and 36 were given papaveretum. Re-evaluation 90 min after premedication indicated that lorazepam reduced significantly the level of anxiety, but that papaveretum did not. Anxiety was assessed by means of a five-point nurse-rating scale and the Multiple-Affect Adjective Check List self-rating form. This self-rating anxiety scale was sensitive and proved suitable for recumbent patients in hospital. The test scores compared favourably with previously published values.

Anxiety↗

Lorazepam as a premedication.

A double-blind random study compared the effects of lorazepam and pantopon an intra-muscular premedication in healthy women for uterine curettage (D & C). Anxiety, as assessed by a self-rating test by the patient and by a trained observer, showed a significant reduction at one and one-half hours after lorazepam and a smaller reduction after pantopon, which was not significant. Sedation was satisfactory with no significant difference between the two drugs in the change before and after the premedication. Lorazepam showed much more amnesia than pantopon (p less than 0.001). The patients who had lorazepam required higher doses of thiopentone for the operation, and this, in part, led to longer intervals in recovery times after lorazepam. However, it is suggested that lorazepam itself was partly responsible for the longer recovery. Pantopon was followed by more nausea, vomiting and headaches, than lorazepam. The intra-muscular injection of lorazepam hurt more patients than did pantopon, but other local complications were negligible and comparable in both groups. The results of this study show that lorazepam produces better reduction of anxiety and much more amnesia than pantopon, with comparable sedation and much less nausea and vomiting. The only disadvantage of lorazepam is the lack of analgesia and, therefore, the need for more anaesthesia during the operation. The conclusion is that lorazepam is a very satisfactory premedication and warrants more use as such.

Adult↗

A consideration of ketamine dreams.

This study was designed to see whether covering of the eyes during and after ketamine anaesthesia would reduce the incidence of dreams. One hundred and fifty patients, randomly divided into three groups, underwent therapeutic abortion with ketamine as the sole anaesthesia. One hundred patients had their eyes completely covered, 50 in the operating room only and 50 in the operating room and in the recovery room. The third 50 were controls, with their eyes uncovered. All patients were questioned post-operatively about dreams, nausea and vomiting, headache, dizziness and experiences, and also how frequently they dreamed at home. Although covering the eyes in the recovery room only reduced the incidence of dreams marginally, it became obvious that the patients who dreamed after ketamine (in all 3 groups) were those who normally dreamed at home. There were 82 patients who were recorded as not being home-dreamers, and only two of these dreamed after ketamine. In contrast, of the 68 home-dreamers, 50 dreamed after ketamine, and 17 of these had unpleasant dreams. In the home-dreamers, covering the eyes reduced the incidence of dreams from 86 per cent in Group 1 to 72 per cent in Group 2 and 64 per cent in Group 3. It is suggested that goggles may be advantageous when dealing with home-dreamers, and a question about the patient's tendency to dream should be included in the preoperative questioning. Alterations in premedication and the use of a quiet dark room during recovery may even further reduce unpleasant dreams in this group.

Anesthesia, Intravenous↗