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PubMed1977

Studies of drugs given before anaesthesia XXVI: lorazepam.

Lorazepam has been studied as preanaesthetic medication given by mouth, i.m. and i.v. Sediation and side-effects and the incidence of anterograde amnesia in patients having a standard operation under methohexitone-nitrous oxide-oxygen anaesthesia were assessed. In a preliminary study of three i.m. (2-, 4- and 8-mg) and six oral (1-,2-,2.5-,4-,5- and 8-mg) doses, the optimum dose was found to be 4 mg for patients with an average weight of 60 kg. This dose was studied in detail when given by all three routes and compared with the commercially available 2.5- and 5-mg tablets. Even when given i.v., there was a delay of 30-40 min in the onset of maximum sedative effect and drowsiness persisted for at least 4 h. Although the onset of action by i.m. injection was slightly faster than when the drug was given by mouth this advantage was more than offset by the high frequencies of pain at the site of injection and restlessness which persisted for 20-40 min. Oral lorazepam in doses of 2.5-5.0 mg was a reliable, effective sedative which could be recommended for routine preanaesthetic medication, provided rapid recovery was not essential. Its soporific effect was accompanied by an appreciable incidence of anterograde amnesia.

Administration, Oral↗
PubMed1979

[The circulatory system in patients under electrostimulation anaesthesia during ophthalmological operations (author's transl)].

Anaesthesia by electrostimulation and its effects on the circulatory system were investigated in 65 elderly patients, in whom operations on the retina and vitreous body were performed. Stimulation of the dermatomes of the first and second trigeminal nerve as well as of C3 and C4 was performed using stimulating needles in 25 patients and adhesive electrodes in 40 patients. All patients were intubated after injection of thiopentone and a muscle relaxant. Anaesthesia was maintained by continuous electrostimulation, intermittent relaxation and normoventilation with N2O/O2 in a ratio of 1/1. During this anaesthesia technique, marked stability of the circulatory system was observed. This was noted in 32 normotensive and 33 hypertensive patients, the latter being partly under antihypertensive medication. Electrostimulation anaesthesia therefore may be recommended for elderly and high risk patients.

Adult↗
PubMedDate not supplied

Acute intravenous premedication with nalbuphine.

In a randomized, double blind study of 75 adult surgical patients, nalbuphine (0.1 mg/kg), morphine (0.1 mg/kg), or a placebo were administered intravenously as premedication 12 to 16 minutes prior to induction of anesthesia. Comparison of the 3 groups showed: (1) patients receiving nalbuphine and morphine had a significant reduction of minute ventilation and a significantly greater incidence of immediate side effects than did patients receiving placebo injections; (2) patients receiving morphine required no medication for pain in the early postoperative period; and (3) patients receiving nalbulphine experienced less nausea and/or vomiting postoperatively than did those in the other 2 groups.

Cervix Uteri↗
PubMed1976

[Anesthesia during resections-anastomoses of the trachea and tracheal bifurcation. Apropos of 4 cases].

The author reports 4 cases of surgery of the lower trachea and of tracheal bifurcation, and consider: -that it is preferable only to intervene after improvement by medical treatment of the phase of acute asphyxia; -that a technique of general anesthesia, with deep curarisation and oro-tracheal catheter placed above the stenosis, permits correct ventilation; -that in cases of impossibility of ventilation, one should use extra-corporeal circulation, which should always be provided for.

Aged↗
PubMed1979

Atropine versus glycopyrrolate. A study of intraocular pressure and pupil size in man.

Following control observations of intraocular pressure and pupil size, in doses suitable for pre-anaesthetic medication, glycopyrrolate (0.004 mg/kg) and atropine (0.01 mg/kg) were given intramuscularly to healthy volunteers in a randomised, cross-over fashion. No significant change in either intraocular pressure or pupil size was noted 45 min after drug administration.

Adult↗
PubMed1975

Studies of drugs given before anaesthesia XXV: Medazepam, a new benzodiazepine.

Medazepam, a new benzodiazepine, was studied as an oral preanaesthetic medication in adult women in a dose of 10 mg, and the findings compared with those obtained with diazepam 10 mg or a dummy capsule using a double-blind technique. In the doses used medazepam produced less drowsiness than diazepam and was no more anxiolytic than the placebo.

Administration, Oral↗
PubMedDate not supplied

Diazepam and lorazepam for intravenous surgical premedication.

Diazepam, 10 and 20 mg, and 2 and 4 mg lorazepam were studied as intravenous surgical premedicants in 120 patients. Relief of anxiety, sedation, patient acceptance, lack of recall, and side effects were the variables evaluated. Both diazepam and lorazepam proved to be excellent surgical premedicants. The basic difference between the two drugs is temporal. Both medications produce similar relief of anxiety, sedation, patient acceptance, and lack of recall. The clinical effects of intravenous diazepam peaks in 2 to 3 minutes and diminishes thereafter. Intravenous lorazepam has a latent period of 8 to 15 minutes, with increasing effects at 15 to 30 minutes.

Adolescent↗
PubMed1979

Effect of preanaesthetic medication on etomidate.

The effects of diazepam and pethidine, when given as preanaesthetic medication, on the induction of anaesthesia and the postanaesthetic sequelae following etomidate were studied in women undergoing minor gynaecological procedures. Pain on injection was present in all the groups. However, the frequency was significantly less with the polyethylene glycol and propylene glycol formulations of the drug compared with the aqueous solution. A fast injection and pethidine premedication decreased the frequency also. The high frequency of excitatory phenomena in unpremedicated patients was decreased significantly by premedication with diazepam and pethidine, especially the latter. Respiratory and cardiovascular effects of the drug were not major problems. The frequency of emetic sequelae was high. Recovery was rapid even in the groups receiving sedative premedication.

Adolescent↗
PubMed1975

The potentialities of some antihistaminics in preanaesthetic medication.

A detailed study has been carried out on the potentialities of antazoline and chlorpheneramine (C.P.M.) in preanaesthetic medication. It included a determination of their sedative action, effects on cardiovascular system and any possible anticholinergic and antiarrhythmic properties. Both drugs depressed spontaneous activity in mice. Antazoline produced hypotension in chloralosed dogs and spinal cats (a peripheral action). Both produced a negative inotropic action on isolated rabbit's heart. On rat's auricle antazoline produced a positive chronotropic action while C.P.M. produced a negative chronotropic action. Both drugs could protect the heart against adrenaline induced arrhythmias during chloroform and halothane anaesthesia. Their anticholinergic properties were demonstrated by studies on isolated rabbit's heart and intestine as well as on isolated guinea pig's ileum.

Animals↗
PubMed1979

Preoperative and postoperative use of clonidine with neurolept anaesthesia.

The abrupt cessation of clonidine therapy can induce a withdrawal syndrome. This may also appear immediately after anaesthesia if clonidine medication is discontinued during the operation day. We studied (1) whether the withdrawal syndrome occurs postoperatively as often as otherwise when clonidine therapy is discontinued, and (2) the action of this clonidine withdrawal on the circulation as compared to patients who received clonidine without interruption during the operation day. During the recovery period in 2 out of 10 patients in whom clonidine medication was discontinued, a hypertensive crisis occurred, which was relieved by clonidine readministration. Clonidine given with premedication eliminated high rises in blood pressure during anaesthesia. During the recovery period, the regular intramuscular administration of the same dose of clonidine as the patients had used orally decreased blood pressure to almost normotensive levels. The slightly increased urinary catecholamine excretion and plasma renin activity in these patients might, however, indicate that the circulatory homeostasis was disturbed in some degree. The results suggest that it is important to give clonidine continuously, even during the operation day. The dose may be the same as, or preferably somewhat smaller than that which the patients have previously received orally.

Administration, Oral↗
PubMed1978

A comparison of high-dose pentazocine with pethidine and diazepam in paediatric premedication.

A comparision of a high dose of pentazocine (0.9 mg/kg), and moderate doses of pethidine (1 mg/kg) and diazepam (0.2 mg/kg) as pre-anaesthetic medication was carried out in a double-blind between-patient placebo-controlled trial in 200 children. The assessment of the drugs as pre-anesthetic medication was made by comparing the sedative effect before induction, the status of the patient at induction and the patient's behaviour in the recovery room. All the active drugs were superior to the placebo at induction of anaesthesia. Postoperatively the sedative effect of the high dose of pentazocine was superior to that of the other active drugs, presumably due to the strong analgesic effect at this dose. The rate of respiration was clearly lower after pentazocine than after the other two active drugs. Other side effects or complications did not differ between the groups. It is concluded that, in spite of its favourable sedative effect, a high dose of pentazocine should be used with caution in pediatric premedication because of the possibility of slight respiratory depression.

Child, Preschool↗
PubMedDate not supplied

A comparison of droperidol, diazepam, and hydroxyzine hydrochloride as premedication.

A double-blind comparison of the efficacy and safety of droperidol (5 mg), hydroxyzine HCl (50 mg), diazepam (5 mg), and saline placebo, given concomitantly with meperidine (50 or 75 mg) for preoperative medication, was conducted in 280 female patients scheduled for minor gynecologic procedures. Droperidol proved to significantly superior to the other study drugs in alleviating apprehension (83% of patients calm versus 54, 46, and 34% for hydroxyzine, diazepam, and placebo, respectively). Some drowsiness, occurred in 68 percent of the droperidol-treated patients versus 31, 30, and 21 percent of the other 3 groups, respectively. Global evaluations were consistent with these findings. No clinically significant changes were observed in vital signs in any of the study-drug groups. Adverse reactions were unremarkable in all groups. Significantly less nausea occurred with droperidol than with other treatments, and signficantly less vomiting occurred with droperidol or hydroxyzine. Significantly fewer patients in the droperidol group than in the diazepam group required postoperative antiemetics.

Adolescent↗
PubMed1979

Anaesthetic management of phaeochromocytoma.

The incidence, mortality, physiology, clinical findings and diagnosis of phaeochromocytoma are reviewed. Treatment, after adequate medical stabilization, must be surgical because of the high incidence of malignancy. Alpha-adrenergic receptor blockade and beta-adrenergic receptor blockade in the preoperative period was discussed. Anaesthetic management of patients with phaeochromocytoma requires close monitoring. Virtually all inhalational anaesthetic agents have been used in cases of phaeochromocytoma. Recent reports have favored enflurane. The merits of neuroleptanaesthesia and the various muscle relaxants are also discussed. Most authors favour lidocaine over propranolol for management of dysrhythmias during operation. Phentolamine or sodium nitroprusside are used for hypertension during operation. Hypotension is treated by fluid replacement with nor-epinephrine if a vasopressor becomes necessary. Close monitoring is necessary in the postoperative period. Adequate urinary output is of more importance than actual blood pressure levels.

Adrenal Gland Neoplasms↗
PubMed1975

Palliation in the management of laryngeal cancer. Surgical concepts in palliation of advanced disease.

Every science has limits to its operation, including medical science concerning malignancy. Beyond a certain stage of a disease, palliation is the only recourse. The word "palliation" amounts to an acceptance of defeat by a clinician while trying to salvage his cancer patients. It means that the patient should breathe and eat without much pain till death takes pity on him. Palliative surgery in laryngeal cancer amounts to doing tracheostomies and gastrostomies and administering painkillers. Most of my cases belong to this category. I extended the accepted parameters of surgical excisions for primary lesion and metastatic nodes. These excisions include laryngectomy with cervical esophagectomy, total laryngectomy, total cervical esophagetomy, total glossectomy, and total mandibulectomy. The extended radical neck dissections include carotid artery, vagus nerve, and sympathetic trunk on one side. Removal of these so-called vital structures was not only compatible with life but proved curative in 20 per cent of these cases.

Anesthesia, Inhalation↗
PubMed1979

Neuroleptanesthesia for the guinea pig. An ideal anesthetic procedure for long-term physiological studies of the cochlea.

The guinea pig is notoriously difficult to anesthetize with conventional agents. Cardiorespiratory depression by general depressant anesthetic agents can render the cochlea abnormal. I report a technique that uses the specific neuroleptic and analgesia properties of the agents droperidol and phenoperidine, respectively, in combination with small doses of pentobarbital sodium, which is required only to produce unconsciousness. These agents can be given intraperitoneally, intramuscularly, or intravenously. The regimen allows performance of substantial surgery (including intracranial) and long-term (minimum, six to ten hours) physiological studies, such as those on the cochlea, with excellent cardiorespiratory stability. The method has been in continuous use in this laboratory since 1974 for single-fiber recordings from the cochlear nerve of normal and kanamycin-treated guinea pigs. This method has proved to be substantially more effective than use of pentobarbital, thiopental sodium, urethan, chloralose, or ketamine alone.

Animals↗
PubMed1976

Evaluation of lorazepam and pentobarbital as surgical premedicants.

Lorazepam, a new benzodiazepine, was compared with a standard surgical premedicant, pentobarbital. In a double-blind study in 128 patients, lorazepam, 2 and 4 mg, and pentobarbital, 50 and 100 mg, were given intravenously in a randomized sequence. Significant differences were noted; lorazepam was found to provide greater sedation, lack of recall, and greater antianxiety effect than pentobarbital. No significant adverse effects were noted following either drug. Vital signs remained stable.

Adolescent↗
PubMed1979

Morphine kinetics in children.

The kinetics of morphine in the plasma of children (0 to 15 yr) can in most cases be adequately described by a triexponential function. When the dosage in children receiving morphine as premedication before surgery is based on kilograms of body weight, there are only minor differences in the kinetic patterns of morphine at different ages (0 to 1, 1 to 7, and 7 to 15 yr). No significant difference in the morphine kinetics was observed between patients (7 to 15 yr) receiving the drug only as premedication and those who also received doses during surgery. The minimum morphine concentration in plasma necessary to suppress the clinical signs of pain during surgery was found to be 65 ng/ml (95% confidence limits of 46 to 83 ng/ml). Based on these minimum effective plasma levels of morphine, there does not seem to be any difference between children of different ages in their sensitivity to morphine. No difference was found in the minimum effective level of morphine when clinical signs of pain were observed by different anesthesiologists.

Adolescent↗