[Rectal administration of barbiturates in anesthesia in labor].
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In the study, the authors evaluated the concentration of rectal methohexital (1% vs 10%) and the length of the rectal catheter (3.8 vs 12.7 cm), on sleep-success rate, administration-sleep time, methohexital plasma concentrations, and recovery time in 85 healthy children scheduled for elective ophthalmic or ear, nose, or throat operations lasting approximately 1 h. At a dose of 25 mg/kg, the 1% solution of rectal methohexital was associated with a significant (P less than 0.05) higher sleep-success rate (95% vs 70%), shorter administration-sleep time (5.7 +/- 1.9 vs 7.0 +/- 2.0 min), higher methohexital plasma concentrations at 20 min (6.5 vs 4.7 ng/mL) and at 30 min (5.3 vs 3.7 ng/mL), and prolonged recovery time (53.2 +/- 31.1 vs 32.4 +/- 18.5 min). The length of the rectal catheters did not significantly affect sleep-success rate, administration-sleep time, methohexital plasma concentrations, or recovery time. The use of 25 mg/kg of 1% rectal methohexital solution to induce anesthesia in children is superior to the use of 25 mg/kg of 10% methohexital solution for induction of anesthesia in children, particularly in operations 1 h or longer in duration.
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Fifteen healthy children 2-10 years old and scheduled for elective surgery, received midazolam 0.35 mg/kg body weight and atropine 0.025 mg/kg as rectal premedication about 35 min before the induction of anesthesia. The induction itself was carried out in a separate and quiet room next to the operating theatre by rectal administration of ketamine 10 mg/kg and midazolam 0.2 mg/kg. With the children breathing spontaneously, anesthesia was maintained by repetitive i.v. bolus injections of ketamine. The sedative and anticholinergic effects of the premedication were satisfactory. Induction of anesthesia was smooth. Consciousness was lost after 9-15 (mean 13) min. No significant adverse effects on hemodynamics or respiration were noted. Recovery from anesthesia was uneventful. No cases of rectal irritation or unpleasant dreams were reported. Post-operative analgesia was good. In conclusion, rectal administration of midazolam and atropine for premedication, followed by ketamine and midazolam for the induction of anesthesia, proved to be a pleasant, safe, and reliable method in pediatric anesthesia.
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