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PubMed1992

Efficacy of rectal ibuprofen in controlling postoperative pain in children.

The efficacy of ibuprofen with scheduled administration, starting preoperatively, for postoperative pain was studied in 128 boys and girls, 4 to 12 yr old, having elective surgery. In a double blind placebo-controlled study, rectal ibuprofen (40 mg.kg-1.day-1 in divided doses) or placebo was given for up to three days. For two hours after surgery heart rate, blood pressure and respiratory rate were recorded every 15 min together with sedation scores and pain scores, as assessed by an observer and the patient. Morphine was given to all children, 0.1 mg.kg-1 iv or 0.15 mg.kg-1 im according to clinical needs. Every morning on the ward the patients were interviewed about the efficacy of the analgesic treatment. All unwanted effects were registered. In the recovery room the heart rate was lower (P less than 0.05) and the patient's pain scores were less (P less than 0.05) in the ibuprofen group. After orthopaedic operations children needed more opioid than after ophthalmic or general surgical procedures (P less than 0.001). However, after all operations the need for additional morphine was less in the recovery room (P less than 0.05), during the day of operation (P less than 0.01) and during the three-day study period (P less than 0.01) in children receiving ibuprofen. On the day of operation the analgesic therapy was considered to be good or very good by 44/53 and 32/49 of the children in ibuprofen and placebo groups, respectively (P less than 0.05). Later, their assessments did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Rectal↗
PubMed1989

Ketamine: an update on the first twenty-five years of clinical experience.

In nearly 25 years of clinical experience, the benefits and limitations of ketamine analgesia and anaesthesia have generally been well-defined. The extensive review of White et al. and the cardiovascular review of Reves et al. are broad in their scope and have advanced the understanding of dissociative anaesthesia. Nevertheless, recent research continues to illuminate different aspects of ketamine pharmacology, and suggests new clinical uses for this drug. The identification of the N-methylaspartate receptor gives further support to the concept that ketamine's analgesic and anaesthetic effects are mediated by separate mechanisms. The stereospecific binding of (+)ketamine to opiate receptors in vitro, more rapid emergence from anaesthesia, and the lower incidence of emergence sequelae, make (+)ketamine a promising drug for future research. Clinical applications of ketamine that have emerged recently, and are likely to increase in the future, are the use of oral, rectal, and intranasal preparations for the purposes of analgesia, sedation, and anaesthetic induction. Ketamine is now considered a reasonable option for anaesthetic induction in the hypotensive preterm neonate. The initial experience with epidural and intrathecal ketamine administration has not been very promising but the data are only preliminary in this area. The use of ketamine in military and catastrophic settings is likely to become more common. The clinical availability of midazolam will complement ketamine anaesthesia in several ways. This rapidly metabolized benzodiazepine reduces ketamine's cardiovascular stimulation and emergence phenomena, and does not have active metabolites. It is dispensed in an aqueous medium, which is usually non-irritating on intravenous injection, unlike diazepam. The combination of ketamine and midazolam is expected to achieve high patient acceptance, which never occurred with ketamine as a sole agent. Finally, it is necessary to point out the potential for abuse of ketamine. While ketamine is not a controlled substance (in the United States), the prudent physician should take appropriate precautions against the unauthorized use of this drug.

Administration, Rectal↗
PubMed1993

Comparison of rectal midazolam and diazepam for premedication in pediatric dental patients.

Rectally administered midazolam (0.35 mg/kg) and diazepam (0.70 mg/kg) were compared with each other and with placebo for preanesthetic medication in children undergoing dental extractions. All rectal medications were very well accepted, but mask acceptance, improvement in anxiety, and sedation were best in the midazolam group. Improvement in anxiety and sedation were significantly better in the two drug groups than in those patients who had received placebo. Thirty minutes after rectal administration of midazolam, patients showed a decrease in both systolic and diastolic blood pressure and heart rate. Although these decreases differed significantly from the premedication values, they were probably of little clinical importance. Only minor adverse effects were observed in this study. Overall rectally administered midazolam appeared to be somewhat more efficacious than diazepam.

Administration, Rectal↗
PubMed1984

[Premedication using intrarectal midazolam. Study of effective dosage in pediatric anesthesia].

The object of this study was to determine the optimal dose of midazolam given per rectum which would produce sedation adequate for inducing inhalational anaesthesia in paediatric practice. Five doses were studied: 0.15, 0.25, 0.30, 0.35 and 0.40 mg X kg-1. The criteria used to appreciate the effectiveness of the sedation at 30 min were the change in the child's behaviour, with a scale of 6 levels, and the acceptance of the mask and anaesthetic vapours. There was a significant correlation between the dose administered and the degree of sedation, as well as between the dose administered and the lack of reaction to the mask. Significantly better results were found with the higher doses of 0.35 and 0.40 mg X kg-1, when compared with the children who had received 0.15 and 0.25 mg X kg-1. Only in the groups who received 0.35 and 0.40 mg X kg-1 were the degrees of sedation and acceptance of induction considered as adequate. The dose of 0.35 mg X kg-1 seemed to be the best dose for adequately premedicating a child.

Age Factors↗
PubMed2000

Anaesthesia with midazolam and S-(+)-ketamine in spontaneously breathing paediatric patients during magnetic resonance imaging.

We evaluated safety and efficacy of a sedation technique based on rectal and intravenous S-(+)-ketamine and midazolam to achieve immobilization during Magnetic Resonance Imaging (MRI). Thirty-four paediatric patients were randomly assigned to undergo either the sedation protocol (study group) or general anaesthesia (control group). Imaging was successfully completed in all children. Children in the study group received a rectal bolus (0.5 mg x kg(-1) midazolam and 5 mg x kg(-1) S-(+)-ketamine) and required additional i.v. supplementation (20+/-10 microg x kg(-1) x min(-1) S-(+)-ketamine and 4+/-2 microg x kg(-1) x min(-1) midazolam), spontaneous ventilation was maintained. Transient desaturation occurred once during sedation and four times in the control group (P=0.34). PECO2 was 5.3+/-0.5 kPa (40+/-4 mm Hg) in the study group and 4.1+/-0.6 kPa (31+/-5 mm Hg) in the control group (P<0.001). Induction and discharge times were shorter in the study group (P<0.001), recovery times did not differ significantly between the groups. Our study confirms that a combination of rectal and supplemental intravenous S-(+)-ketamine plus midazolam is a safe and useful alternative to general anaesthesia for MRI in selected paediatric patients.

Administration, Rectal↗
PubMed1998

Acceptance of dental care following early extractions under rectal sedation with diazepam in preschool children.

The aim of the study was to evaluate the effect of amnesia in preschool children on their later acceptance of dental care. Forty-six 4-6-year-old children, who between 2 and 4 years previously had had primary incisors extracted because of trauma, were reexamined for dental health and acceptance of dental care. The extractions had been performed under rectal sedation with diazepam (0.7 mg/kg body weight). Information about dental treatment and degree of cooperation during the intervening period was obtained from records at the referring clinic. The parents were interviewed about their child's experience of amnesia concerning the extractions, background variables, and experiences of dental care before the follow-up examination. Amnesia concerning the extractions was reported in 85% of the children. Twenty-nine percent had on some occasion exhibited behavior management problems (BMP) during the intervening period. Lack of amnesia was significantly associated with BMP (P< 0.002). Children without amnesia concerning the extractions tended to accept dental care less well at the reexamination. Parents were able to predict their child's acceptance of dental care at the follow-up with a significant degree of success (P= 0.02). In conclusion, amnesia in preschool children concerning extractions seems to be essential to facilitate positive acceptance of future dental care.

Administration, Rectal↗
PubMed1987

Pharmacokinetics of i.v. and rectal methohexitone in children.

The pharmacokinetics of methohexitone were investigated in 15 healthy children undergoing minor surgery under inhalation anaesthesia. Six received 1% methohexitone 1-2 mg kg-1 i.v. and nine received 10% methohexitone 20-25 mg kg-1 per rectum. On i.v. administration, three-compartment pharmacokinetics generally applied. The mean elimination half-life of methohexitone was 193 +/- 75 min; that is, considerably longer than previously reported for children, but in good agreement with findings in adults. The mean clearance was 17.9 +/- 8.3 ml min-1 kg-1, the volume of distribution at steady state was 2.1 +/- 0.24 litre kg-1 and the mean residence time was 134 +/- 47 min. The pharmacokinetic model used for the i.v. data was easily modified to suit the plasma concentration curves obtained on rectal administration. The mean bioavailability of methohexitone administered per rectum was 17%, with a six-fold variation between individuals.

Administration, Rectal↗
PubMed1990

Oxygen saturation during inhalation induction with halothane and isoflurane in children: effect of premedication with rectal thiopentone.

Anaesthesia was induced by inhalation in 100 children using nitrous oxide in oxygen supplemented by either halothane or isoflurane, with or without rectal thiopentone premedication. Respiratory problems occurred more frequently in the unpremedicated isoflurane group, resulting in significant reductions in oxygen saturation. Premedication reduced the frequency of these complications, and oxygen saturation was usually maintained.

Administration, Rectal↗
PubMed1993

Plasma concentrations of midazolam after i.v., nasal or rectal administration in children.

Midazolam is used frequently for premedication in children, preferably by non-parenteral administration. We have compared plasma concentrations of midazolam after nasal, rectal and i.v. administration in 45 children (aged 2-9 yr; weight 10-30 kg) undergoing minor urological surgery. General anaesthesia consisted of spontaneous respiration of halothane and nitrous oxide in oxygen via a face mask. After administration of atropine and fentanyl i.v., children were allocated randomly to receive midazolam 0.2 mg kg-1 by the nasal, rectal or i.v. route. In the nasal group, children received 50% of the dose of midazolam in each nostril. In the rectal group, midazolam was given rectally via a cannula. Venous blood samples were obtained before and up to 360 min after administration of the drug. Plasma concentrations of midazolam were measured by gas chromatography and electron capture detection. After nasal and rectal administration, midazolam Cmax was 182 (SD 57) ng ml-1 within 12.6 (5.9) min, and 48 (16) ng ml-1 within 12.1 (6.4) min, respectively. Rectal administration resulted in smaller plasma concentrations. In the nasal group, a plasma concentration of midazolam 100 ng ml-1 occurred at about 6 min. After 45 min, the concentration curves after i.v. and nasal midazolam were similar.

Administration, Intranasal↗
PubMed2004

Ketamine and midazolam for invasive procedures in children with malignancy: a comparison of routes of intravenous, oral, and rectal administration.

We investigated the efficacy of a combination of ketamine and midazolam, comparing intravenous, oral, and rectal administrations for invasive procedures in children with malignancy. Seventy-three children under 5 years of age, who were scheduled for invasive procedure, were assigned to one of three groups: IV group (n = 25), ketamine 1 mg/kg and midazolam 0.05-0.1 mg/kg were given intravenously; PO group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg were given orally; and PR group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg given rectally. Vital signs including blood pressure, pulse rate, respiratory rate, and oxygen saturation were monitored, and patients were observed for side-effects. Optimal sedation (drowsy and asleep) was provided in 78 per cent of all patients and no statistical difference was observed among the three groups. No severe complications were observed in all groups. Recovery time from sedation was significantly longer in the intravenous group (>120 min in two patients). Hallucination was noted in three (12 per cent) patients given intravenous medication, but not in those given oral or rectal medications. It is concluded that intravenous, oral, and rectal midazolam/ketamine are equally effective for invasive procedures in children with malignancy. The use of intravenous ketamine/midazolam may produce prolonged sedation and psychedelic effects in children. These adverse effects may alter the child's comfort and parental satisfaction.

Administration, Oral↗
PubMed1986

Nikolai Ivanovich Pirogoff.

A short description of the life of Nikolai Ivanovich Pirogoff and some of his accomplishments are given. His book on administration of ether for anaesthesia (analgesia) by inhalation and by rectum is of special interest. In this book he also describes his experiments, mainly on dogs, with all kinds of administration. He was one of the first to write a book on ether and also to utilise anaesthesia under war conditions. Later he tended to favour chloroform, which he considered to be better. He accomplished a lot in life and was highly regarded at home and abroad.

Anesthesia, Inhalation↗
PubMed1995

Premedication with midazolam in children. Effect of intranasal, rectal and oral routes on plasma midazolam concentrations.

We report a study performed to compare the time and plasma drug concentrations necessary to achieve a similar state of sedation after midazolam premedication given by various routes in children of 2-5 years old. Children were randomly allocated to one of three groups to receive midazolam 0.2 mg.kg-1 given intranasally, 0.5 mg.kg-1 given orally or 0.3 mg.kg-1 given rectally. Sedation was measured regularly until venepuncture was possible in a cooperative child. At this time, a first blood sample was taken to measure plasma concentration, followed by another 10 min later. Anaesthesia consisted of intravenous propofol supplemented with regional analgesia. At recovery from anaesthesia, a third blood sample was taken. Adequate sedation occurred sooner (7.7, SD 2.4 min) with intranasal than oral (12.5, SD 4.9 min) or rectal (16.3, SD 4.2 min) midazolam. The initial blood levels were lower when the drug was given by the alimentary routes despite higher doses (146, SD 51 ng.ml-1 in 11.5, SD 3.9 min; 104, SD 34 ng.ml-1 in 21 +/- 6 min; and 93, SD 63 ng.ml-1 in 23.1, SD 3.5 min for the intra nasal, rectal and oral routes respectively). Duration of surgical procedures, and of propofol infusion, and recovery from anaesthesia was similar for the three groups. The only problem arose in a 30-month-old boy in the intranasal group who developed respiratory depression with a plasma midazolam concentration of 169 ng.ml-1. Intranasal midazolam is an excellent alternative for rapid premedication provided that respiratory monitoring is used.

Administration, Intranasal↗
PubMed1987

Effects of rectal thiopentone and methohexitone on carbon dioxide tension in infant anaesthesia with spontaneous ventilation.

The influence of rectal administration of barbiturates on PCO2 during mask anaesthesia with spontaneous ventilation was studied in 72 infants. The age of the patients ranged between 6 and 24 months and they were all subjected to minor paediatric surgery. The patients were divided into four equally large groups: a control group receiving no premedication, a group receiving rectal thiopentone 30 mg X kg-1 and two groups receiving methohexitone either 20 or 30 mg X kg-1. In all patients PCO2 was measured in an arterialized capillary blood sample obtained during stable anaesthesia with oxygen, nitrous oxide and halothane before and after surgery. After rectal induction with barbiturates, the mean PCO2 was significantly higher in the different barbiturate groups than in the control group (P less than 0.05). The mean PCO2 value +/- s.d. in kPa for the control group was 5.6 +/- 0.7, for the group receiving thiopentone 30 mg X kg-1 6.5 +/- 1.6, for the groups receiving methohexitone 20 or 30 mg X kg-1 6.1 +/- 1.2 and 6.3 +/- 1.1, respectively. It is concluded that the combination of rectal induction with barbiturates and mask anaesthesia with oxygen, nitrous oxide and halothane carries an increased risk of hypoventilation in infants under 2 years of age.

Administration, Rectal↗
PubMed1988

Comparison of rectal to intramuscular administration of midazolam and atropine for premedication of children.

The effectiveness of midazolam and atropine as anaesthetic premedication was investigated, comparing rectal to intramuscular administration. A total of 202 children varying in age from 10 months to 9 years, who had been admitted to the Day Surgery Department for short ENT procedures, were assigned to one of two groups on a random basis. The first group (n = 102) was given 0.5 mg/kg midazolam and 0.05 mg/kg atropine as a rectal solution 30 to 75 min prior to induction, while the second group (n = 100) was given 0.15 mg/kg midazolam and 0.02 mg/kg atropine as an intramuscular injection 20 to 60 min prior to induction. The levels of sedation and salivation were compared, as was the degree of tolerance to intravenous induction. The parents of children older than 3 years of age were given a questionnaire designed to determine the degree of amnesia. We found this combination of drugs to be effective in the relief of anxiety, the inhibition of salivary secretion and the promotion of memory loss, regardless of the route of administration. We feel that rectal administration is preferable because it is not associated with pain or anxiety.

Administration, Rectal↗
PubMed1990

Rectal flunitrazepam as premedication in preschool children. A double-blind randomized study.

The efficacy of flunitrazepam (0.04 mg.kg-1) as a premedicant was evaluated in 40 young children of less than 5 years of age in a double-blind, placebo-controlled study. Flunitrazepam was given by the rectal route 15 min prior to an inhalational mask induction with halothane. Sedation score, mask acceptance and induction score were significantly better in premedicated children than in the placebo group. There were no hypoxic episodes, prolonged sedation or other complications in either group. This suggests that flunitrazepam administered rectally in a low dose is an acceptable premedication in young children.

Administration, Rectal↗
PubMed1988

Sleep effect of rectal methohexitone (10 mg/kg) in children premedicated for anaesthesia.

Methohexitone (10 mg/kg) was administered before 464 general anaesthesias for 317 children following intramuscular atropine and pethidine for various ophthalmological procedures. Approximately 70% of the children were asleep when anaesthesia was continued or started, usually with halothane in nitrous oxide and oxygen. Although the dose of methohexitone used here was smaller than that recommended in the literature, the results of the study did not greatly differ from earlier investigations in which no other premedication was given but where 20 mg/kg methohexitone was used.

Administration, Rectal↗