Premedication Research Articles

Comparison of Haemodynamic Response among Patients Posted for Laparoscopic Cholecystectomy with or without Oral Clonidine as Premedication- A Prospective Comparative Study

Background: Laparoscopic cholecystectomy is one of the most commonly performed surgeries and has now being recognized as the gold standard for the treatment of cholelithiasis. It is known fact that laparoscopy has several advantages due to creation of pneumoperitoneum during the surgical procedure which is responsible for several deleterious haemodynamic and cardiorespiratory changes. Thus, our present study was designed tostudy of haemodynamic response to oral clonidine as pre medication in laparoscopic cholecystectomy. Methods: In this prospective comparative study, 128 patients between the age group of 18-60 years, belonging to ASA 1 and ASA 2 categories scheduled for elective laparoscopic cholecystectomy under general anaesthesia were categorized into 2 groups as Group C and Group NC with 64 patients in each group. Patients in Group C received premedication with oral clonidine 150μg 90 minutes prior to surgery and Group NC did not receive oral clonidine 150μg. The two groups were compared with respect to heart rate, systolic and diastolic blood pressure and post operative complications. Results: There was significant increase in all the haemodynamic variables in group C as compared to group NC where the variables remained close to baseline while the patients in Group C showed less post operative complications as compared to NC group. Conclusion: Oral premedication with clonidine helps in blunting the haemodynamic response to pneumoperitoneum and also has less post operative complications.

Эффективность и безопасность премедикации современными α-2 агонистами в периоперационном периоде

α-2 адреномиметики обладают рядом фармакодинамических эффектов, таких как анксиолитический, симпатолитический, антиноцицептивный, которые полезны в анестезиологической практике. С другой стороны, их применение ограничено побочными эффектами: выраженной гипотензией и брадикардией, особенно при взаимодействии с анестетиками. На сегодняшний день в Украине доступны клонидин, известный давно, и дексмедетомидин — современный α-2 агонист. Изучены эффективность и безопасность премедикации дексмедетомидином в дозе 0,7 мкг/кг. Продемонстрированы положительные эффекты применения дексмедетомидина у пациентов с абдоминальной хирургической патологией.

EFFECT OF MODERN VERSUS STANDARD OF CARE ANTI-FAILURE MEDICATIONS ON LEFT VENTRICULAR FUNCTION IN HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION AS DETECTED BY2D SPECKLE TRACKING ECHOCARDIOGRAPHY

Background: Heart failure (HF) is a major and growing public health problem, as 21 million adults worldwide are living with heart failure and this number is expected to rise due to aging population, increasing prevalence of risk factors and improved post myocardial infarction (MI) survival. Objective: This study was discuss the effect of modern versus standard of care anti failure medications on LV function in heart failure patients with reduced ejection fraction using 2D speckle tracking echocardiography. Patients and methods: The study population includes 100 heart failure patients with reduced ejection fraction 50 on modern anti-failure medications including angiotensin receptor neprilysin inhibitor (ARNI) and 50 controls on standard anti-failure medications including angiotensin I-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs). All patients attended the outpatient clinic of the Cardiology Department at Al-Azhar University Hospital (Cairo) from March 2020 to March 2021. Results: There was no significant statistical difference between groups also regard sex distribution there was no significant difference between groups and male were majority in both groups. There was no significant difference between the two studied groups regarding levels of serum creatinine and serum K. Results of comparison of end systolic, end diastolic diameters of left ventricle and diameter of left atrium showed no significant difference between both groups at pre medication assessment but there was a highly significant after medications in both groups (p= 0.00, 0.038 and 0.035 respectively) also in group A there was a significant decrease from pre to post assessment (p=0.003, 0.012 and 0.004 respectively). There was a statistically significant improve in mitral regurgitation after medication in group A than in group B (p=0.00) but was of no significant in pre medication assessment (p=0.48). Conclusion: In HFrEF patients, sacubitril/valsartan significantly improves the mitral regurgitation LV remodeling and with a significant effect on LV diastolic and systolic echo parameters. Accordingly, sacubitril/valsartan could be used at an earlier time in HFrEF patients in order to further limit LV remodeling.

Oral premedication in children: A randomized study of a combination of oral midazolam, ketamine with atropine vs midazolam and atropine vs ketamine and atropine

Introduction: Premedication is widely used in pediatric anesthesia in order to provide sedation and anxiolysis. Aim of the study was to compare the effectiveness of combination of low dose oral midazolam and ketamine with oral midazolam or oral ketamine as premedication. Materials and Methods: 150 childrens between ages 2 and 10 were divided into 3 groups of 50 members each. They received either combination of oral midazolam 0.5 mg/kg and oral ketamine 3mg/kg or oral midazolam 0.5 mg/kg or oral ketamine 6 mg /kg as pre medication. Premedication was given 30 minutes before the induction of anesthesia. Patients also received oral atropine 0.02mg/kg along with the study drug. Sedation and anxiolysis were assessed before giving premedication and at an interval of 10 minutes, 20 minutes and 30 minutes after premedication. Behavior at separation from parents and acceptance or response to venipuncture was also assessed at the end of 30 minutes. Statistical analysis was performed using SSPE computer software version 16. Groups are compared using chi square tests. Result: We found that oral combination of midazolam 0.5 mg/kg and ketamine 3 mg/kg with atropine 0.02mg/kg offered better sedation [96% children], anxiolysis [76% children], acceptance of parentral separation [80% children] and comfortable venous cannulation [84% children]. We conclude that Combination of oral ketamine, midazolam and atropine is a superior premedicating agent than using these drugs individually. Keywords: Ketamine, Midazolam, Premedication, Pediatric

A comparative study of efficacy and safety of oral ketamine and oral midazolam as premedicant for paediatric cardiac catheterization

Use of an effective sedative premedicant significantly minimizes the emotional trauma associated with perioperative anxiety and its sequelae. Currently, oral midazolam is the most commonly used premedicant in most of the countries followed by oral ketamine. Aims and Objectives: To compare the efficacy and safety of oral ketamine and oral midazolam as premedicant for paediatric cardiac catheterization. Materials and Methods: This study was carried out in the tertiary care centre in sixty patients randomly assigned into two groups of thirty patients each, to compare the efficacy of oral ketamine and oral midazolam pre medication as sedative for paediatric patients undergoing cardiac catheterization using various parametes and observation scale of response and Visual Analogue scale. Data collected was analysed and the statistical significance of these intra-group and inter-group observations thus made was determined using either a ‘Chi Square test’ or an ‘Unpaired T-test’ or Mann whitney test. Results: The demographic trends in all the groups were comparable. The type of procedure performed were also comparable in both the groups. The mean heart rate, mean systolic and diastolic blood pressures, mean arterial blood pressure were higher in the ketamine group than in the midazolam group. Though there was fall in oxygen saturation in both the groups the ketamine group required oxygen supplementation more than midazolam group though it was statistically insignificant. The mean onset of sedation was earlier for midazolam than for ketamine. Also the parental separation was smoother and calmer in patients who had oral midazolam than oral ketamine. Similarly while positioning the children for cath study also patients medicated with midazolam showed better response than those medicated with ketamine. The response to local anaesthetic injection during femoral vessels cannulation also showed midazolam with better results. The adverse effects such as secretions, nystagmus,

Injection ranitidine induced death

Ranitidine is a histamine-2-receptor antagonist. It was a commonly used drug. It holds excellent safety record. Anaphylactic reactions to ranitidine is uncommonly encountered. Death due to ranitidine is extremely a rare event and very few cases are reported world-wide. Clinical history, Lab investigations and histological data of a 43-Years old woman with negative history of allergic events, who died suddenly after the intra-venous administration of 50mg of intravenous ranitidine which was prescribed as a routine pre medication prior hysterectomy is presented below. Though the incidence of anaphylactic reactions is less with ranitidine, precautions to be taken prior administration of the drug and when such an event is encountered it should be promptly managed.

COMPARISON OF ORAL PREMEDICATION IN CHILDREN (1-16YRS) USING MIDAZOLAM VERSUS CLONIDINE: A PROSPECTIVE DOUBLE BLIND STUDY

Background Premedication in pediatric anesthesia is a challenge for Anesthesiologist. Anxious children have higher incidence of negative postoperative behaviors for up to two weeks after surgery. Hence, right premedication is the eternal search for anesthesia fraternity. Aims and Objectives To compare oral midazolam (0.5mg/kg) with oral clonidine (4 micrograms/kg) as a pre medication in children Material & Methods This study was carried out on 30 children who were admitted to Yenepoya Medical College & Hospital for surgical intervention under general anaesthesia during the period from 01-10-2009 to 30-11-2011. Result In the midazolam group the sedation score after 30 mins and 90 mins, 80% of the subjects were awake . In the Clonidine group it was found that 66.7% are drowsy at 30 mins and 70% are drowsy at 90 mins. The difference between to the groups was statistically highly significant. In the midazolam group parental separation were good only in 56% of the subjects where as it was 93.3% in the Clonidine group which is statistically highly significant. In the midazolam group the mask acceptance was good in 86.7% of the subjects . In the Clonidine group 100% of the subjects had good acceptance. Conclusion Present study showed that premedication oral clonidine appeared to superior than oral midazolam.Oral clonidine produces significantly better sedation than oral midazolam

Association between dexamethasone treatment and alterations in serum concentrations of trace metals.

Previously, a significant elevation in the serum levels of iron (Fe) was observed within a few days after the initiation of cisplatin (CDDP)-based chemotherapy. To clarify the underlying mechanisms, the serum concentration of hepcidin, a negative regulator of Fe release, was determined in the clinical samples obtained from six patients with cancer. The result showed that the serum concentration of hepcidin in patients receiving CDDP-based chemotherapy was significantly increased after 4-6 days of treatment, in comparison to the baseline level, suggesting that aforementioned excessive systemic Fe was not explained by the change of serum hepcidin level. All these patients received antiemetic premedication. We next evaluated of the effects of Pt-containing drugs and prophylactic antiemetic dexamethasone medication on the serum concentration of trace metals in mice, and on the hepatic and renal concentration of trace metals. The serum concentrations of Fe, Cu, and Zn in the CDDP-treated and oxaliplatin-treated mice were not significantly altered in comparison to those of the vehicle-treated control group. The serum concentrations of Fe, Cu, and Zn were increased after 24 h of dexamethasone treatment, compared to those of the control group (P < 0.05). The hepatic concentration of Mn was significantly reduced, whereas those of Fe and Cu inclined to diminish. The present findings suggest that dexamethasone can partly contribute to the changes in the serum concentrations of trace metals during anticancer chemotherapy.

Kedi ve Köpeklerde Sezaryen ve Piyometra Operasyonlarında Anestezi Teknikleri

Veteriner doğum ve jinekolojide sıklıkla uygulanan sezaryen ve piyometra operasyonlarında hem hastanın ağrı ve acı hissini ortadan kaldırmak hem de hekim ve yardımcılarının güvenliğini sağlamak amacıyla anestezik maddeler kullanılmaktadır. Sezaryen ve piyometra operasyonlarında yapılan premedikasyon, preoperatif dönemde yapılacak intravenöz kateterizasyon ve oksijenizasyon sırasında annede oluşabilecek stres ve kaygıyı önler. Bununla birlikte dengeli ve etkili bir premedikasyon, indüksiyon için kullanılacak anestezik madde miktarının azalmasına neden olur. İndüksiyon için sedatif-hipnotik (tiyopental, propofol, alfaksalon, etomidat), dissosiyatif (Ketamin HCL) ve inhalasyon ajanlar (izofluran, sevofluran, desfluran) sıklıkla kullanılmaktadır. Gebe hayvanlarda kullanılacak anestezik ve analjezik maddeler fiziko-kimyasal özellikleri nedeniyle etkilerini kan-beyin bariyerini geçerek gösterir. Bu durum anestezik maddelerin, plasental bariyeri de kolayca geçerek fetüs üzerinde olumsuz etkiler görülmesine yol açar. Yavruları etkilemeden sadece anneyi anesteziye alabilecek bir protokol yoktur. Bu nedenle hem anneyi hem de yavruyu en az şekilde etkileyen bir anestezi protokol seçilmelidir. Piyometralı hayvanlarda ise başlıca; böbrek yetmezliği, kardiyak aritmi ve hepatik işlev bozukluğu gözlendiğinden, bu sorunlara karşı uygun anestezi protokolü seçilmelidir. Bu derleme sezaryen ve piyometra operasyonlarına alınacak hastalarda kullanılabilecek güvenli ve etkili anestezik maddeler ve anestezi protokolleri hakkında bilgi vermek amacıyla hazırlanmıştır.

Comparison of intranasal midazolam versus intranasal ketamine for preoperative anesthetic sedation in pediatric patients

Introduction: During induction of anesthesia anxiety of children may be reduced more effectively by sedative medication than parental presence. Keeping in view, the necessity of reducing preoperative anxiety and postoperative psychological problem in pediatric patients, this study was conducted to compare the efficacy and safety of intranasal midazolam versus intranasal ketamine for preanesthetic sedation in pediatric patients. Methods: Ninety patients scheduled for the surgery lasting between 30 min and 120 min under general anesthesia were randomly divided into two groups: Group A patients received intranasal midazolam 0.2 mg/kg as premedication (5 mg/mL ampoule), whereas Group B patients received intranasal ketamine 5 mg/kg as premedication (50 mg/mL vial). The primary outcome measures were the comparison of degree of sedation of intranasal midazolam versus intranasal ketamine for preanesthetic sedation in pediatric patients by accessing parental separation, acceptance of face mask, venipuncture score, and postoperative sedation, whereas the secondary outcome measures were the comparison of side effects. The comparison of quantitative and qualitative variables between the groups was done using the unpaired student's “t”-test and Chi-square test or Fisher's exact test, respectively. Results: The percentage of patients in the ketamine group with parental separation score more than 2 was significantly higher as compared to the midazolam group. Acceptance of face mask, response to venipuncture, postoperative sedation, and postoperative side effects were comparable between the two groups. Both groups have minimal side effects. Conclusions: Both midazolam and ketamine nasally are an effective pediatric premedication for sedation with minimal side effects. Parental separation was better in the ketamine group as compared to the midazolam group.

Applications of dexmedetomidine by nasal spray during pediatric anesthesia

Dexmedetomidine (DEX ) is an α2 adrenalin-receptor agonist with potent sedation, analgesia, anti-anxiety and anti-sympathetic effect. Moreover, DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect. Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state. Thus, an ideal pediatric anesthetic premedication is getting a lot of attention. DEX is superior to other premedication in sedation with high safety. Compared with others, DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug. The relevant research progress of the effective dose, efficacy and safety will be reviewed. Key words: Dexmedetomidine; Administration, intranasal; Anesthesia; Child; Review

Impact of Premedication on Anxiety

Impact of Premedication on Anxiety

Research progress of less invasive surfactant application in premature infants with respiratory distress syndrome

Intratracheal surfactant administration is the only specific treatment for respiratory distress syndrome and usually requires endotracheal intubation, positive pressure and/or mechanical ventilation which are harmful to the immature lung.One of these alternative methods is less invasive surfactant application (LISA) via a thin endotracheal catheter during spontaneous breathing with continuous positive airway pressure.Use of LISA allows administration of surfactant while avoiding intubation and positive pressure.Observational studies have fostered expectations of a positive effect of LISA on serious complications of preterm infants and the need for mechanical ventilation.However, there is still a controversy about indications, premedication and serious complications of preterm infants while using LISA.This article reviews the controversies of LISA technology in preterm infants with respiratory distress syndrome. Key words: Less invasive surfactant application; Respiratory distress syndrome; Pulmonary surfactant; Endotracheal intubation; Infant, premature; Mechanical ventilation; Serious complications

Premedication with intravenous steroids does not influence the incidence of infusion reactions following infliximab infusions in pediatric inflammatory bowel disease patients\u2014a case-control study

PurposeInfusion reactions (IR) are commonly described side effects of infliximab (IFX) infusions, often leading to discontinuation of IFX. This study aimed to investigate the influence of steroid premedication (PM) on incidence of IR in pediatric inflammatory bowel disease (PIBD) patients receiving IFX.MethodsA case-control study in two tertiary centers in Amsterdam, The Netherlands, including PIBD patients receiving IFX. PM with steroids was part of standard care in one center (PM+) but not in the other center (PM−). Acute IR were divided into mild/severe reactions and in grade 1/2/3/4 for detailed exploration. Differences between subgroups were assessed with the T or chi-square test. Multivariate logistic regression was used to assess associations between PM and IR incidence, correcting for co-medication usage.ResultsWe included 226 patients (91 PM+, 50% male, mean age at onset of IBD 12.7 years), receiving 3433 infusions. There was no difference between the PM+ and PM− subgroups in incidence of IR (14.3% vs. 17.0% of patients, p = 0.58) and in percentage of infusions followed by IR (1.4% in both subgroups). The OR of developing IR when using PM was 1.06 (95% CI 0.49–2.27, p = 0.89), and the OR of developing a grade 3 or 4 IR when using PM was 0.90 (95% CI 0.24–3.39, p = 0.88) when correcting for co-medication usage.ConclusionThe incidence of IR was low, and premedication with steroids did not decrease the incidence of IR in this cohort of PIBD patients receiving IFX. Our results indicate that PM with steroids is not indicated in PIBD to prevent IR.

A Prospective Evaluative Study between Low Dose Ketamine and Fentanyl as Pre Medication for Alleviation of Propofol Injection Pain

A Prospective Evaluative Study between Low Dose Ketamine and Fentanyl as Pre Medication for Alleviation of Propofol Injection Pain

Midazolam or haloperidol premedication reduced ketamine-induced recovery agitation and increased ED recovery time.

Source Citation Akhlaghi N, Payandemehr P, Yaseri M, Akhlaghi AA, Abdolrazaghnejad A. Premedication with midazolam or haloperidol to prevent recovery agitation in adults undergoing procedural sedat...

Timing May Influence the Pharmacodynamics of Atropine as Pre-Medication.

Timing May Influence the Pharmacodynamics of Atropine as Pre-Medication.

Comparative efficacy and safety of intra-nasal dexmedetomidine and oral midazolam as pre medication in children undergoing minor elective surgical procedures: Results of a randomized, double blind trial

Comparative efficacy and safety of intra-nasal dexmedetomidine and oral midazolam as pre medication in children undergoing minor elective surgical procedures: Results of a randomized, double blind trial

Transfusion Practices Among Hematology/Oncology Healthcare Professionals

Introduction/Background:There are no evidence-based guidelines for optimal transfusion practices for patients undergoing chemotherapy and stem cell transplant. There are minimal low-quality studies regarding transfusion thresholds as well as the efficacy of pre-transfusion medications (to reduce febrile non-hemolytic transfusion reactions) for these patients. To pursue a prospective quality improvement study, it is important to know the current transfusion standards used by practitioners regarding: 1) transfusion thresholds for platelets and red blood cells and 2) routine use of pre medications prior to transfusions. Additional research questions included differences in the above standards by region or by pediatrics vs. adult providers.Study Design and Methods:Expedited IRB approval was obtained. We conducted a REDCap survey from 3/1/18-4/12/18 targeting hematology oncology providers of both pediatric and adult providers. The survey was emailed through multiple databases with members form several countries that included both adult and pediatric hematology/oncology practitioners.Results:One hundred and nineteen hematology/oncology practitioners completed the survey: 94 attending physicians, 19 fellows and 6 nurse practitioners. Most respondents practiced in United States (90 %, 107/119), the rest practiced in Canada, India, Italy and Iran. The majority of participants were pediatric hematology/oncology providers (84 %, 100/119). Of the remaining providers 10 treated only adults and 9 treated both adults and children. The vast majority (97%, 115/119) of participants did not utilize a standard policy for premedication prior to red blood cell transfusions. Similarly, 95 % (111/117) or participants made individual decisions on premedication with platelet transfusions rather than using an institutional policy. When asked about the threshold to transfuse blood products, 71% (75/105) of those who treated patients undergoing chemotherapy said they would transfuse red blood cells when patients had a hemoglobin of</= 7 g/dL, and 79% (82/104) would transfuse platelets when patients had a platelet count <10 K/mL. Practitioners treating bone marrow transplant (BMT) patients had more variability and used higher transfusion thresholds. Fifty-two percent (33/64) of them would transfuse red blood cells for patients undergoing BMT with a higher threshold of hemoglobin of 8 g/dL while only 36% used the lower threshold of 7 g/dL. Similarly, for platelet transfusions for patients undergoing BMT, 47% (31/66) would use a 20K/mL threshold, and 45% would transfuse platelets at a threshold of 10 K/mL.Conclusion:There is currently no routine practice of utilizing pre-medications prior to transfusions of red blood cells or platelets. Instead, practitioners surveyed indicated a preference for individualizing the use of pre-medications only if patients had a previous transfusion reaction. As the use of these medications is not evidence-based, additional studies are needed to determine their efficacy. Transfusion thresholds are relatively consistent among providers with the majority aiming for more liberal thresholds in patients undergoing chemotherapy and more conservative for those undergoing BMT. More studies are needed to evaluate the risks and benefits of using different transfusion thresholds. [Display omitted] DisclosuresKanter:Sancilio: Research Funding; ASH: Membership on an entity's Board of Directors or advisory committees; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Research Funding; Apopharma: Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Pfizer: Research Funding.

Preanesthesia Premedication

Preanesthesia Premedication