BACKGROUND: Dexmedetomidine is an alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties. This study was designed to evaluate the inhibitory effects of preoperative administration of 0.5 µg/kg dexmedetomidine on hemodynamic responses caused by endotracheal intubation in elderly patients undergoing treatment for hypertension. METHODS: Forty elderly (≥ 65 years old) patients who had been receiving hypertension treatment, had American Society of Anesthesiologists physical status II, and were scheduled to undergo elective noncardiac surgery were randomly selected and assigned to 2 groups. Group C received normal saline and group D received 0.5 µg/kg dexmedetomidine intravenously over 10 min just before endotracheal intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded preoperatively in the ward, immediately after study drug administration, and at 1, 3, and 5 min after endotracheal intubation. RESULTS: Compared to group C, group D showed significantly lower SBP and MAP at 1, 3, and 5 min as well as significantly lower DBP and HR at 3 and 5 min after endotracheal intubation. CONCLUSIONS: In elderly patients receiving hypertension treatment, a single preanesthetic dose of dexmedetomidine (0.5 µg/kg) effectively suppressed the hemodynamic responses to endotracheal intubation.
Adrenergic Agonists ; Aged* ; Arterial Pressure ; Blood Pressure ; Dexmedetomidine* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Intubation ; Intubation, Intratracheal* ; Preanesthetic Medication

INTRODUCTIONPain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions.

METHODSThis randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores.

RESULTSMaximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores.

CONCLUSIONMelatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.

Adult ; Aged ; Anxiety ; drug therapy ; prevention & control ; Female ; Humans ; Male ; Melatonin ; therapeutic use ; Middle Aged ; Molar, Third ; surgery ; Pain Measurement ; Pain, Postoperative ; drug therapy ; Preanesthetic Medication ; methods ; Preoperative Period ; Prospective Studies ; Sex Factors ; Surgery, Oral ; methods ; Tooth Extraction ; Young Adult

BACKGROUND: Triazolam has similar pharmacological properties as other benzodiazepines and is generally used as a sedative to treat insomnia. Alprazolam represents a possible alternative to midazolam for the premedication of surgical patients. The purpose of this study was to evaluate the anxiolytic, sedative, and amnestic properties of triazolam and alprazolam as pre-anesthetic medications. METHODS: Sixty adult patients were randomly allocated to receive oral triazolam 0.25 mg or alprazolam 0.5 mg one hour prior to surgery. A structured assessment interview was performed in the operating room (OR), the recovery room, and the ward. The levels of anxiety and sedation were assessed on a 7-point scale (0 = relaxation to 6 = very severe anxiety) and a 5-point scale (0 = alert to 4 = lack of responsiveness), respectively. The psychomotor performance was estimated using a digit symbol substitution test. As a memory test, we asked the patients the day after the surgery if they remembered being moved from the ward to the OR, and what object we had shown them in the OR. RESULTS: There were no significant differences between the groups with respect to anxiety and sedation. The postoperative interviews showed that 22.2% of the triazolam-treated patients experienced a loss of memory in the OR, against a 0% memory loss in the alprazolam-treated patients. In comparison with alprazolam 0.5 mg, triazolam 0.25 mg produced a higher incidence of amnesia without causing respiratory depression. CONCLUSIONS: Oral triazolam 0.25 mg can be an effective preanesthetic medication for psychomotor performance.
Adult ; Alprazolam* ; Amnesia ; Anesthesia, General* ; Anxiety ; Benzodiazepines ; Humans ; Incidence ; Memory ; Memory Disorders ; Midazolam ; Operating Rooms ; Preanesthetic Medication ; Premedication* ; Psychomotor Performance ; Recovery Room ; Relaxation ; Respiratory Insufficiency ; Sleep Initiation and Maintenance Disorders ; Triazolam*

STUDY DESIGN: A randomized prospective study. PURPOSE: To assess postoperative analgesic requirements after Phyback therapy preemptively in patients undergoing lumbar stabilization. OVERVIEW OF LITERATURE: Frequency Rhythmic Electrical Modulation System is the latest method of preemptive analgesia. METHODS: Forty patients were divided into two groups. Patients who were to receive tramadol were allocated to "group A" and those who were to receive Phyback therapy were allocated to "group B." In patients with a visual analog scale score of >4 or a verbal rating scale score of >2, 75 mg of diclofenac IM was administered. The amount of analgesic consumption, the bolus demand dosage, and the number of bolus doses administered were recorded. Patient satisfaction was evaluated using the visual analog patient satisfaction scale. RESULTS: There were statistically significant differences in the visual analog scale and verbal rating scale scores in the fourth, sixth, 12th, and 24th hours. The number of bolus infusions was significantly lower in group B. The amount of analgesic consumption was higher in group A. There was a significant difference between the two groups in the number of bolus infusions and the total amount of analgesic consumption, and this comparison showed better results for group B. CONCLUSIONS: Application of Phyback therapy reduced postoperative opioid consumption and analgesic demand, and it contributed to reducing patients' level of pain and increased patient satisfaction. Moreover, the application of preemptive Phyback therapy contributed to reducing preoperative pain which may have reduced patient anxiety.
Analgesia* ; Analgesics ; Anxiety ; Constriction, Pathologic* ; Diclofenac ; Electric Stimulation Therapy ; Humans ; Pain, Postoperative ; Patient Satisfaction ; Preanesthetic Medication ; Prospective Studies ; Spinal Stenosis ; Tramadol ; Visual Analog Scale

Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, and the potential for drug interactions with anesthesia. In general, most medications are tolerated well through surgery and do not interfere with anesthetic administration. Therefore, most drugs should be continued through the morning of surgery. However, some medications are known to influence surgical risk or surgical decisions (e.g., antiplatelet agents, anticoagulants, some hormonal therapies, and herbal remedies), so it is important to obtain a complete medication list from the patient and to advise adjusting doses or discontinuing certain potentially complicating medications in advance of surgery. This article reviews general recommendations for perioperative management of a number of common medication classes.
Anesthesia* ; Anticoagulants ; Disease Progression ; Drug Interactions ; Humans ; Medication Therapy Management ; Perioperative Care ; Platelet Aggregation Inhibitors ; Preanesthetic Medication

Preoperative assessment and optimization of a patient's condition are important components of anesthesia practice. Improvements in evaluation and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. Although routine preoperative laboratory tests are ordered in many institutions, history taking and physical examination provide more information about patients than laboratory tests do. Therefore, history taking and physical examination should be used to direct test ordering, and a test should be ordered only if the results will impact the decision to proceed with the planned procedure or alter the care plans. Preoperative laboratory tests without specific indications lack clinical usefulness and may actually lead to patient injury because of unnecessary interventions, delay of surgery, anxiety, and even inappropriate therapies. After sufficient discussion between anesthesiologists and surgeons in each institution, diagnostic testing guidelines for the preoperative evaluation should be developed to improve patient care, standardize clinical practice, improve efficiency, and reduce costs. For preoperative management for infants, preoperative evaluation is similar to that for the adult, but reducing anxiety of patients and their parents is especially important. Although many nonpharmacologic methods are used to reduce anxiety, the pharmacologic methods are more effective than nonparmacologic methods. The administration of sedative premedication to infants who are about to undergo anesthesia and surgery can result in beneficial effects during the preoperative and postoperative periods by decreasing anxiety, increasing cooperation during anesthesia induction, and reducing negative postoperative behavioral responses.
Adult ; Anesthesia ; Anxiety ; Caregivers ; Diagnostic Tests, Routine ; Humans ; Infant* ; Parents ; Patient Care ; Physical Examination ; Postoperative Period ; Preanesthetic Medication ; Premedication ; Preoperative Care

OBJECTIVETo compare the effects of penehyclidine hydrochloride, atropine and scopolamine as the preanesthetic medication before operation for patient with cleft lip/palate (CL/P) who would undergo general anesthesia.

METHODS120 CL/P patients who would undergo general anesthesia with tracheal intubation as research objects were chosen. The patients were divided into three groups randomly, group of penehyclidine hydrochloride (group PH), group of atropine (group ATR) and group of scopolamine (group SCO), 40 patients in each group. Penehyclidine hydrochloride (0.01 mg/kg), atropine (0.01 mg/kg) or scopolamine (0.006 mg/kg) was given respectively to the patients. The changes of heart rate, temperature, blood pressure and the secretion of respiratory tract were observed before medication, 15 minutes and 30 minutes after medication, after trachea cannula and after operation.

RESULTSThere were no significant changes in heart rate, temperature and blood pressure in group PH after medication (P > 0.05). The heart rate and temperature in group ATR and group SCO increased significantly after medication (P < 0.05), however, the blood pressure had no obvious change (P > 0.05). The secretion of respiratory tract was decreased significantly in group PH comparing to group ATR and group SCO when the operation was over (P < 0.05).

CONCLUSIONPenehyclidine hydrochloride has no significant effect on heart rate, temperature and blood pressure to the patients, and it's effect of secretion inhibition is longer and it is better than atropine and scopolamine.

Cleft Lip ; Cleft Palate ; Female ; Humans ; Male ; Preanesthetic Medication ; Quinuclidines

BACKGROUND: This study was designed to evaluate the efficacy and safety of midazolam premedication administered by a jet-injector in pediatric patients. METHODS: Children undergoing outpatient surgery were randomized into three groups: intravenous induction with thiopental sodium (control group, n = 20), oral midazolam premedication (PO-med group, n = 20) or midazolam premedication using a jet-injector (Jet-med group, n = 20). In the PO-med and Jet-med group patients, anesthetic induction was performed by sevoflurane inhalation and an intravenous catheter (IVC) was inserted after the children had been anesthetized by sevoflurane inhalation. For the control group patients, an IVC was placed in the preoperative holding area. Agitation scores were recorded in the preoperative holding area and recovery room. Anesthesia times and the views of the medical staff concerning the technique benefits were also noted. Patients and parents were interviewed on the following day. RESULTS: Maximum agitation scores in the preoperative holding area and during separation with parents were significantly lower in the PO-med and Jet-med groups. The induction time was significantly longer in the PO-med and Jet-med groups. No statistically significant differences were found for the recovery characteristics. Though interviews with patients and parents produced similar results for patients in each group, the medical staff satisfaction levels were significantly higher for patients in the PO-med and Jet-med groups. CONCLUSIONS: The findings of this study suggest that the application of the jet-injector for midazolam premedication may be clinically useful in children who do not have an IVC. The use of the jet-injector could be a substitute for the oral route for midazolam administration.
Ambulatory Surgical Procedures ; Anesthesia ; Catheters ; Child ; Dihydroergotamine ; Humans ; Inhalation ; Medical Staff ; Midazolam ; Parents ; Preanesthetic Medication ; Premedication* ; Recovery Room ; Thiopental

BACKGROUND: Most surgical patients experience perioperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contributes to postoperative pain. The effect of music on perioperative patient anxiety was studied. METHODS: Forty patients undergoing surgery with spinal anesthesia, were divided into two groups. Group I (n = 20) did not listen to music, and Group II (n = 20) listened to music selected by the patient. At ward, hemodynamic variables including systolic and diastolic blood pressures and pulse rates were measured as control values. Hemodynamic variables and the anxiety scores by the Hamilton anxiety rating scale and the Visual Analogue Scale (VAS) were prepared for Group I and Group II in the operating room. RESULTS: No difference was observed between the groups with regard to systolic blood pressure, diastolic blood pressure, mean arterial pressure, or pulse rate when patients arrived at the operating room. In Group II, 30 minutes after listening to music, anxiety scores, VAS, systolic blood pressures, and mean arterial pressures were significantly lower than in Group I. CONCLUSIONS: Music was found to effectively reduce intraoperative anxiety.
Anesthesia, Spinal* ; Anesthetics ; Anxiety* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Music* ; Operating Rooms ; Pain, Postoperative ; Preanesthetic Medication

BACKGROUND: Clonidine, a prototype alpha2-adrenoreceptor agonist, has been shown to be effective as a preanesthetic medication in adults. Many authors have reported the effects of intravenous clonidine pretreatment on the hemodynamic responses to tracheal intubation, on the anesthetic requirements during the operation and on postoperative analgesia in adults. The current study was designed to investigate the efficacy of two doses of intravenous clonidine as a premedicants. METHODS: In a prospective, randomized, double-blind, controlled clinical trial, 60 children, aged 5 12 years, undergoing an elective adenotonsillecctomy received saline, 1 microgram/kg clonidine or 2 microgram/kg clonidine intravenously. These agents were administered 10 minutes before the estimated time of induction of anesthesia with intravenous atropine 0.01 mg/kg. A blinded observer noted the childrens'levels of sedation, the quality of separation from parent, and degree of acceptance of mask application during the inhalation of 100% oxygen just after pentothal sodium injection. Hemodynamic changes after tracheal intubation were compared among the three groups. RESULTS: Clonidine produced significant sedation, and this effect were dose related. The clonidine administered groups provided a better quality of separation than the control group. Amnesia about mask application was significantly higher in the clonidine 2 microgram/kg administered group. These doses of clonidine did not attenuate increases in blood pressure and heart rate after tracheal intubation. No consistent differences in the blood pressure or heart rate after tracheal intubation were observed in the three groups. No clinically significant perioperative hypotension or bradycardia was observed. CONCLUSIONS: These data indicate that, the combination of intravenous 1 microgram/kg clonidine or 2 microgram/kg clonidine with atropine 0.01 mg/kg is an effective form of premedication in pediatric surgery. However, the optimal dose of clonidine for both sedation and hemodynamic stability after tracheal intubation in this setting remains to be determined.
Adult ; Amnesia ; Analgesia ; Anesthesia ; Atropine ; Blood Pressure ; Bradycardia ; Child ; Clonidine* ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Inhalation ; Intubation ; Masks ; Oxygen ; Parents ; Preanesthetic Medication ; Premedication* ; Prospective Studies ; Sodium ; Sympathetic Nervous System ; Thiopental