Benzodiazepine hypnotics as oral preanaesthetic medication: a comparative clinical study
DOI:
https://doi.org/10.18203/2349-2902.isj20164460Keywords:
Anxioysis, Anterograde amnesia, Benzodiazepines, Pre-anesthetic medication, SedationAbstract
Background:An ideal pre-medicant should allay fear and anxiety without producing its effect on vital functions of the body and body chemistry, with minimal depression of the respiratory and circulatory systems. The ideal pre-medicant with all good qualities and no side effects at all is yet to be found. The search for a drug which will be an appropriate pre-anesthetic medication is still going.
Methods: Four drugs of BZD group namely diazepam, nitrazepam, lorazepam, and oxazepam were chosen as oral pre-anesthetic medication. Total number of cases were 100, of which 25 patients belonging to each group of drug respectively. Standard doses of oxazepam (30 mg), nitrazepam (5 mg), diazepam (10 mg) and lorazepam (2 mg) by oral route were administered. All study participants were examined night before operation to observe the following clinical parameters like level of apprehension, excitement, blood pressure, heart rate, respiration (rate, rhythm and minute volume).
Results:Diazepam and nitrazepam produced fair degree of sedation whereas oxazepam appears to be lagging behind. So far as anxiolysis is concerned, all the drugs appear to be good anxiolytics. Nausea, vomiting and dizziness are some of the problems which may occasionally be faced by this group of drug. On reassessment of patients 60 minutes after premedication, it was revealed that the efficacy so as anxiolysis and sedative effect is concerned was in the following order, lorazepam headed the list; diazepam and nitrazepam followed closely and oxazepam was at the bottom. Toxicity in all the four drugs were minimal. The degree of sleepiness varied from drug to drug. Ninety minute after premedication patients were found to be in a better state of sedation than at 60 minute’s level in all the four groups. The degree of sedation and anxiolysis was in the same order as that of 60 minutes level.
Conclusions:The overall impression was that four members of the benzodiazepines, serve as as a good premedication in the absence of pain. The sedation and anxioysis produced by them are of fair degree even when given orally. Side effects produced were minimal except in the lorazepam group when they are used as night time sedative. Given orally only lorazepam is capable of producing anterograde amnesia.
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References
Wallace G. Preanesthetic medication without narcotics: use of promethazine and a sympathomimetic agent in 5,500 patients. JAMA. 1960;173(7):797-9.
Vaskle P, Pal R, Arora KK. Efficacy and safety of two doses of oral midazolam as premedication in paediatric patients: A prospective randomized and comparative study. IOSR Journal Pharmacy. 2015;5(6):46-9.
White PF. Pharmacologic and clinical aspects of preoperative medication. Anesth Analg. 1986;65:963-74.
Shearer WM. The evolution of premedication. Br J Anaesth. 1960;32:554-62.
Vela DR, Bordel BE, Jiménez BB, Martín CL. Diazepam (valium) in preanesthetic medication and in general anesthesia clinical observations of 2,457 cases. Rev Esp Anestesiol Reanim. 1968;15(2):264-87.
Drug therapy of depression and anxiety disorders. In: Dandan RH, Brunton L, Goodman and Gilman's Manual of Pharmacology and Therapeutics. 2nd edition. New York,NY: McGraw-Hill;2015:331-351.
Drugs used to treat anxiety. In: Humphrey P. Rang, James M. Ritter, Rod J Flower, Graeme Henderson. Rang and Dale's Pharmacology. 8th edition. Churchill Livingstone. 2015;545-560.
Gamble JA, Dundee JW, Assaf RA. Plasma diazepam levels after single dose oral and intramuscular administration. Anaesthesia. 1975;30(2):164-9.
Assaf RA, Dundee JW, Gamble JA. The influence of the route of administration on the clinical action of diazepam. Anaesthesia. 1975;30(2):152-8.
Mirakhur RK, Clarke RSJ, Elliott J, Dundee JW. Atropine and glycopyrrolate premedication. Anaesthesia. 1978;33:906-12.
Moore J, Dundee J. Promethazine, its influence on the course of thiopentone and methohexital anaesthesia. Anaesthesia. 1961;16:61-73.
Dundee J, Moore J. The effect of scopolamine on methohexital anaesthesia. Anaesthesia. 1961;16:194-206.
Irwin DJ, Bross. How to use ridit analysis. Biometrics. 1958;14(1):18-38.
Madej TH, Passuke RT. Anaesthesia premedication: aims, assessment and methods. Can J Anaesth 1987; 34:259-73.
Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Analg. 1997;84:427-32.
Beecher HK. Experimentation in man. J Am Med Assoc. 1959;169(5):461-78.
Walker KJ, Smith AF. Premedication for anxiety in adult day surgery. Cochrane Database Sys Rev. 2009;(4):CD002192.
Vaughn F, Wichowski H, Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN J. 2007;85(3):589-604.
Caumo W, Schmidt AP, Schneider CN. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45:298-307.
Roizen MF. Pre-operative evaluation. In: Miller RD, Anesthesia 3rd edition. New York, Churchill Livingstone Inc, 1990.
Bunker TD. An information leaflet for surgical patients. Ann R Coll Surg Engl. 1983;65:242-3.
Bugge K, Bertelsen F, Bendtsen A. Patient’s desire for information about anaesthesia danish attitudes. Acta Anaesthesiol Scand. 1998;42:91-6.
Norris W, Telfer AB. Nitrazepam in premedication. Br J Anaesth. 1969;41(10):877-9.
Dundee JW. Comparison of the actions of diazepam and lorazepam. Br J Anaesth. 1979;51(5):439-46.
Suri Y. Evaluation of midazolam and diazepam for preoperative sedation. MJAFI. 2000;56:287-92.
Agelink MW, Majewski TB, Andrich J, Mueck-Weymann M. Short-term effects of intravenous benzodiazepines on autonomic neurocardiac regulation in humans: a comparison between midazolam, diazepam, and lorazepam. Crit Care Med. 2002;30(5):997-1006.
Jakobsen H, Hertz JB, Johansen JR, Hansen A, Kolliker K. Premedication before day surgery. A double-blind comparison of diazepam and placebo. Br J Anaesth. 1985;57:300-5.
Kangle P, Sharma M. Double blind trial with lorazepam and placebo for oral premedication. Ind J Anaesth. 1977;4:383.
Burtles R, Astley B. Lorazepam in children. A double-blind trial comparing lorazepam, diazepam, trimeprazine and placebo. Br J Anaesth. 1983;55(4):275-9.
Haslett WH, Dundee JW. Studies of drugs given before anaesthesia. Two benzodiazepine derivatives chlordiazepoxide and diazepam. Br J Anaesth. 1968;40(4):250-8
Knapp RB, Fierro L. Evaluation of the cardiopulmonary safety and effects of lorazepam as a premedicant. Anesth Analg. 1974;53(1):122-4.
Dundee JW, McKay AC. Drug induced retrograde amnesia. Anaesthesia. 1978;33(4):375.
Galloon S, Gale GD, Lancee WJ. Comparison of lorazepam and diazepam as premedicants. Br J Anaesth. 1977;49(12):1265-9.
Mac DS, Kumar R, Goodwin DW. Anterograde amnesia with oral lorazepam. J Clin Psychiatry. 1985;46(4):137-8.
Boyle CA. Benzodiazepine-induced amnesia and anaesthetic practice: a review. Psychopharmacol Ser. 1988;6:146-65.
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