scholarly journals Separation Time of Children From Parents: A Randomized Comparison Between oral versus Atomized Intranasal Administration of Midazolam

2016 ◽  
Vol 27 (1) ◽  
pp. 17-23
Author(s):  
Mohammad Obaidullah ◽  
Parash Chandra Sarkar ◽  
Manash Kumer Basu ◽  
Mohammad Omar Faruq ◽  
Sabina Yeasmeen ◽  
...  
Keyword(s):  
Conscious Sedation ◽  
Oral Route ◽  
Sedation Score ◽  
Route Of Administration ◽  
Intranasal Route ◽  
Duration Of Action ◽  
Sedative Agent ◽  
Nasal Irritation ◽  
Oral Midazolam ◽  
Care Surgery

Background: Sedation has become more common for children undergoing procedures in the emergency department, dentistry, and day care surgery. A desirable sedative agent has a rapid onset with short duration of action and is effective and safe. Midazolam as a sedative agent that fulfills these criteria. However controversy surrounds regarding its route of administration, particularly with respect to its ease of administration and patient acceptance. Although the oral route of administration is the most popular among pediatric surgeons and dentists, confrontation and frustration often arise when children refuse to accept the sedative medication.Objectives: To evaluate the outcome (satisfactory anxiolysis and smooth early parental separation) between oral midazolam (OM) and intranasal midazolam(INM)spray in children for conscious sedation before general anaesthesia.Methods: Children aged 1 – 6 years scheduled for routine elective surgery were included to receive midazolam as premedication drug. A total of 80 children were recruited consecutively. Of them 40 were randomly assigned to either single dose of 0.5 mg/kg via oral route (OM0) or 0.5 mg/kg of body weight by intranasal spray(INM). The outcome variables were smooth separation of children from their parents at the level of conscious sedation and time to smooth separation.Results: No change in sedation score was evident in first 3 minutes following midazolam administration. Then the sedation score of INM group increased sharply to assume a mean score of 2 at 9 minutes. No demonstrated change was further noted up to the end of observation. Meanwhile the sedation score of OM group began to increase steadily up to the end of observation when it assumed a mean score of 1.5. The INM group attained a good level of sedation much earlier than its OM counterpart. The mean sedation scores were significantly higher in the former group than those in the latter group. During the first 3 minutes of midazolam administration no change in anxiolysis was noted. Then the score began to increase in both the INM and OM groups, but INM group experienced a much faster increase than the OM group so that the former group reached a mean score of almost 3 and the latter group to a mean score of nearly 2 at 15 minutes interval. The levels of anxiolysis attained by the intranasal group were significantly higher compared to those attained by the oral midazolam group (table II).All but 1 children (97.5%) in the INM group were separated from their parents smoothly as opposed to 90% in the OM group (p = 0.148). In the INM group 12.8% of children were separated at 9 minutes, 69.2% from 10 – 12 minutes (over two-thirds) and 18% from 15 – 18 minutes. In the OM group 13.9% were separated at 15 minutes, about 39% at 18 – 21 minutes, 22.3% at 24 minutes and the rest 11.1% at 27 minutes after premedication. Overall more than 80% of the children in the INM group were separated at 9 – 12 minutes following midazolam administration when none of the children in the OM group was separated (p < 0.001). Complications like nasal irritation was staggeringly higher in the INM group shown on table IV.Conclusion: Despite the intranasal route causes a substantial proportion of children to suffer from nasal irritation, it is the preferred route over oral route, because intranasal route induces much faster sedation and anxiolysis and helps easy and smooth separation of children from their parents.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 17-23

Acomparative Study between Epidural Analgesia of Levobupivacaine with Fentanyl versus Dexmedetomidine for knee replacement surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Naglaa Mohammed Ali ◽  
Ehab Hamed Abd El Mohsen ◽  
Rania Maher Hussien ◽  
Omar Abd El Gawad Kamel Massoud
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Knee Replacement ◽  
Sedation Score ◽  
Gamma Aminobutyric Acid ◽  
University Hospitals ◽  
Research Committee ◽  
Duration Of Action ◽  
Dose Dependent Decrease ◽  
Double Blinded

Abstract Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. In addition to improved patient outcome. Objective To compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural levobupivacaine in knee replacement surgeries regarding duration of action and the analgesic potency of both drugs. Patients and Methods This prospective double blinded randomized clinical trial study was conducted in Maadi Military and Ain Shams University Hospitals after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent knee replacement surgeries were included in the study their ages range between 21 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30). Results As regards sedation score intraoperative and postoperative, in the present study, we found that Ramsay sedation score was significantly higher in group ‘BD’ when compared to group ‘BF’ intraoperative and postoperative. This finding may be attributed to the sedative properties of dexmedetomidine that is far superior to fentanyl acting by dose-dependent decrease in activity of noradrenergic neurons in the brain stem via post-synaptic receptor-mediated inhibition. This increases gamma-aminobutyric acid (GABA) neurone activity, which mediates central sedative effects. Conclusion Epidural levobupivacaine with dexmedetomidine provided better sedation, adequate surgical anesthesia with prolonged postoperative analgesia for lower limb surgeries. Both adjuvants reduced the epidural dose of levobupivacaine and potentiated its efficacy.

Vilazodone Hydrochloride Multi-Dose Nasal Spray Solution for the Treatment of Depression: Design, Optimization, and Evaluation

2021 ◽  
Vol 16 ◽  
Author(s):  
Praful Giradkar ◽  
Deepa H. Patel
Keyword(s):  
Nasal Spray ◽  
Benzalkonium Chloride ◽  
Research Work ◽  
Tween 80 ◽  
Oral Route ◽  
Sodium Carboxymethylcellulose ◽  
Intranasal Route ◽  
Spray Solution ◽  
Treatment Of Depression ◽  
The Brain

Introduction: The aim of present research work was to prepare, optimized, and evaluate the multi-dose nasal spray solution for delivery of vilazodone hydrochloride to the brain by the intranasal route in order to overcome the drawback associated with the oral route for the treatment of depression. Background: Depression is a mental disorder associated with abnormalities in neuronal transport in the brain primarily serotonin, norepinephrine, and dopamine that adversely affects a person's lifestyle, sleep pattern, work, eating habits, and general health. Vilazodone hydrochloride acts by enhancing the serotonergic activity in the brain by inhibiting serotonin (5-HT) reuptake. Materials/ Methods: The excipients used to formulate vilazodone hydrochloride multi-dose nasal spray solution were sulphobutylether-β-cyclodextrin sodium (solubilizer), sodium carboxymethylcellulose (viscosity builder), tween 80 (surface tension modifier), glycerol (humectant), benzalkonium chloride (preservative), and purified water (vehicle). The simple conventional mixing technique was used for the preparation of the multi-dose nasal spray solution. The solution was prepared in two parts, in the first part sulphobutylether-β-cyclodextrin sodium and drug substance dissolved in purified water under stirring followed by the addition of glycerol and benzalkonium chloride solution. In the second part, tween 80 dissolved in warm water followed by the addition of sodium carboxymethylcellulose under stirring, finally both parts mixed and the required volume was adjusted with purified water. The central composite design was used for the optimization of the formulation. The solution was evaluated for physicochemical properties, selective toxicity, and experimental kinetics. Results: The prepared vilazodone hydrochloride multi-dose nasal spray solution was shown viscosity (40.5 ± 1.65 mPa.s), droplet size distribution (span) (1.88 ± 0.55 µm), spray area (288 ± 1.25 mm2), ovality (1.10 ± 1.35), dripping speed (0.25 cm /30 sec), visual appearance (clear free from particulate matter), pH (6.35 ± 0.10), shot weight (100.6 ± 0.32 mg), density (1.03 ± 0.20 g/ml), % drug content (101.8 ± 0.15 %), displacement value for in-vitro mucoadhesion (3.47 ± 0.25 cm), average flux (Jss) for permeability (241.06 ± 1.45 μg/cm2/hrs), permeability coefficient (48.21 ±1.46 cm/hrs), enhancement ratio (1.73), local toxicity study shows no epithelium cell damage, isotonicity (386.58 mOsmol / kg). Plasma Cmax (24.56 ±3.98 ng/ml), Tmax (1.0 hrs), and AUC 0-12 (82.68 ±10.22 ng.h/ml). Brian tissue Cmax (22.95 ±4.22), Tmax (1.0 hrs) and AUC 0-12 (77.82 ±6.25 ng.h/ml). Nasal bioavailability (251.74 ±45.12% ) and, drug targeting index 1.54 Conclusion: The present research work results showed that the prepared multi-dose nasal spray solution of vilazodone hydrochloride was suitable for the delivery of the drug to the brain by the intranasal route and might be beneficial to overcome drawbacks associated with the oral route of administration for the treatment of depression.

scholarly journals A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

2019 ◽  
Vol 4 (2) ◽  
pp. 724-728
Author(s):  
Sabin Gauchan ◽  
Chitra Thapa ◽  
Abha Prasai
Keyword(s):  
General Anesthesia ◽  
Separation Anxiety ◽  
Elective Surgery ◽  
Sedation Score ◽  
Preoperative Anxiety ◽  
Parental Separation ◽  
Emergence Agitation ◽  
Oral Midazolam ◽  
Significant Difference ◽  
Group D

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist. Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia. Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups. Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication. Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

Conscious Sedation in Dentistry: Selecting the Right Patient

Dental Update ◽  
2020 ◽  
Vol 47 (4) ◽  
pp. 353-359
Author(s):  
Roya Hazara
Keyword(s):  
Adverse Events ◽  
Physical Examination ◽  
Staff Training ◽  
Clinical Relevance ◽  
Conscious Sedation ◽  
Oral Route ◽  
Patient Assessment ◽  
History Play ◽  
Guidelines And Standards ◽  
The Right

In recent years, conscious sedation has grown in popularity as an alternative to general anaesthesia in a primary setting due to its safety and efficiency. It is imperative to carry out a full patient assessment prior to treatment under conscious sedation. Conscious sedation is provided intravenously, by inhalation or oral route. Clinical and physical examination as well as medical, social and mental history play a fundamental role in selecting the right patient. In addition, to optimize safety of patients, it is necessary to follow available guidelines and standards, provide an appropriate environment and adequate staff training. CPD/Clinical Relevance: This article highlights the importance of pre-assessment prior to treatment under conscious sedation. The vast majority of adverse events during sedation occur as a result of inadequate pre-assessment and preparation.

Anabolic effects of the beta 2-adrenoceptor agonist salmeterol are dependent on route of administration

1994 ◽  
Vol 267 (3) ◽  
pp. E475-E484 ◽  
Author(s):  
N. G. Moore ◽  
G. G. Pegg ◽  
M. N. Sillence
Keyword(s):  
Soleus Muscle ◽  
Body Weight Gain ◽  
Route Of Administration ◽  
Duration Of Action ◽  
Routes Of Administration ◽  
Adrenoceptor Agonists ◽  
Slow Twitch ◽  
Beta 2 ◽  
Long Acting

It is reported that a long duration of action is required for beta 2-adrenoceptor agonists to evoke an anabolic response. In the present study, we compare the potency of clenbuterol with that of the new long-acting compound salmeterol, when given at equimolar doses to female Wistar rats by different routes of administration. Given orally for 10 days, salmeterol had no effect on growth at a dose of 120 micrograms/day, whereas at 2.4 mg/day the drug caused significant increases in body and carcass weight and in the mass of the mixed-fiber gastrocnemius/plantaris and tibialis anterior muscles, but there were no increases in the slow-twitch soleus muscles. A similar growth response was seen when clenbuterol was given orally at a dose of only 97 micrograms/day, with an additional response seen in soleus muscle at 1.9 mg/day. Thus clenbuterol was more potent than salmeterol when given by this route of administration. When the drugs were infused by osmotic minipump, both salmeterol (130 micrograms/day) and clenbuterol (100 micrograms/day) caused increases in body weight gain and in the weights of the mixed-fiber muscles, with the most dramatic effect of infusion being to greatly increase the anabolic effect of salmeterol in soleus muscle. A single intraperitoneal injection of salmeterol (53 micrograms) or clenbuterol (40 micrograms) caused a similar rapid increase in the concentration of adenosine 3',5'-cyclic monophosphate in gastrocnemius muscle. These results indicate that the potency of salmeterol in vivo is dependent on its route of administration and that slow-twitch muscles are less sensitive than mixed-fiber muscles to the anabolic effects of beta 2-adrenoceptor agonists.

Comparison of Oral Midazolam and Triclofos in Conscious Sedation of Uncooperative Children

2011 ◽  
Vol 36 (2) ◽  
pp. 189-196 ◽  
Author(s):  
Afreen Shabbir ◽  
Sham Bhat ◽  
Hegde Sundeep ◽  
Sheikh Mohammed Salman
Keyword(s):  
Conscious Sedation ◽  
Rating Scale ◽  
Body Movement ◽  
Rank Test ◽  
Behavior Rating Scale ◽  
Dental Patients ◽  
Oral Midazolam ◽  
Wilcoxon Sign Rank ◽  
Sign Rank Test ◽  
To Receive

Objective: To compare the safety and efficacy of two orally administered conscious sedation agents, Triclofos 70mg/kg and Midazolam 0.5mg/kg in pediatric dental patients. Study Design: In this cross over study twenty four sedation sessions were carried out with twelve children between the age group of 3 to 9 years. Children exhibiting negative behavior according to Frankl behavior rating scale (Rating No.2) were selected. Patients were randomly assigned to receive oral midazolam 0.5mg/kg or triclofos 70mg/kg. The alternate drug was administered at the next appointment. Patients' behavioral responses were recorded using a scoring system established by Houpt et al and modified by Badalaty et al considering the degree of sleep, body movement, crying and overall behavior. Scoring was done for both midazolam and triclofos session as well as for the session which was tried without medication. Ratings were made during all the procedures like injection of LA, extraction, cavity preparation, restoration and pulp therapy. Statistical analysis was done using Friedman test and Wilcoxon sign rank test. Results: Both the drugs showed significantly higher scores when compared to the session which was tried without medication although the scores for midazolam were significantly higher than triclofos. Conclusion: Oral midazolam in a dose of 0.5mg/kg is more effective in regulating patient behavior when compared to triclofos.

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