scholarly journals Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries

2021 ◽  
Vol 12 ◽  
Author(s):  
Yu-Hang Cai ◽  
Cheng-Yu Wang ◽  
Yang Li ◽  
Jia Chen ◽  
Jun Li ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Separation Anxiety ◽  
Anesthesia Induction ◽  
Inhalation Induction ◽  
Beneficial Effects ◽  
Oral Midazolam ◽  
Sedative Effects ◽  
Drug Regimens ◽  
Group D

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction.Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time.Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p < 0.001).Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

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.

COMPARATIVE STUDY OF INTRAVENOUS DEXMEDETOMIDINE AND MIDAZOLAM AS A PREOPERATIVE SEDATION UNDER SPINAL ANESTHESIA

2019 ◽  
pp. 2-3
Author(s):  
Anisha Chokshi
Keyword(s):  
Spinal Anesthesia ◽  
Ventilatory Response ◽  
Young Patients ◽  
Psychological Trauma ◽  
Sedative Effect ◽  
Comfort Level ◽  
Anesthesia Induction ◽  
Negative Experience ◽  
Sedative Effects ◽  
Group D

INTRODUCTION: Preoperative anxiety is a frequent condition. Comfortable anesthesia induction and maintenance can be achieved by controlling anxiety. Various agents are used to relieve anxiety and provide sedation. We conducted this study to compare the sedative effects of dexmedetomidine versus midazolam for patients undergoing spinal anesthesia. AIMS AND OBJECTIVES : To compare the sedative effect of both drugs and observe intraoperative and postoperative comfort level, cardiovascular and respiratory changes and side effects of both drugs. MATERIALS AND METHODS: Sixty patients between 18-65 years of age requiring spinal anaesthesia for their procedures were selected randomly and division was done in 2 groups (Each group having 30 patients). Group D was given Inj. Dexmedetomidine at the dose of 1 mcg/kg within 10 mins in 100 ml NS and group M was given Inj Midazolam at the dose of 0.04 mg/kg in 100 ml NS within 10 mins. DISCUSSION: Anxiety is more common among young patients, women, and people with negative experience of anesthesia or fear that arises just before the operation and anesthesia my lead to psychological trauma. Various agents such as phenothiazines, bezodiazepines, barbiturates, opioids, propofol, ketamine, dexmedetomidine or clonidine and antihistamines are used to relieve anxiety and provide sedation. Midazolam is a benzodiazepine,commonly used as an intravenous sedative agent for pre-operative sedation. Dexmedetomidine is an alpha-2 agonist which acts on adrenoreceptors in many tissues including the nervous, cardiovascular and respiratory systems. Unlike midazolam, dexmedetomidine does not affect the ventilatory response to carbon dioxide, it also produces analgesia which could potentially alleviate pain.

scholarly journals Comparison of ketamine-diazepam with ketamine-xylazine anesthetic combinations in sheep spontaneously breathing and undergoing maxillofacial surgery

2010 ◽  
Vol 10 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Fatih Özkan ◽  
Nilüfer Çakır-Özkan ◽  
Ahmet Eyibilen ◽  
Tamer Yener ◽  
Ünal Erkorkmaz
Keyword(s):  
Surgical Procedures ◽  
Maxillofacial Surgery ◽  
Anesthesia Induction ◽  
Respiratory Parameters ◽  
Drug Regimens ◽  
Group 2 ◽  
Short Time ◽  
Spontaneously Breathing ◽  
Group 1

The objective of this study was to choose a suitable anesthetic combination for use in experimental surgical models by comparing the anesthetic and cardio-respiratory changes. Fourteen healthy male sheep were randomly assigned to two different drug regimens. In Group 1 the sheep were anesthetized with ketamine + xylazine (22 mg/kg im. + 0.2 mg/kg i.m., respectively). Anesthetic combination of ketamine + diazepam (22 mg/kg im. + 0.4 mg/kg i.m., respectively) was used in Group 2. Heart rate, respiratory rate and mean arterial pressures were evaluated before anesthesia, after induction of anesthesia up to 30 minutes in 5 minute intervals and during recovery. In all sheep, duration of anesthesia induction, duration of anesthesia and duration of recovery were recorded. Quality of induction, anesthesia, analgesia and recovery were evaluated. Cardio-respiratory parameters decreased below baseline values after anesthesia induction in both groups. However, no profound effects on cardio-respiratory functions were observed during study. In Group 2, it was observed that; anesthesia induction time was longer, the depth of anesthesia was inadequate during the osteotomy stage of the surgical procedure and recovery time was longer in comparison to Group 1. Otherwise the quality of anesthesia induction, anesthesia, analgesia and recovery was better in Group 1 than Group 2. These findings indicate that both drug combinations can provide short time anesthesia for minor surgical procedures. Ketamine+xylazine combination can be used as a more suitable anesthetic combination in experimental surgical procedures such as maxillofacial surgery than ketamine+diazepam combination, in sheep.

COMPARATIVE STUDY OF INTRAVENOUS DEXMEDETOMIDINE AND MIDAZOLAM AS A PREOPERATIVE SEDATION UNDER SPINAL ANESTHESIA

2019 ◽  
pp. 2-3
Author(s):  
Anisha Chokshi
Keyword(s):  
Spinal Anesthesia ◽  
Ventilatory Response ◽  
Young Patients ◽  
Psychological Trauma ◽  
Sedative Effect ◽  
Comfort Level ◽  
Anesthesia Induction ◽  
Negative Experience ◽  
Sedative Effects ◽  
Group D

INTRODUCTION: Preoperative anxiety is a frequent condition. Comfortable anesthesia induction and maintenance can be achieved by controlling anxiety. Various agents are used to relieve anxiety and provide sedation. We conducted this study to compare the sedative effects of dexmedetomidine versus midazolam for patients undergoing spinal anesthesia. AIMS AND OBJECTIVES : To compare the sedative effect of both drugs and observe intraoperative and postoperative comfort level, cardiovascular and respiratory changes and side effects of both drugs. MATERIALS AND METHODS: Sixty patients between 18-65 years of age requiring spinal anaesthesia for their procedures were selected randomly and division was done in 2 groups (Each group having 30 patients). Group D was given Inj. Dexmedetomidine at the dose of 1 mcg/kg within 10 mins in 100 ml NS and group M was given Inj Midazolam at the dose of 0.04 mg/kg in 100 ml NS within 10 mins. DISCUSSION: Anxiety is more common among young patients, women, and people with negative experience of anesthesia or fear that arises just before the operation and anesthesia my lead to psychological trauma. Various agents such as phenothiazines, bezodiazepines, barbiturates, opioids, propofol, ketamine, dexmedetomidine or clonidine and antihistamines are used to relieve anxiety and provide sedation. Midazolam is a benzodiazepine,commonly used as an intravenous sedative agent for pre-operative sedation. Dexmedetomidine is an alpha-2 agonist which acts on adrenoreceptors in many tissues including the nervous, cardiovascular and respiratory systems. Unlike midazolam, dexmedetomidine does not affect the ventilatory response to carbon dioxide, it also produces analgesia which could potentially alleviate pain.

Rationale, baseline characteristics and methodology of the non-interventional VIVA study in postmenopausal osteoporosis

2014 ◽  
Vol 23 (01) ◽  
pp. 49-55
Author(s):  
L. C. Hofbauer ◽  
D. Felsenberg ◽  
M. Amling ◽  
A. Kurth ◽  
P. Hadji
Keyword(s):  
Quality Of Life ◽  
Postmenopausal Osteoporosis ◽  
Primary Outcome ◽  
Osteoporosis Treatment ◽  
Secondary Outcome ◽  
Matched Pairs ◽  
Fracture History ◽  
Baseline Characteristics ◽  
Study Inclusion

SummaryIt is important to understand compliance and persistence with medication use in the clinical practice of osteoporosis treatment. The purpose of this work is to describe the “intravenous ibandronate versus oral alendronate” (VIVA) study, a non-interventional trial to assess the compliance and persistence of osteopenic postmenopausal women with treatment via weekly oral alendronate or intravenous ibandronate (Bonviva®) every three months.4477 patients receiving ibandronate 3 mg i. v. quarterly and 1491 patients receiving alendronate 70 mg orally weekly were included in the study. Matched pairs of 901 subjects in each group were also generated. Matching was performed on the basis of age, body mass index, fracture history at study inclusion, prior treatment with bisphosphonates and the number of concomitant disorders. Secondary outcome measures of osteoporosis related fractures, mobility restriction and pain, analgesia, quality of life questionnaires as well as attitudes to medications were assessed. The primary outcome parameters of compliance and persistence will be tracked in these subjects.At baseline, the entire collectives differed significantly on body weight (less in ibandronate group), duration since osteo - porosis diagnosis (longer in ibandronate), and incidence of prior osteoporotic fracture (higher in ibandronate group). The matched-pairs differed only on mobility restriction and quality of life (both worse in ibandronate group).The results from the VIVA study trial will provide scientific rationale for clinical recommendations in the pharmacological treatment of postmenopausal osteoporosis.

Review of Constipation Treatment Methods with Emphasis on Laxative Foods

2020 ◽  
Vol 16 (5) ◽  
pp. 675-688
Author(s):  
Shamsi Abbasalizadeh ◽  
Behzad Ebrahimi ◽  
Aslan Azizi ◽  
Rogaye Dargahi ◽  
Maryam Tayebali ◽  
...  
Keyword(s):  
Well Being ◽  
Health Concern ◽  
Lifestyle Factor ◽  
Flax Seed ◽  
Lifestyle Modifications ◽  
Food Ingredients ◽  
Beneficial Effects ◽  
Daily Exercise

Constipation is a common public health concern experienced by all individuals during their life affecting the quality of life. In this paper, we aimed to provide an overview of the existing evidence regarding the role of food ingredients, including bran, prune, fig, kiwifruit, and flax-seed in constipation treatment. We searched Scopus, Pub Med, and Science Direct by using the keywords, “laxative foods” and “constipation”, for searching studies assessing laxative food ingredients and their beneficial effects on constipation treatment and/or control. Lifestyle modifications such as increasing dietary fiber and fluid intake and daily exercise are the proposed first line treatments for constipation. Optimizing ‘diet’ as an efficient lifestyle factor may contribute to the well-being of patients. The use of laxative food ingredients including bran, prune, fig, kiwifruit, flax-seed, probiotics, and prebiotics is a convenient alternative to cope with constipation. According to previous findings, laxative food ingredients could be considered as effective treatments for subjects suffering from constipation. Many studies have assessed the pharmacological and non-pharmacological roles of these ingredients in treating constipation, however, their importance has not been thoroughly investigated.

Modified Intermittent Fasting in Psoriasis (MANGO) trial: a two-arm pilot randomized controlled open cross-over study (Preprint)

2020 ◽  
Author(s):  
Lynda Grine ◽  
Niels Hilhorst ◽  
Nathalie Michels ◽  
Souheila Abbedou ◽  
Stefaan De Henauw ◽  
...  
Keyword(s):  
Complex Disease ◽  
Intermittent Fasting ◽  
Gut Health ◽  
Metabolic Markers ◽  
Regular Diet ◽  
Beneficial Effects ◽  
General Quality ◽  
Randomized Control ◽  
Psoriasis Severity

BACKGROUND Psoriasis is a complex disease associated with multiple comorbidities, including metabolic syndrome and leaky gut syndrome. Dietary lifestyle interventions have been reported to affect the disease in terms of lesional severity. It remains unclear how diets affect these comorbidities and the general health in psoriasis patients. Modified Intermittent Fasting (MIF) on 2 non-consecutive days has shown beneficial effects on metabolic parameters. A significant advantage of MIF over the currently investigated dietary changes is its feasibility. OBJECTIVE Here, we aim to study the effects of MIF on skin, gut and metabolic health in psoriasis patients. METHODS A two-arm pilot prospective cross-over randomized control trial (RCT) will be performed in 20 patients with psoriasis as a pilot study. Patients will be randomized 1:1 to either start with MIF and subsequent regular diet for 12 weeks each or to start with regular diet and subsequent MIF for 12 weeks each. The following parameters will be assessed: demographics, disease phenotype, medical and familial history, psoriasis severity, dermatology-specific and general quality of life, nutritional and physical habits, mental and intestinal health, intestinal and cutaneous integrity, inflammatory and metabolic markers, and satisfaction. RESULTS The aim is to uncover the effects of MIF on psoriasis severity and gut health integrity through clinical and molecular investigation. More precisely, we want to map the evolution of the different markers in response to MIF as compared to the regular diet, such as psoriasis severity, permeability and inflammation. CONCLUSIONS Understanding how dietary lifestyles can affect epithelial lineages such as the skin and gut, will greatly improve our understanding on the development of psoriasis and may pose a non-pharmacological venue for treatments. CLINICALTRIAL ClinicalTrials.gov, NCT04418791. Registered June 5 2020, https://clinicaltrials.gov/ct2/show/NCT04418791. Current protocol date/version: May 20 2020

scholarly journals Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1070
Author(s):  
Maike Wolters ◽  
Annkathrin von der Haar ◽  
Ann-Kristin Baalmann ◽  
Maike Wellbrock ◽  
Thomas L. Heise ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Treatment Duration ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Pufa Supplementation ◽  
Depressive Symptomology ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

scholarly journals Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis

2020 ◽  
Author(s):  
Karine E Manera ◽  
David W Johnson ◽  
Yeoungjee Cho ◽  
Benedicte Sautenet ◽  
Jenny Shen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Reported Outcomes ◽  
Randomized Trials ◽  
Primary Outcome ◽  
Median Number ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Inform Decision Making ◽  
Solute Clearance

Abstract Background Randomized trials can provide evidence to inform decision-making but this may be limited if the outcomes of importance to patients and clinicians are omitted or reported inconsistently. We aimed to assess the scope and heterogeneity of outcomes reported in trials in peritoneal dialysis (PD). Methods We searched the Cochrane Kidney and Transplant Specialized Register for randomized trials in PD. We extracted all reported outcome domains and measurements and analyzed their frequency and characteristics. Results From 128 reports of 120 included trials, 80 different outcome domains were reported. Overall, 39 (49%) domains were surrogate, 23 (29%) patient-reported and 18 (22%) clinical. The five most commonly reported domains were PD-related infection [59 (49%) trials], dialysis solute clearance [51 (42%)], kidney function [45 (38%)], protein metabolism [44 (37%)] and inflammatory markers/oxidative stress [42 (35%)]. Quality of life was reported infrequently (4% of trials). Only 14 (12%) trials included a patient-reported outcome as a primary outcome. The median number of outcome measures (defined as a different measurement, aggregation and metric) was 22 (interquartile range 13–37) per trial. PD-related infection was the most frequently reported clinical outcome as well as the most frequently stated primary outcome. A total of 383 different measures for infection were used, with 66 used more than once. Conclusions Trials in PD include important clinical outcomes such as infection, but these are measured and reported inconsistently. Patient-reported outcomes are infrequently reported and nearly half of the domains were surrogate. Standardized outcomes for PD trials are required to improve efficiency and relevance.

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