Intranasal midazolam versus intranasal dexmedetomidine as premedication in paediatric patients: A comparative study

: Preanesthetic medication is important among the paediatric patients undergoing surgeries. A good preanesthetic medication reduces the anxiety and the post-operative pain among paediatric patients. A randomised controlled trial was done to compare the two groups of Dexmedetomidine, and Midazolam given as preanesthetic medication intranasally.: Both the groups had comparable baseline values before premedication but there was a significant difference in the vital parameters of heart rate and systolic blood pressure after medication. The mean Parental Separation Anxiety Scale was found to be 1.4 ± 0.85 and 2.5 ± 0.98 among Dexmedetomidine and Midazolam group respectively. This was found to be significant (p < 0.001). Dexmedetomidine when given as preanesthetic medication intranasally significantly controls the vitals within the normal range and produces better parental separation anxiety scores and mask acceptance scores as compared to Midazolam.

Postoperative analgesic effects of Reiki therapy in bitches undergoing ovariohysterectomy

ABSTRACT: This study aimed to evaluate the effects of Reiki therapy on postoperative pain in bitches undergoing elective minimally invasive ovariohysterectomy (OVH). Thirty bitches were randomly assigned to three groups: Control, Placebo, or Reiki. All dogs received methadone as preanesthetic medication (PAM), meloxicam in the preoperative period, propofol for anesthetic induction, and isoflurane for anesthetic maintenance. Immediately after OVH, the dogs in the Reiki were submitted to a single session of Reiki therapy, dogs in the Placebo received simulated Reiki therapy from a non-therapist, and dogs in the Control received no treatment. All dogs were evaluated for pain using short-form Glasgow composite measure pain scale (CMPS-SF) and visual analog scale (VAS) before (M0) and 2 (M2), 4 (M4), 8 (M8), 12 (M12), and 24 hours (M24) after administration of PAM. Comparing the CMPS-SF scores between the groups, at M2 Reiki scores were lower than those of the Placebo and at M4 those in the Reiki were lower than those of the Control or Placebo groups. Comparing the VAS scores, at M4 and M8, Reiki scores were lower than those of the Control or Placebo groups. Additional analgesia (morphine 0.2 mg.kg-1 intramuscularly) was administered to three bitches in Control and to four bitches of the Placebo. Reiki did not require additional opioid analgesia in the postoperative period. It was concluded that Reiki therapy provided analgesic effect and contributed to improve postoperative comfort of bitches submitted to elective OVH.

Effect of Midazolam on Vestibular Signs in Two Geriatric Dogs with Vestibular Disease

ABSTRACT An abrupt balance impairment, including leaning, falling, and rolling, occurred after IV administration of 0.2 mg/kg midazolam as a preanesthetic medication in two geriatric dogs with a history of nystagmus and head tilt. In the second case, leaning, falling, and rolling recurred after recovery from general anesthesia but gradually ceased after IV administration of 0.01 mg/kg flumazenil. These two cases suggest that the IV administration of midazolam was responsible for the balance impairment in dogs who were suspected to have idiopathic peripheral vestibular disease.

Oral versus intramuscular midazolam for paediatric preanaesthetic medication

Background: The need for effective preanesthetic medication in children is obvious and midazolam has proven to be one reliable choice. The aim of the present study was to compare the efficacy, acceptability and reliability of the oral and intramuscular routes of administration of midazolam towards paediatric preanesthetic medication at various doses.Methods: Hundred eligible patients in the age group of 1 to 10 years undergoing ambulatory or routine planned, minor or major surgery during study period were allocated to one of the four groups of 25 participants each, formed on the basis of premedication they received. Haemodynamic parameters, level of sedation and anxiety and induction score were noted before premedication and after each 15 minutes interval for next 45 minutes in all the four groups. Postoperative assessment included sleep level, anterograde amnesia, picture recall and occurrence of complications.Results: The sedative and anxiolytic effects were observed to be maximum at 45 minutes after premedication in all the four groups and better sedation, anxiolysis and quality of induction were achieved with higher doses for both oral as well as intramuscular routes. Postoperatively, the sleep level did not increase with higher dose and 64% patients were awake with 0.75 mg/kg oral midazolam. The sleep level was more with higher dose with the Intramuscular route, with 60% patients feeling drowsy with 0.1mg/kg dose. 0.75 mg/kg dose showed better anterograde amnesia (64%) than 0.5 mg/kg (28%), while it was present in 64% participants premedicated with 0.8 mg/kg intramuscular does and 72% in 0.1 mg/kg intramuscular dose.Conclusions: Intramuscular midazolam at 0.1 mg/kg dose seems to be the ideal dose and route for paediatric preanesthetic medication, with oral midazolam at 0.75 mg/kg to be considered an effective and acceptable alternative.

Evaluation of Postoperative Analgesia of DexmedetomidineAlone or Associated to Morphineas Premedicants in Bitches Undergoing Ovariosalpingohisterectomy

Background:Elective ovariossalpingohysterectomy is a common surgery that causes mild to moderate pain. Aiming at the treatment of pain in these patients, analgesia should be balanced from pre-anesthetic, transoperative and postoperative medication, with α-2-agonists and opioids being commonly used, especially dexmedetomidine that has sedation, relaxation muscle and analgesia. The aim of the present study was to evaluate the postoperative analgesic efficacy of dexmedetomidine alone and associated with morphine when used in the preanesthetic medication of bitches submitted to elective ovarian oysterectomy using the modified Glasgow pain scale and the Melbourne pain scale.Materials,Methods & Results:Twenty bitches were used in this study, all of them submitted to ovarian oysterectomy, and were clinically healthy according to laboratory and clinical exams. During the experiment, bitches were randomly distributed into two groups, which received preanesthetic medication (MPA) with 5μg/kg dexmedetomidine alone (GD) or associated with 0.3 mg/kg morphine (GDM) intramuscularly (IM). In both groups, anesthetic induction with dose-effect propofol was performed and maintained with isoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weight of the animal and maintained on spontaneous ventilation. After stabilization of the patient the surgery was started, which lasted 45 min. The bitches were evaluated by the Modified Glasgow Scale (GSM), the Melbourne Scale (MS) and the Dobbins Sedation Scale (DS), previously administered MPA (T0) and the others performed in 1h (T1), 2h (T2), 4h (T3), 8h (T4), 12h (T5) and 24h (T6) after extubation. If the GSM score was greater than the value of 3.3 an analgesic rescue of 0.5 mg/kg of morphine intramuscularly would be administered. An increase in the scoring of pain scales in both groups can be observed from the T1, with significant difference only of the T1 in relation to the T0 in the GSM of the GDM. Two rescues were performed in T1 of GD and three rescues in T1 and a rescue in T3 of GDM. There was no significant difference between the groups in relation to this variable, as a result of P = 0.62.Discussion:Based on the results of this study, dexmedetomidinedoes not have adequate analgesic effect for use in preemptive analgesia of bitches submitted to elective OSH due to the high number of analgesic rescues. A small increase in GSM and MS scores from T1 can be expected compared to values prior to the surgical procedure since there was no nociceptive stimulation. This increase was only significant in T1 of GDM, moment of greatest rescue number (n = 3). The absence of significant difference between the groups proves that the analgesic effect of dexmedetomidine was not potentiated by the association with morphine at the dose and route used in this experiment. Although morphine is widely used and proven to be effective for the surgical procedure of ovariossalpingohysterectomy, both when used alone and in combination with other drugs, this fact has not been proven in the present study. This fact may have occurred due to the low dose of dexmedetomidine used or due to its short duration. Therefore, dexmedetomidine at the dose used as preanesthetic medication did not produce an adequate analgesic effect in the postoperative period of bitches submitted to elective ovariossalpingohysterectomy. The effects of the same were not potentiated by the association with morphine, at the dose used. Not being recommended for postoperative analgesic control of electiveovariossalpingohysterectomy in bitches. However, further studies are needed to better evaluate the analgesic effect of this α-2-agonist.

Evaluation of Cardiorespiratory Effects of Dexmedetomidine Isolated and Associated With Morphine in Bitches Submitted to Elective Ovariossalpingohisterectomy under General Inhalation Anesthesia

Background: Elective ovariossalpingohysterectomy is one of the most accomplished surgeries in veterinary practice, presenting moderate degree of pain. Aiming at balanced anesthesia, α2-agonists have been increasingly used, with dexmedetomidine being characterized by its sympatholytic, sedative, analgesic properties and synergism with opioids, benzodiazepines and other drugs. The objective of this study was to evaluate the effects of dexmedetomidine alone and associated with morphine under the cardiovascular, respiratory and body temperature variables in the pre and trans-operative periods in bitches submitted to elective ovariossalpingohisterectomy under general inhalation anesthesia.Materials, Methods & Results: Sixteen bitches were used in this study, which were submitted to elective ovariossalpingohisterectomy, all of which were clinically healthy based on clinical and hematological results. The animals were randomized into two groups, in which intramuscular dexmedetomidine alone and 5 µg/kg (DG) and 0.3 mg/kg morphine (GDM). In both groups, anesthesia was induced with propofol administered and maintained with isoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weight of the animal and kept under spontaneous ventilation. After stabilization of the patient, the surgical procedure started, which lasted 45 minutes. The parameters evaluated were heart rate (HR), respiratory rate (ƒ), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body temperature (TºC), expired isoflurane concentration , partial carbon dioxide gas pressure (ETCO2) and oxygen saturation in hemoglobin (SatO2), which were measured before and after the application of preanesthetic medication and at specific surgical times: 5 and 15 min after anesthetic induction; during the incision of the skin; muscle incision; ligation of the left ovary; ligation of the right ovary; ligation of the uterine body; laparorrafia; suture and at the end of surgery. A significant difference was observed between the groups in respiratory rate, systolic blood pressure, body temperature, partial pressure of carbon dioxide, saturation of oxygen in hemoglobin and pH, only in some times evaluated. GDM bradycardia occurred 30 min after preanesthetic medication; acidemia and mild to moderate hypercapnia in both groups, being more pronounced in GDM, although without statistical difference, and hypothermia. The concentration of isoflurane expired in both groups was higher during the muscle incision until laparorrhaphy compared to the other surgical times.Discussion: The results of this study show that there was adequate analgesia during the elective ovarian resection procedure, considering that the values found during the surgery were relatively lower than the baseline values and within the physiological limits for the species, even during the moments of greater painful stimulation, such as ligation of the ovaries and ligation of the uterine body. In the GDM group, bradycardia occurred after 30 min of pre-anesthetic medication, but its occurrence was transient and without interfering with blood pressure, increasing to the next evaluation time and stabilizing in physiological values for the species. There was also a gradual reduction in respiratory rate in both groups over time, with an increase in PaCO2 in GDM at the end of surgery, indicating respiratory depression, as well as a reduction in pH in both groups at all times.

EFFECT OF DEXMEDETOMIDINE ON DOSE REQUIREMENT OF PROPOFOL AND THIOPENTONE INDUCTION IN PATIENTS UNDER GENERAL ENDOTRACHEAL ANESTHESIA

Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance.Methods: A double-blinded randomized controlled study was conducted during the year 2014–2015 among 120 patients aged 18–55 years with American Society of Anesthesiologists’ physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) - saline infusion before induction with propofol, group DP - dexmedetomidine infusion before induction with propofol, group ST (control group) - saline infusion before induction with thiopentone, and group DT - dexmedetomidine infusion before induction with thiopentone.Results: The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001).Conclusion: Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone.