Assessment of a new hypnotic imidazo‐pyridine (zolpidem) as oral premedication.

Abstract

1 A new imidazo‐pyridine hypnotic (zolpidem 10 mg and 20 mg) was compared with placebo as premedication before general anaesthesia in female patients undergoing minor gynaecological surgery. Efficacy and tolerance before and after anaesthesia were assessed. Psychomotor testing was used to study recovery from anaesthesia. 2 Both doses of zolpidem produced good sedation pre‐operatively but only the higher dose was associated with anterograde amnesia. 3 Premorbid anxiety scores were low in the group of patients studied and were unaffected by either dose of zolpidem. 4 There were no significant effects on the course of anaesthesia. However, postoperatively there was a tendency for wake‐up to be delayed in those patients who received either dose of zolpidem. 5 Postoperative recovery, as indicated by tests of psychomotor performance, was noticeably delayed with a dose of 20 mg compared with placebo whilst psychomotor performance had returned towards baseline levels 3 h after wake‐up in those patients who had received placebo. The zolpidem 10 mg group was intermediate. 6 Zolpidem may be a suitable premedicant when hypnosis and amnesia only are required.

A comparison of midazolam and zolpidem as oral premedication in children, a prospective randomized double‐blinded clinical trial

“…13 Additionally, one study has demonstrated utility of zolpidem as oral premedication in adults prior to general anesthesia. 14 Blumer et al 15 reported no serious adverse events in a controlled trial of zolpidem in the treatment of insomnia in children with attention-deficit/hyperactivity disorder in children. Our hypothesis was that the medication profile of zolpidem makes it a promising premedication for use in children since a sleepy or sleeping child may not respond to anxiety triggers.…”

“…It has a very rapid onset of action, can be orally administered, and is rapidly metabolized and eliminated . Additionally, one study has demonstrated utility of zolpidem as oral premedication in adults prior to general anesthesia . Blumer et al reported no serious adverse events in a controlled trial of zolpidem in the treatment of insomnia in children with attention‐deficit/hyperactivity disorder in children.…”

Tonic GABAergic Inhibition of Sympathetic Preganglionic Neurons: A Novel Substrate for Sympathetic Control

“…A high proportion of the hemodynamic effects of diazepam were attributed to modulation of central pathways and may be due in part to contribution of these tonic receptors. Zolpidem in contrast had no significant effect on blood pressure in humans (Cashman et al, 1987) or in rats (Mailliet et al, 2001). Others report conflicting changes in RR intervals, depending on the dose of zolpidem administered but mainly due to a change in cardiac vagal tone, rather than on sympathetic outflow (Chen et al, 2005).…”

How sympathetic are your spinal cord circuits?

“…In fact the idea that this tonic inhibition could contribute to overall blood pressure changes is supported by our understanding of the haemodynamic effects in humans of the two modulators used here. Diazepam, which enhances tonic inhibition, causes hypotension and reduces muscle sympathetic activity (Kitajima et al, 2004) while zolpidem, which was without effect on tonic inhibition, does not cause changes in blood pressure in humans (Cashman et al, 1987). Tonic inhibition may also play a role in limiting the frequency of oscillatory activity in other brain regions such as hippocampus (Mann & Mody, 2010), and a component of the effect of bicuculline of rhythmic network activity in the spinal cord slice may due to in part to blockade of the tonic current (Pierce et al, 2010).…”