Lorazepam in Children

Abstract

SUMMARYOne hundred patients aged 5-13yr were randomly allocated to four groups in a double-blind study of premedication. Drugs studied were lorazepam, diazepam and trimeprazine. A placebo group was included. All the drugs appeared satisfactory as premedicants. Lorazepam induced the most sedation immediately after surgery, but by 4 h lorazepam and diazepam appeared similar. Lorazepam produced better amnesia than the other drugs. There were no untoward side-effects and no cardiorespiratory depression in any group. Lorazepam appears a suitable premedicant for children.Lorazepam has been used successfully as an oral premedicant in adult patients (Paymaster, 1976; Dundee et al., 1977). Its desirable properties include anxiolysis (Harry and Richards, 1972; Maleet al., 1980), anterograde amnesia (Wilson and Ellis, 1973;Pandit, Heisterkamp and Cohen, 1976), minimal effects on cardiovascular and respiratory systems (Cormack, Milledge and Harming, 1976;Dundee, Johnston and Gray, 1976) and the long duration of action makes the timing of premedication less crucial (Fragen and Caldwell, 1976).In children (Boyd and Manford, 1973;Richardson and Manford, 1979;Beeby and Morgan Hughes, 1980) it is now accepted that the administration of premedication by mouth is safe, effective and preferred by the patient (Doughty, 1959). Lorazepam has been studied in children (Mundeleer, 1980) and appeared satisfactory. However, no comparison was made with an established drug.In the present study we have compared, in children, lorazepam, diazepam, trimeprazine and placebo as oral premedicants. PATIENTS AND METHODSOne hundred patients aged 5-13 yr were studied. The operations performed were mainly plastic surgical procedures, ENT operations or minor general surgical procedures. Children were drawn from three wards. Day cases were not included, nor were

What is the level of evidence for the amnestic effects of sedatives in pediatric patients? A systematic review and meta-analyses

“…Benzodiazepines used alone were compared to placebos in 17 studies [7,18,19,31–33,35,36,40,52,58,59,63, 64,66,68,69], twelve of which were included in the meta-analysis. The remaining trials were excluded because it was impossible to group the data [40,52,63] or there was an overall high risk of bias [64] or after the sensitivity analysis [35].…”

“…Benzodiazepines were compared to each other in 17 studies [7,18,27,29,31,39,41,43,53,54,55,57,59,61,62,64,67]. Six of these studies compared different benzodiazepines [18,39,43,53,57,62], six compared dosages [29,31,41,55,61,64], one compared the time of administration [7], and 4 compared routes [27,54,59,67].…”

“…Six of these studies compared different benzodiazepines [18,39,43,53,57,62], six compared dosages [29,31,41,55,61,64], one compared the time of administration [7], and 4 compared routes [27,54,59,67]. Only four studies found significant differences among groups: in one study, intravenous midazolam was more likely than intravenous diazepam to produce amnesia for pain, but there was no difference with regard for amnesia of events [39].…”

“…Benzodiazepines were compared to non-benzodiazepines in 13 studies [18,44,45,48,50,51,56–60,70,71]. In four studies, anterograde amnesia was significantly more likely when benzodiazepines were used than when nitrous oxide [50], antihistamines [45,48,60], or triclofos [48] were used.…”

“…The degree of amnesia can differ according to the drug, the measurement used to study memory, and the characteristics of the participants [11]. While in some studies, all participants presented complete anterograde amnesia for procedure [13–17], in other investigations, only a few patients failed to remember perioperative events [18,19]. New knowledge regarding the potential of different sedatives to produce amnesia would therefore be pivotal to the decision-making process that takes place when choosing a sedative regimen for a pediatric patient because young children can show uncooperative behavior even when sedated.…”