Oral Premedication in Children

Abstract

In view of the current interest in the subject of oral premedication in children it seemed desirable to stage a blind controlled clinical trial of drugs recently recommended by various authors. Pecazine has been recommended by Corssen and Allen (1958) and by Green (1959); trimeprazine by Cope and Glover (1959) and by Gunner and Fox (1960); and methylpentynol by Rendell (1954), Gusterson (1955) and by Kelsall (1957). In this trial the drugs were ordered to be administered 1 hour before operation in accordance with the dosage given in table I. As a salivary suppressant, hyoscine hydrobromide was mixed with each of the sedative drugs and, to provide a control, a blank solution containing hyoscine-only was used. The effects of the four premedications were studied on 480 children aged 2 to 12 undergoing adenotonsillectomy or other minor nose and throat surgery. The premedications were allocated at random and the bottles containing the drug solutions were labelled with code letters which were changed five rimes during the trial. The identification of the code was known only to the hospital pharmacist. The method of anaesthesia was intravenous thiopentone 50 mg/stone (7.9 mg/kg), suxamethonium, oral intubation, nitrous oxide, oxygen and halothane 1 per cent. Each child was seen personally by the writer on the evening before operation, the method of induction of anaesthesia explained to him and a promise elicited to hold the hand quite still during venepuncrure. All the anaesthetics were given by the author. Palatability of premedication (table II). The solutions were flavoured with a sweet syrup and oil of peppermint. The latter was added primarily in an attempt to disguise the charac-80

Oral midazolam compared with diazepam‐droperidol and trimeprazine as premedicants in children

“…Furthermore, there produce sleep in the majority of younger patients is evidence that the frequency of crying and when used as a premedicant (18,21). There is probably struggling at induction is increased by the use of this synergism between the sedative properties of drug (31,38,39). While Phillips et al (32) and Layfield droperidol and diazepam, the latter having been et al (40) showed that the frequency of satisfactory noted to produce a greater sedative effect at anxiolytic sedation with trimeprazine could be improved by doses than other benzodiazepines (27).…”

“…Premedication with comparable anxiolysis on arrival at the anaesthetic larger doses of trimeprazine (4.0 mg·kg −1 ) has been room; however, anxiolysis was superior in the found to improve preoperative conditions by midazolam group at induction of anaesthesia. This increasing the proportion of children who were may be explained by the fact that butyrophenones, asleep or drowsy in the anaesthetic room (31,39); such as droperidol, are relatively ineffective against however, this was associated with a significantly acute situational anxiety such as that present during prolonged postoperative recovery time (21,39-41). induction of anaesthesia (28).…”

“…Despite attempts to reduce stress by minimizing Droperidol is a substituted butyrophenone closely hospital stay (8) and avoiding parental separation resembling haloperidol and certain phenothiazine (42), psychological trauma and personality changes derivatives. It has been used alone (29,30), with may occur in children after stressful experiences diazepam (21), trimeprazine (31) and opioids (14,29, during hospitalization, anaesthesia and surgery (8,32). The preoperative effects of droperidol alone were 10,39,[43][44][45][46].…”

Influence of Oral Atropine or Hyoscine on the Absorption of Oral Diazepam

“…It is conceivable that several other drugs with an absorption pattern similar to diazepam could be administered with an anticholinergic without effect on the rate of absorption, provided both drugs are administered orally at the same time. The satisfactory results of combining a sedative-hypnotic drug with an anticholinergic as oral premedication in children (Joseph and Vale, 1960;Doughty, 1962;Gordon and Turner, 1969) support this view. However, drug interactions in gastrointestinal absorption may be very complex, involving several mechanisms, so that the results of this study should be extended to other drugs with caution.…”