Premedication with midazolam in out‐patient general anaesthesia. A comparison with morphine‐scopolamine and placebo

Abstract

Strong premedication may prolong recovery and cause side-effects after short surgical procedures in general anaesthesia. To be operated without premedication may be unpleasant for the patient. Midazolam is a water-soluble benzodiazepine with rapid onset and short half-life. In a randomized study with 193 female patients, we compared the effects and side-effects of three different premedicants i.m.: midazolam, morphine-scopolamine (Mo-Scop) and placebo. Midazolam and Mo-Scop had an equal and significantly better effect than placebo on preoperative anxiety and alertness. Side-effects like nausea, dry mouth and prolonged recovery occurred significantly more often in the Mo-Scop than the midazolam or placebo groups. The midazolam-premedicated patients had significantly more amnesia compared with the other two groups. Only 3% of the patients would prefer no medication before anaesthesia, whereas 80% would prefer a combination of an anxiolytic and hypnotic premedication. Sixty-three percent of the patients would prefer a premedicant administered by injection. The results indicate that midazolam i.m. is an effective premedicant, with few side-effects, for short procedures in general anaesthesia.

Discomfort after Outpatient Abortion Using Paracervical Block: A Comparison between Two Opioids and One Non-Opioid Drug for Premedication

“…In the present investigation all three drugs, given as premedication, were associated with about the same frequency of emetic symptoms postoper atively. This is at variance with previous reports w'here morphine-scopolamine was reported to be associated with a considerably higher frequency of nausea and vom iting [7], This discrepancy may be explained by different anesthetic techniques, since the report of Reader and Brevik [7] dealt with general anesthesia. It is of course of greatest importance to measure the patients subjective reaction to premedication and not only rely on evalua tions of observers [8].…”

“…Premedication with mor phine-scopolamine was associated with a significantly longer period in the recovery room compared to midazo lam. a finding w'hich corresponds with that of other authors [7,15]. The clinical relevance for the observed difference in the present study is hard to determine, as the average times were 2.5 and 2.9 h, respectively.…”

“…Nausea and vomiting, common postoperative com plications, have been shown to be related to premorbid personality, duration of preoperative fasting, type of sur gery, anesthetic drugs and premedication [1][2][3][4][5]. The use of premedication before short surgical procedures is con troversial [6], Some authors claim that premedication should be avoided in order to prevent prolonged recov ery, however, others have found that most patients also prefer some sedation before minor surgery [7,8], Due to its analgesic and sedative properties, morphine-scopol amine is frequently used in many centers, although an increased frequency of nausea and vomiting as well as prolonged recovery, in comparison to no premedication or light benzodiazepine premedication, has been re ported [9], The aim of the present study was to analyze postoperative discomfort after outpatient abortion un der local anesthesia in relation to 3 different premedica tion drugs, two opioids and one non-opioid. …”

Preoperative ropivacaine infiltration in breast surgery

“…S INCE OPIOIDS produce a number of dose-dependent adverse effects such as nausea, vomiting and sedation (1), alternative analgesic regimes in the periand postoperative periods may reduce unwanted side effects. Administration of local anaesthetics in the surgical wound is a simple and attractive technique to improve postoperative pain relief.…”

Oral premedication one hour before minor gynaecological surgery — does it have any effect?

“…The role of premedication for the incidence of postoperative nausea and vomiting is complex (30)(31)(32). It is well known that opioid premedication may increase the risk (33,34). The role of benzodiazepines for the occurrence of postoperative nausea is still not fully investigated.…”