Buprenorphine and lorazepam

Abstract

Correspondence tion with oral lorazepam 2 4 mg, 2 hours preoperatively. induction of anaesthesia with fentanyl (2-5 pg/kg). droperidol (up to 70 pg/kg). sleep dose of either thiopentone or etomidate, alcuronium or atracurium. the passage of a cuffed orotracheal tube and maintenance of anaesthesia with oxygen and nitrous oxide with intermittent positive pressure ventilation of the lungs.Our experience has reinforced our opinion that monitoring of the electrocardiograph of all patients under anaesthesia is mandatory. This can present problems with the young or older uncooperative patient and the services of anaesthetists are frequently sought in these circumstances, often in situations remote from the operating theatres. A major difficulty with many current techniques of basal sedation is that of unpredictability. The patients may not be adequately sedated for the procedure to be undertaken, or they may become too severely depressed to be safely lelt unattended. One technique which overcomes some of these problems uses gauhahydroxybutyrate, a drug which is widely used in Europe but has enjoyed little or no popularity in this country.' Gammahydroxybutyrate used alone does not provide surgical anaesthesia. It has little or no analgesic action and any painful stimulus may provoke brisk reflex movement and may induce vomiting. It is, however, eminently suitable for provision of sedation for non-painful procedures, and has been shown to be a satisfactory agent to employ in cardiac catheterisation.2 Thirty chihiren presenting either for evoked response audiometry or for cerebral computerised axial tomography were d a t e d using the following technique. Their ages ranged between 2 months and 12 years.Children over a year old were premedicated with oral trimcpradnc tartrate 1.7 m a g and atropine 0.03 mg/kg up to a maximum of 0.6 mg.Children less than 12 months old did not receive any(1 mg/kg) followed immediately by gammahydroxybutyric acid (40 mg/kg) administered intravenously through a 25-gauge indwelling needle. A further increment of gammahydroxybutyric acid (10 mg/kg) was given intravenously, half an hour after induction if the examination was not nearing completion at that time. All patients breathed air except for a 2-year-old with a ventricular septa1 defect who was given 30% oxygen by face mask. Each child was observed continuously throughout the procedure. Full resuscitative facilities were always immediately available.The airway was maintained without any sign of obstruction in all but two patients. These two both had anatomical abnormalities of the upper airway. One had a very large tongue associated with Down's syndrome, while the other suffered from periodic airway obstruction caused by very large palatine tonsils. In both cases . the,obstruction was relieved by the insertion of a pharyngeal airway. Two other patients developed moderate bradycardia which responded to intravenous atropine.After the examination patients were nursed on their side in a recovery area until crying or speaking on stimulation. Fro...

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