Comparative Study of Lorazepam and Trimeprazine for Oral Premedication in Paediatric Anaesthesia

Peters, Colin; Brunton, Jenifer Telfer

doi:10.1093/bja/54.6.623

Cited by 22 publications

(8 citation statements)

References 14 publications

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“…Anterograde amnesia was evaluated in all studies, whereas retrograde amnesia was assessed in only 10 studies [7,33,35,37,39,40,52,54,60,66]. Amnesia was evaluated mainly by measuring patient recall of pictures/toys and events, except for the six trials [13,41,16,19,38,42].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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. However, one study showed the anterograde amnesia was less likely to occur when benzodiazepines were used than when butorphanol was used [71].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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BackgroundStudies have suggested that benzodiazepines are amnestic drug par excellence, but when taken together, what level of evidence do they generate? Are other sedatives as amnestic as benzodiazepines? The aim of this study was to assess the level of scientific evidence for the amnestic effect of sedatives in pediatric patients who undergo health procedures.MethodsThe literature was searched to identify randomized controlled trials that evaluated anterograde and retrograde amnesia in 1-19-year-olds who received sedative drugs during health procedures. Electronic databases, including PubMed, Scopus and Cochrane Library besides clinical trial registries and grey literature were searched. Two independent reviewers performed data extraction and risk of bias assessment using the Cochrane Collaboration's Tool. The meta-analyses were performed by calculating relative risk (RR) to 95% confidence intervals (CI). The quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach.ResultsFifty-four studies were included (4,168 participants). A higher occurrence of anterograde amnesia was observed when benzodiazepines, the most well-studied sedatives (n = 47), were used than when placebo was used (n = 12) (RR = 3.10; 95% CI: 2.30–4.19, P<0.001; I2 = 14%), with a moderate level of evidence. Higher doses of alpha2-adrenergic agonists (clonidine/dexmedetomidine) produced more anterograde amnesia than lower doses (n = 2) (RR = 1.83; 95% CI: 1.03–3.25; P = 0.038; I2 = 0%), with a low level of evidence; benzodiazepines’ amnestic effects were not dose-dependent (n = 3) (RR = 1.54; 95% CI: 0.96–2.49; P = 0.07; I2 = 12%) but the evidence was low. A qualitative analysis showed that retrograde amnesia did not occur in 8 out of 10 studies.ConclusionsIn children, moderate evidence support that benzodiazepines induce anterograde amnesia, whereas the evidence for other sedatives is weak and based on isolated and small studies. Further clinical trials focused on the amnesia associated with non-benzodiazepine sedatives are therefore needed.Trial registrationPROSPERO CRD42015017559.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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“…Increasing the dose causes excessive and prolonged post-operative drowsiness which is not appreciated by many [12]. It is more humane to give sedating dose of ketamine by intramuscular injection than to struggle with a distressed 4 Subanaesthetic Doses of Intramuscular Ketamine and crying child.…”

Section: Discussionmentioning

confidence: 99%

Premedication in Hyperirritable Children Using Subanaesthetic Doses of Intramuscular Ketamine

Khanduri

1999

Medical Journal Armed Forces India

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This study was conducted to highlight the role of intramuscular Ketamine in subanaesthetic doses as a premedicant in highly uncooperative children. Forty children between 1-7 years of age with the highest anxiety level as assessed pre-operatively, were divided into two equal groups. Children in group'A' received 2 mg/kg and those in group 'B' received 4 mg/kg of intramuscular ketamine, 10 min before induction of anaesthesia. The degree ofsedation was observed after 5 min and their response to separation from parents and response to venepuncture was assessed. They were also observed for their post-operative state. It was observed that the children in group 'B' had uniform and predictable sedation (100%) compared to 75% in group'A'. Response to separation and intravenous access in group 'B' was more favourable (100%) compared to 65% and 75% respectively in group 'A'. Induction and recovery were smooth in both the groups. No incidence of emergence delirium was recorded in any group. It is concluded that preanaesthetic medication and route of administration in infants and young children should be individualised based on their different anxiety levels. Intramuscular ketamine in subanaesthetic dose of 4 mglkg, is found to be an ideal premedicant in irritable and uncooperative group of paediatric patients. MJAFI 1999; 55 : 45-48.

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“…For example, lorazepam has generally been reported to provide poor sedation, while its anticonvulsant properties make it a preferred agent for acute seizure disorders in children. [83][84][85][86] Lorazepam has been associated with myoclonus and other adverse effects in low-birthweight infantsJ8?88] Studies have reported an increased frequency of complications and endotracheal intubation in chil- a The lack of recent comprehensive data on morphine and meperidine precludes an accurate assessment of the serious complications associated with their use for conscious sedation in children.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Comparative Review of the Adverse Effects of Sedatives Used in Children Undergoing Outpatient Procedures

D'Agostino

Terndrup

1996

Drug Safety

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Children often fear medical procedures and interventions. Sedative agents enhance the care of these children who undergo outpatient procedures by decreasing anxiety, increasing cooperativity, and providing amnesia. Although higher dosages and intravenous administration of sedatives often produce improved sedation, adverse effects and complications are more frequent. The goals of therapeutic efficacy and safety must be balanced in all patients. The presence or anticipation of anxiety and pain helps in deciding whether to use a sedative alone, or a regimen also providing analgesia. The patient's clinical cardiorespiratory or neurological status, other relative contraindications, the duration of the intended procedure, and the presence or absence of an intravenous line will help in choosing specific drugs. Drug complications are a common cause of adverse events in patients. The combination of a sedative and analgesic, especially a benzodiazepine and an opioid given intravenously, is associated with a higher risk of serious complications. The practitioner responsible for the administration of a sedative to a child must be competent in its use and have the ability to detect and manage complications. Patients who are deeply sedated should be continuously monitored and observed by an individual dedicated to this task. Vital signs and oxygen saturation should be documented at frequent intervals and the patient should be appropriately monitored until discharge criteria have been met. The risk of serious complications with these agents may be reduced with vigorous monitoring and a judicious choice of dosage.

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Comparative Study of Lorazepam and Trimeprazine for Oral Premedication in Paediatric Anaesthesia

Cited by 22 publications

References 14 publications

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

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

Premedication in Hyperirritable Children Using Subanaesthetic Doses of Intramuscular Ketamine

Comparative Review of the Adverse Effects of Sedatives Used in Children Undergoing Outpatient Procedures

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