cOMPARISON OF FLUNITRAZEPAM AND DIAZEPAM FOR ORAL PREMEDICATION IN OLDER CHILDREN

Richardson, F.J.; Manford, Margaret L.M.

doi:10.1093/bja/51.4.313

Cited by 28 publications

(14 citation statements)

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“…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].…”

Section: Resultsmentioning

confidence: 99%

“…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].…”

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%

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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“…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.…”

Section: Discussionmentioning

confidence: 99%

Lorazepam in Children

Burtles¹,

Astley

1983

British Journal of Anaesthesia

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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

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“…Studies in children have been limited to its use as a premedication. It appears that flunitrazepam is an effective premedicant in both adults and children (Kanto et al 1979b;Lindgren et al 1979;Richardson & Manford 1979).…”

Section: Use In Pregnancy and In Childrenmentioning

confidence: 99%

Clinical Pharmacokinetics of the Newer Intravenous Anaesthetic Agents

Davis

Cook

1986

Clinical Pharmacokinetics

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In the last 15 years the role of opioids in anaesthesia management has undergone dramatic change. Initially used as premedicants, or adjuvants to inhalation anaesthetic agents or as analgesics for postoperative pain relief, narcotics have now evolved into primary anaesthetic agents, primarily because of their ability to maintain cardiovascular stability especially in patients with compromised myocardial function. Sufentanil, alfentanil, and lofentanil are 3 new synthetic congeners of fentanyl. Sufentanil and alfentanil afford not only the haemodynamic stability but also the desirable anaesthetic properties of analgesia, and unconsciousness. Their major advantage lies in their pharmacokinetic behaviour; a rapid onset of action and short elimination half-life, allowing for greater flexibility in anaesthetic management. Sufentanil's pharmacokinetic profile is consistent with a 2-compartment model. Its elimination half-life is 149 minutes and its clearance is 11.3 ml/min/kg. Alfentanil's pharmacokinetic profile has been described by both 2- and 3-compartment models. Its distribution and redistribution are rapid, with an elimination half-life of 83 to 137 minutes and a clearance of 4.37 to 6.47 ml/min/kg in adult patients. Lofentanil, however, is an extremely long-acting narcotic analgesic. Presently, its use is justified only when prolonged mechanical ventilation is anticipated. Etomidate, a carboxylated imidazole, is rapidly distributed within a central compartment and then to peripheral compartments; its slow distribution and terminal elimination half-lives are 28 and 273 to 330 minutes, respectively, and its clearance (11.6 to 25 ml/min/kg) is equal to its hepatic plasma flow. Its ability to maintain cardiovascular stability in patients with compromised myocardial function make it a useful induction agent. However, reports of increased mortality and inhibition of steroidogenesis in patients receiving either single injections or constant infusions have created controversies regarding its use. Minaxolone is a water-soluble steroid whose pharmacokinetic profile is consistent with a 2-compartment model. Distribution is rapid with a mean half-life of 2.1 minutes and an elimination half-life of 47 minutes. There do not appear to be any cumulative effects. Plasma levels on recovery were similar in those patients receiving single bolus or continuous infusions. Midazolam and flunitrazepam are two new benzodiazepines. As a class of drugs, benzodiazepines provide the pharmacological properties of anxiolysis, sedation, hypnosis, muscle relaxation, amnesia and anticonvulsant activity.(ABSTRACT TRUNCATED AT 400 WORDS)

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cOMPARISON OF FLUNITRAZEPAM AND DIAZEPAM FOR ORAL PREMEDICATION IN OLDER CHILDREN

Cited by 28 publications

References 20 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

Lorazepam in Children

Clinical Pharmacokinetics of the Newer Intravenous Anaesthetic Agents

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