Sedation of Children as Out-patients for Dental Operations under General Anaesthesia

Goulding, Roy; Helliwell, P. J.; Kerr, A. C.; Wilkin, Eileen

doi:10.1136/bmj.1.5023.855

Cited by 13 publications

(5 citation statements)

References 3 publications

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“…That the anxiolytic effect was less in younger children agrees with earlier studies on premedication in children [1,5,[10][11][12]. The present study further supports the idea [5] that children should be divided into different age categories for studies of premedication.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Chloral Hydrate and Midazolam by Mouth as Premedicants in Children Undergoing Otolaryngological Surgery

Saarnivaara

Lindgren

Klemola

1988

British Journal of Anaesthesia

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Chloral hydrate 25, 50 or 75 mg kg-1 or midazolam 0.4, 0.5 or 0.6 mg kg-1, all given by mouth in combination with atropine 0.03 mg kg-1, were compared as premedication in 248 children in a randomized, double-blind study. Chloral hydrate was significantly less palatable than midazolam. The anxiolytic effect of chloral hydrate 75 mg kg-1 was "good" in children younger than 5 yr, whereas the other doses of chloral hydrate, and all doses of midazolam, provided only "fair" anxiolysis in this age group. All doses of both premedicants provided good anxiolysis in the older children. A satisfactory antisialogogue effect was seen in 83-90% of each group. About 20 min after extubation, restlessness was observed in 15-25% of the younger children premedicated with chloral hydrate 25 mg kg-1 or with midazolam 0.4 or 0.6 mg kg-1. The mean total recovery score (0-10) based on activity, ventilation, heart rate, conscious level and colour ranged between 5.8 and 6.8 at 10 min and between 9 and 9.5 at 70 min after extubation in all groups. Midazolam 0.5 mg kg-1 is recommended for children less than 5 yr of age and midazolam 0.4-0.5 mg kg-1 for older ones. Chloral hydrate 75 mg kg-1 provided good anxiolysis in both age groups; however, it was less palatable than the midazolam.

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Section: Discussionsupporting

confidence: 92%

Comparison of Chloral Hydrate and Midazolam by Mouth as Premedicants in Children Undergoing Otolaryngological Surgery

Saarnivaara

Lindgren

Klemola

1988

British Journal of Anaesthesia

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“…Those cases falling in any of the first four categories were regarded as showing satisfactory demeanour and those in the latter three categories as showing unsatisfactory demeanour. This broad classification seems to correspond with that used in previously published trials in which the demeanour of the children was described as "calm", "disturbed" or "turbulent" (Goulding et al, 1957;Rollason, 1959) and at first sight there appears to be little difference between the four methods of premedication. However, the umbrella term "calm" conceals important differences between groups.…”

Section: Demeanour In the Anaesthetic Room (Table Ii)supporting

confidence: 75%

ORAL PREMEDICATION IN CHILDREN WITH TRIMEPRAZINE: The Effect of varying Dosage and Timing

Davies¹,

Doughty²

1966

British Journal of Anaesthesia

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In the belief that both dosage and timing of premedication may be important, a double blind trial was carried out on 484 children undergoing adenotonsillectomy receiving trimeprazine with hyoscine according to four differing methods within the limits suggested by the manufacturers' instructions. Thus trimeprazine was given in doses of 1 or 2 mg/lb. (2.2 or 4.4 mg/kg), 1 or 2 hours pre-operatively. The most intense action of the drug was evident when the stronger dose was given 2 hours before operation. However, this was associated with a comparative deterioration in behaviour of the children in the anaesthetic room and a higher frequency of undue postoperative pallor. Possible advantages of the more intense action of trimeprazine are salivary suppression and amnesia. Postoperative vomiting was infrequent with all four methods of premedication. A plea is made for the more critical evaluation of premedicant drugs.

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“…Lindgren et al found triclofos 70 mg/kg superior to diazepam 0.25 mg/kg or flunitrazepam 0.02 mg/kg in children under five years. 8 Goulding et al, in 1957, remarked on an increase in turbulent and disturbed behaviour in children under six years receiving methylpentynol, butobarbitone and chlorpromazine when compared with children older than six years in whom premedication was almost unnecessary. 9 Alprazolam is a relatively new benzodiazepine used in children with anxiety disorders.…”

Section: Discussionmentioning

confidence: 99%

“…8 Goulding et al, in 1957, remarked on an increase in turbulent and disturbed behaviour in children under six years receiving methylpentynol, butobarbitone and chlorpromazine when compared with children older than six years in whom premedication was almost unnecessary. 9 Alprazolam is a relatively new benzodiazepine used in children with anxiety disorders. 10 There is no report of its use in children as a premedicant.…”

Section: Discussionmentioning

confidence: 99%

Oral Premedication in Children: A Comparison of Chloral Hydrate, Diazepam, Alprazolam, Midazolam and Placebo for Day Surgery

Anderson

Exarchos

Lee

et al. 1990

Anaesth Intensive Care

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A double-blind study consisting of 339 randomly selected children investigated the effects of several premedicants on the preoperative and postoperative behaviour of children who underwent day-stay surgery. Patients were allocated into two groups. Group 1 consisted of 165 children aged between 6 and 47 months. Group 2 consisted of 174 children aged four years and older to a body weight of 50 kg. Each child received one premedicant. Both groups included alprazolam 0.005 mglkg, midazolam 0.3 mglkg and placebo. In addition Group 1 included chloral hydrate 40 mglkg and Group 2 diazepam 0.25 mglkg. Chloral hydrate produced superior conditions (more patients calm or asleep) at induction of anaesthesia. Postoperative behaviour and incidence of vomiting were similar for all drugs. No premedicant reduced anxiety in the older group. The time to awaken postoperatively with diazepam was longer than with placebo. Alprazolam and midazolam were unpalatable for children over four years and conferred no advantage over placebo.

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Sedation of Children as Out-patients for Dental Operations under General Anaesthesia

Cited by 13 publications

References 3 publications

Comparison of Chloral Hydrate and Midazolam by Mouth as Premedicants in Children Undergoing Otolaryngological Surgery

Comparison of Chloral Hydrate and Midazolam by Mouth as Premedicants in Children Undergoing Otolaryngological Surgery

ORAL PREMEDICATION IN CHILDREN WITH TRIMEPRAZINE: The Effect of varying Dosage and Timing

Oral Premedication in Children: A Comparison of Chloral Hydrate, Diazepam, Alprazolam, Midazolam and Placebo for Day Surgery

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