A. Rochette

Comparaison du midazolam et du flunitrazépam en prémédication par voie rectale chez le nourrisson

The present study aimed to assess the pharmaco-clinical profile of infants premedicated with rectal midazolam. The results were compared with those of a reference drug, flunitrazepam. Infants undergoing minor surgery were divided into three groups : group A (n=30), with a mean age of 15.8±13.2 months and a mean weight of 8.6±3.3 kg, receiving 0.33 mg · kg−1 flunitrazepam; group B (n=15), with a mean age of 11.2±10.7 months and a mean weight of 9.3±3.1 kg, receiving 0.3 mg · kg−1 midazolam; and group C (n=30), with a mean age of 15.5±9.1 months and a mean weight of 10.7 ±2.5 kg, receiving 0.4 mg · kg−1 midazolam. An aqueous solution of each drug was administered with atropine sulfate (0.02 mg · kg−1) 20 min prior to induction of anaesthesia. The drug was well tolerated in 84 % of cases. Statistically significant haemodynamic changes consisted of: a 9 c · min−1 decrease in heart rate (p <0.05) and a 12 mmHg decrease in systolic and diastolic blood pressures (p <0.05) in group C; a 6 mmHg decrease in systolic blood pressure (p <0.05) in groupe B. The tranquillizer action was either excellent or good in 93 % of groups B and C compared with only 40 % in group A (p <0.001 in both cases). Somnolence was attained in 60 % of group A, 26.6 % of group B and 30 % of group C. A mask was much better accepted in group C (86.6 %) than in group B (66.6 %; p <0.05) or in group A (36.6 %; p <0.01). Therefore, midazolam given rectally at 0.4 mg · kg−1 was better than flunitrazepam, because of a greater therapeutic effect for an equivalent rate of side effects.

BROMOCRIPTINE INHIBITION OF HYPERPROLACTINEMIA DURING SURGERY

Abstract. The material included two groups of 10 women undergoing diagnostic laparoscopy. General anesthesia was administered by injection of 0.1 mg fentanyl followed by infusion of propanidide‐succinylcholine. The control group received no medication prior to surgery, whereas patients in the experimental group were given 5 mg bromocriptine per os. Blood samples for prolactin determinations were drawn as the patients were placed on the operating table and immediately following surgery. The association of anesthesia and surgery caused prolactin levels to rise from 10.9±3.5 to 168+18.7 ng.ml−1 in the control group (p <0.001) and from 3.5±0.5 to 7.5±1.1 ng.ml−1 in the test group (p<0.001). A significant difference was noted between the two groups for their pre‐ and postoperative levels and prolactin response (p<0.05, p<0.001 and p<0.001, respectively). The proposed protocol successfully suppresses prolactin increase during surgery and constitutes a useful tool for investigating hyperprolactinemia and its consequences during this same time. Possible applications include in vitro fertilization and studies on prolactin receptor‐bearing tumors.

Le midazolam comme agent de prémédication intramusculaire: Définition des posologies en fonction de l'âge

In order to determine the optimal posology of midazolam as an intramuscular premodication according to age, three groups of 25 patients were constituted. The mean age of group 1 receiving 0.12 mg . kg-1, was 31.6 +/- 7.3 years, the mean age of group 2, receiving 0.16 mg . kg-1, was 31.8 +/- 7.6 years and the mean age of group 3, receiving 0.10 mg . kg-1, was 73.8 +/- 8.2 years. The results were the following: sedation of anxiety was good or very good in respectively 80 p. 100 and 95 p. 100 of patients in groups 2 and 3, versus 48 p. 100 in group 1; a reversible sleep was obtained in 18 p. 100 of cases in group 2 and 44 p. 100 in group 3; no patient was asleep in group 1; overall clinical results were found satisfactory in 80 p. 100 of patients in group 2, and 95 p. 100 in group 3 versus 48 p. 100 in group 1. Neither incident nor adverse reactions were to be reported. There was no modification in respiratory rate; the slight hemodynamic modifications which appeared can be attributed to atropine sulfate administered together with midazolam. In conclusion, the appropriate posology of midazolam administered intra-muscularly decreases with age, from 0.16 mg . kg-1 for the thirty years old patients to 0.10 mg . kg-1 for the seventy years old patients. Midazolam exhibits a remarkable cardiorespiratory neutrality event in the elderly.

Le midazolam intraveineux comme agent hynotique d'une neuroleptanalgésie

42 patients are given, before any neuroleptanalgesia mixture, 0.2 mg · kg−1 of IV midazolam. Pain during the injection is reported in two cases. The loss of conversation onset is 38 ± 18 seconds and of the lid reflex is 75 ± 43 seconds. The only clinical variation is a drop of the systolic blood pressure from 121.4 ± 19.5 mmHg to 114.8 ± 19.6 mmHg, p <0.005. Apnea occurs in nine patients (21 per cent). It lasts 29 ± 35 seconds. But in a steady ventilatory state, the minute ventilation, the tidal volume and the respiratory rate are unchanged from the control values. At the end of the procedure, the answer to simple orders and the space and time orientation come back after 10 ± 13 minutes and 33 ± 28 minutes. The punctured vein is free of any reaction up to the third day. In conclusion, midazolam is a useful hypnotic drug mainly in the debilitated patient.