Summaey And Conclusions
The present study was undertaken to evaluate the tranquillizers objectively as premedicating drugs. The sedative effects of placebo, hydroxyzine (2.5 mg/kg), diazepam (0.2 mg/kg) and nitrazepam (0.2 mg/kg) were judged both subjectively by the double-blind method and objectively by measurement of free Cortisol levels in the plasma of 54 patients.
These agents were administered by mouth at 8.00 pm on the day before operation and at 7:00 am on the day of operation just after the first blood sampling. In order to avoid the diurnal variation in the plasma Cortisol level, the plasma levels of the same patients at 7:00, 7:30, 8:00, and 8:30 am on the previous day served as controls to the values at corresponding times on the operative day.
While placebo had no measurable effects, diazepam and nitrazepam clearly decreased plasma free Cortisol levels at 8:30 am and hydroxyzine significantly reduced the value at 8:00 am. The sedative effects of these tranquillizing agents and the ineffectiveness of the placebo definitely correlated with the alterations in plasma Cortisol levels. The clinical application of these findings was also discussed.
Résumé
Ce travail a été fait pour évaluer objectivement les tranguillisants comme agents de prémédication. Les effects sédatifs du placebo, de ľhydroxyzine (2.5 mg/kg ), du diazépam (0.2 mg/kg) et du nitrazépam (0.2 mg/kg) ont été évalués subjectivement par la méthode à double inconnu et objectivement en mesurant les niveaux de Cortisol libre dans le plasma de 54 malades.
Ces agents ont été administrés par la bouche à 8:00 heures pm la veille de ľopération et à 7:00 heures am le jour de ľopération, immédiatement après le premier prélèvement de sang. Pour éviter la variation diurne dans le niveau de Cortisol du plasma, les niveaux plasmatiques des mêmes malades à 7:00, 7:30, 8:00 et 8:30 heures am le jour précédent ont servi de contrôle pour les résultats aux mêmes heures le jour de ľopération.
Alors que le placebo n’a pas eu ďeffets appréciables, le diazépam et le nitrazépam ont diminué clairement les niveaux de Cortisol libre à 8:30 heures am et ľhydroxymine a réduit sensiblement le niveau à 8:00 heures am. Les effets sédatifs de ces tranquillisants et ľabsence ďeffet du placebo ont été définitivement en corrélation avec les changements de niveaux du Cortisol plasmatique. On a aussi étudié ľapplication clinique de ces constatations.
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References
Norris, W. &Baird, W. L. M. Pre-operative Anxiety: A Study of the Incidence and Aetiology. Brit. J. Anaesth.39: 503 (1967).
Oyama, T.;Shibata, S.;Kimura, K.; &Takazawa, T. An Objective Evaluation of Pentobarbital as Preanesthetic Medication: Effect on Adrenocortical Function. Anesth. & Analg. (in press, 1969).
Hammond, W. G.;Vandam, L. D.;Davis, J. M.;Carter, R. D.;Ball, M. R.; &Moore, F. D. Studies in Surgical Endocrinology: IV. Anesthetic Agents as Stimuli to Change in Corticosteroids and Metabolism. Ann. Surg.148: 199 (1958).
Virtue, R. W.;Helmreich, M. L.; &Gainza, E. The Adrenal Cortical Response to Surgery: I. The Effect of Anesthesia on Plasma 17-hydroxy Corticosteroid Levels. Surgery.41: 549 (1957).
Vandam, L. D. &Moore, F. D. Adrenocortical Mechanism Related to Anesthesia. Anesthesiology.21: 513 (1960).
Van Brunt, E. E. &Ganong, W. F. The Effects of Preanesthetic Medication, Anesthesia and Hypothermia on the Endocrine Response to Injury. Anesthesiology.24: 500 (1963).
Way, E. L. &Sutherland, V. C. Pharmacologically Active Brain Substances and Their Relation to Endocrine Effects. Anesthesiology.24: 543 (1963).
De Wied, D. Chlorpromazine and Endocrine Function. Pharmacol. Rev.19: 251 (1967).
Rudd, B. T.;Sampson, P.; &Brooke, N. A New Flurometric Method of Plasma Cortisol Assay with a Study of Pituitary-adrenal Function Using Metyrapone (su 4885). J. Endocrin.27: 317 (1963).
Lear, E.;Suntay, R.;Fisch, H.;Chiron, A. E.; &Pallin, I. M. Ataraxic Drugs in Preanesthetic Medication. Blind Studies in 1,852 Patients. Anesthesiology.22: 529 (1961).
Tornetta, F. J. Diazepam as Preanesthetic Medication: A Double-blind Study. Anesth. & Analg.44: 449 (1965).
Brandt, A. L. &Oakes, F. D. Preanesthesia Medication: Double-blind Study of a New Drug, Diazepam. Anesth. & Analg.44: 125 (1965).
Randall, L. O.;Schallek, W.;Scheckel, C.;Bagdon, R. E.; &Rieder, J. Zur Pharmakologie von Mogadon, einem Schlafmittel mit neuartigem Wirkungsmechanismus. Schweiz. med. Wchnschr.95: 334 (1965).
Alder, A. Mogadon in der Narkosepràmedikation. Praxis.54: 365 (1965).
Christy, N. P.;Longson, D.;Horwitz, W. A.; &Knight, M. M. Inhibitory Effect of Chlorpromazine upon the Adrenal Cortical Response to Insulin Hypoglycemia in Man. J. Clin. Invest.36: 543 (1957).
Gold, E. M.;Di Raimondo, V. C.;Kent, J. R.; &Forsham, P. H. Comparative Effects of Certain Non-narcotic Central Nervous System Analgesics and Muscle Relaxants on the Pituitary Adrenocortical System. Ann. New York Acad. Sc.86: 178 (1960).
Sloane, R. B.;Saffran, M.; &Cleghorn, R. A. Steroid Response to acth and the Effect of Ataractic Drugs. In: Psychoendocrinology, ed. M. Reiss. New York: Grune & Stratton (1958).
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Oyama, T., Kimura, K., Takazawa, T. et al. An objective evaluation of tranquillizers as preanaesthetic medication: effect on adrenocortical function. Can. Anaes. Soc. J. 16, 209–216 (1969). https://doi.org/10.1007/BF03004441
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DOI: https://doi.org/10.1007/BF03004441