Abstract
The clinical effects of a new administration form of triazolam, 0.2 mg sublingual (sl) tablet, were compared with those of a 10 mg tablet of diazepam in a double-blind study, in 100 ASA I-II patients scheduled for opthalmic surgery under local anaesthesia. The sedative and anxiolytic effects of the study drugs were followed at 15 min intervals by plotting the patient’s assessments on a visual analogue scale and by a trained observer. The onset of sedative and anxiolytic effect was similar. At 75 min after premedication and after the operation triazolam 0.2 mg caused deeper sedation than diazepam 10 mg according to the observer (P < 0.001, P < 0.01) and according to the patient (P < 0.01, P < 0.05). Ten patients (20%) in the triazolam group and one in the diazepam group were assessed to be too sedated during the operation. All these patients were 61–70 yr old. The study drugs resulted in equal reduction of anxiety during the preoperative period. Both premedicants provided good patient comfort but caused total amnesia only to one patient in each group. Neither caused any severe cardiorespiratory or other side effects. It is concluded that 0.2 mg triazolam si produces deeper sedation than 10 mg oral diazepam. For elderly patients this dose is excessive for intraocular surgery.
Résumé
Les effets d’une nouvelle présentation de triazolam 0,2 mg sublingual (si) sont comparés à ceux de la tablette de diazépam 10 mg dans une étude à double aveugle chez 100 patients ASA 1–2 programmés pour une chirurgie ophthalmique sous anesthésie locale. Les propriétés sédatives el anxiolytiques des médicaments à l’étude sont cotés aux 15 min par le malade et un observateur competent sur une échelle visuelle analogue. Le debut de l’activité sédative et anxiolytique ne differe pas pour les deux drogues. A 75 min après la prémédication et après la chirurgie, le triazolam 0,2 mg produit une sédation plus profonde que le diazépam 10 mg d’après l’observateur, (P < 0,001, P < 0,01) et d’après le patient (P < 0,01, P < 0,05). On note une sédation exagérée chez dix patients (20%) du groupe triazolam et un du groupe diazepam. Tous ces patients sont ages de 61 à 70 ans. Les drogues étudiées produisent une réduction égale de lanxiété préopératoire. Les malades sont comfortables sous les deux prémédications. L’amnésie totale ne survient que pour un seul malade dans chaque groupe. On ne note pas d’effets cardiorespiratoires importants. Nous concluons que le triazolam 0,2 mg si produit une sédation plus profonde que diazépam 10 mg po. Pour les patients plus âgés, cette posologie est excessive en chirurgie oculaire.
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References
Kennedy SK, Longnecker DE. History and principles of anesthesiology.In: Gilman AG, Rail TW, Nies AS, Taylor P (Eds.). Goodman and Gilman’s the Pharmacological Basis of Therapeutics, 6th ed. New York: Pergamon Press, Inc., 1991; 269–84.
White PF. Pharmacologic and clinical aspects of preoperative medication. Anesth Analg 1986; 65: 963–74.
Hey H, Sørensen K, Jørgensen FB, Hasselbalch, Wamberg T. Kapslers og tabletters passagetid gennem esophagus. Ugeskr. f. Laeger 1983; 145: 2432–5.
Baughman VL, Becker GL, Ryan CM, Glaser M, Abenstein JP. Effectiveness of triazolam, diazepam, and placebo as preanesthetic medications. Anesthesiology 1989; 71: 196–200.
Riefkohl R, Kosanin R. Experience with triazolam as a preoperative sedative for outpatient surgery under local anesthesia. Aesthetic Plast Surg 1984; 8: 155–7.
Forrest P, Galletly DC, Yee P. Placebo controlled comparison of midazolam, triazolam and diazepam as oral premedicants for outpatient anaesthesia. Anaesth Intensive Care 1987; 15: 296–304.
Tigerstedt I, Tammisto T. A modified visual analogue scale (VAS) for evaluation of pain intensity during immediate postoperative recovery. Schmerz Pain Doleur 1988; 9: 27–31.
Maunuksela E-L, Olkkola KT, Korpela R. Measurement of pain in children with self-reporting and behavioral assessment. Clin Pharmacol Ther 1987; 42: 137–41.
Aitken RC. Measurement of feelings using visual analogue scale. Proceedings of the Royal Society of Medicine 1969; 62: 939–93.
Manani G, Blasone R, Cirillo L, et al. La sedazione nella piccola chirurgia ambulatoriale del cavo orale: il triazolam sublinguale. Giornale di Anestesia Stomatologica 1989; 4: 7–17.
Pokes GE, Brogden RN, Heel RC. Speight TM, Avery GS. Triazolam: a review of its pharmacological properties and therapeutic efficacy in patients with insomnia. Drugs 1981; 22: 81–110.
Male CG, Lim YT, Male M, Stewart JM, Gibbs JM. Comparison of three benzodiazepines for oral premedication in minor gynaecological surgery. Br J Anaesth 1980; 52: 429–36.
Male CG, Johnson HD. Oral benzodiazepine premedication in minor gynaecological surgery. Br J Anaesth 1984; 56: 499–507.
Greenblatt DJ, Divoll M, Abernethy DR, Moschitto LJ, Smith RB, Shader RI. Reduced clearance of triazolam in old age: relation to antipyrine oxidizing capacity. Br J Clin Pharmacol 1983; 15: 303–9.
Nikaido AM, Ellinwood EH Jr, Heatherly DG, Gupta SK. Age-related increase in CNS sensitivity to benzodiazepines as assessed by task difficulty. Psychopharmacology (Berl) 1990; 100: 90–7.
Pinnock CA, Fell D, Hunt PCW, Miller R, Smith G. A comparison of triazolam and diazepam as premedication agents for minor gynaecological surgery. Anaesthesia 1985; 40: 324–8.
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Kontinen, V.K., Maunuksela, EL. & Sarvela, J. Premedication with sublingual triazolam compared with oral diazepam. Can J Anaesth 40, 829–834 (1993). https://doi.org/10.1007/BF03009253
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DOI: https://doi.org/10.1007/BF03009253