Craniofacial skeletal pattern: is it really correlated with the degree of adenoid obstruction?

OBJECTIVE: The aim of this study was to compare the cephalometric pattern of children with and without adenoid obstruction.METHODS: The sample comprised 100 children aged between four and 14 years old, both males and females, subjected to cephalometric examination for sagittal and vertical skeletal analysis. The sample also underwent nasofiberendoscopic examination intended to objectively assess the degree of adenoid obstruction.RESULTS: The individuals presented tendencies towards vertical craniofacial growth, convex profile and mandibular retrusion. However, there were no differences between obstructive and non-obstructive patients concerning all cephalometric variables. Correlations between skeletal parameters and the percentage of adenoid obstruction were either low or not significant.CONCLUSIONS: Results suggest that specific craniofacial patterns, such as Class II and hyperdivergency, might not be associated with adenoid hypertrophy.

OBJETIVO: a presente pesquisa teve como objetivo comparar o padrão cefalométrico de crianças com e sem obstrução adenoidiana.MÉTODOS: a amostra consistiu de 100 crianças, com idades entre 4 e 14 anos, de ambos os sexos, submetidas a exames cefalométricos para a avaliação de variáveis cefalométricas horizontais e verticais. A amostra também foi submetida à nasofibroendoscopia, por meio da qual o grau de obstrução adenoidiana foi objetivamente aferido.RESULTADOS: os pacientes avaliados demonstraram tendência ao crescimento vertical acentuado, ao perfil convexo e à retrusão mandibular. No entanto, não houve diferenças entre pacientes portadores e não portadores de obstrução, em relação a todas as variáveis cefalométricas. As correlações estabelecidas entre os parâmetros esqueléticos e os percentuais de hipertrofia foram baixas ou não significativas.CONCLUSÕES: os resultados sugerem que padrões faciais específicos, tais como Classe II e hiperdivergência, parecem não estar associados à hipertrofia adenoideana.

[Tolerance of prostate biopsy with use of local anesthesia and benzodiazepines: a randomized, prospective study]. / Tolerancia a la biopsia prostática con el uso de anestesia local y benzodiacepinas: estudio prospectivo aleatorizado.

INTRODUCTION: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. MATERIALS AND METHODS: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. RESULTS: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant differences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant differences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant difference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant differences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). CONCLUSION: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted.

[Abuse of alcohol and benzodiazepine during substitution therapy in heroin addicts: a review of the literature]. / Abus d'alcool et de benzodiazépines lors des traitements de substitution chez l'héroïnomane : une revue de la littérature.

INTRODUCTION: In spite of its seriousness, dependence on alcohol and benzodiazepines during substitution treatment are poorly documented. Its frequency is nonetheless significant. According to studies, between one and two thirds of patients are affected. This consumption is under verbalized by patients and underestimated by carers. In one study, where the average diazepam doses were from 40 to 45 mg per day, 30% of the patients were taking 70 to 300 mg per day, two thirds having experimented with a fixed dose of 100mg. Benzodiazepines, especially diazepam and flunitrazepam, were studied versus placebo. Thus, 10 to 20mg of diazepam gave rise to euphoria, a sensation of being drugged, sedation and lessening of cognitive performance. The aim of this consumption is to potentiate the euphoria induced by opioids, a "boost" effect during the hour after taking it, or the calming of the outward signs of withdrawal. The most sought after molecules are the most sedative, those with pronounced plasmatic peaks, and the most accessible. LITERATURE FINDINGS: In multidependant subjects, opioid dependence had been earlier in adolescence, with a number of therapeutic failures. They had been faced with repetitive rejection and separation during childhood, medicolegal and social problems. Somatization, depression, anxiety and psychotic disorders are frequent in this subgroup. Heavy drinkers under methadone treatment are highly vulnerable to cocaine. Their behaviour is at risk, with exchange of syringes; their survival rate is 10 years less than that of moderate consumers of alcohol. Most are single, with a previous prison, psychiatric or addictive cursus and they present significant psychological vulnerability. For some authors, benzodiazepines indicate a psychiatric comorbidity. Methadone significantly reduces the consumption of alcohol by nonalcoholic heroin addicts. Although alcohol is an enzymatic inductor of methadone catabolism, with bell-shaped methadone plasma curves over 24 hours, a substitution treatment is recommended. It has a minimum impact on care, in spite of efficiency and retention in therapeutical programs, allowing the subject's inclusion in the framework of a more regular and sustained medical follow-up. Treatment of benzodiazepine dependence by a progressive regression of doses has little efficacy in subjects which cannot control how much medication they are taking. Certain authors have suggested maintenance treatments of clonezepam. The most appropriate therapeutic propositions are: (1) maintenance of therapeutic links though a framework of deliverance from flexible substitution treatment; (2) prevention by cautious prescribing and control of dispensing medication; (3) parallel treatment of psychiatric comorbidities and related personality disorders; (4) individual psychiatric treatment, either institutional or in consistent networks.

[Comparison of premedication regimes. A randomized, controlled trial]. / Prämedikationsregime im Vergleich. Eine prospektive, randomisierte, kontrollierte Studie.

BACKGROUND: The effect of two premedication regimes with different benzodiazepines on anxiety, hemodynamic data, sympatho-adrenal activity, and bispectral index (BIS) was evaluated during the variable time period prior to induction of anesthesia. PATIENTS AND METHODS: This prospective, double-blind study was performed with 50 ASA class I and II patients. Patients were randomized either to group I: evenings 22.00 hours 50 mg chlorazepate dipotassium (CD), mornings 07.00 hours 25 mg CD, placebo 30 min prior to anesthesia (on demand) or group II: evenings 50 mg CD, mornings placebo, 7.5 mg midazolam on demand. RESULTS: In group I the BIS dropped after administration of 25 mg CD and was significantly lower at 08.00, 09.00 and 10.00 hours compared to baseline (mean+/-SD; 90+/-5, 87+/-7 and 87+/-7, respectively vs. 95+/-4; p<0.05), whereas the BIS of group II did not decrease significantly. Both groups did not differ significantly with respect to all variables obtained throughout the study period. CONCLUSION: We conclude that 50 mg CD the evening before surgery prevented an increase of anxiety and sympatho-adrenal activity in both groups and might therefore be sufficient as premedication. Fixed time application of 25 mg CD at 07.00 hours or 7.5 mg midazolam 30 min prior to anesthesia did not further affect these variables preoperatively.

[Optimizing anesthesiologic premedication with reference to biopsychological theories. Exemplified by the effect of dipotassium clorazepate and zolpidem in combination with promethazine]. / Optimierung der anästhesiologischen Prämedikation unter Berücksichtigung biopsychologischer Erklärungsansätze. Aufgezeigt am Beispiel der Wirkung von Dikaliumclorazepat und Zolpidem in Kombination mit Promethazin.

UNLABELLED: The following double-blind randomized placebo-controlled study dealt with three questions: 1. Are differentiated psychometric test systems suitable measuring emotions before anaesthesia? 2. What are the effects of different doses of zolpidem (8.03 mg vs. 16.06 mg) compared with dipotassiumclorazepat (10 mg vs. 20 mg) on emotions in premedication? 3. Is the combination with Promethazin suggestive? METHOD: 320 patients were randomly assigned to different regimes of preanaesthetic medication. As primary premedication they received either zolpidem 8.03 mg or zolpidem 16.06 mg or dipotassium clorazepate 10 mg or dipotassium clorazepate 20 mg or placebo. The secondary premedication was either promethazine 50 mg or placebo. The tablets/dragees were given in the evening before surgery (09.00 p.m.-10.00 p.m.). Every cell of the 5 x 2-factorial design contained 16 men and 16 women. Emotions were measured by a multidimensional rating scale, comprising the aspects elated mood, anxiety, hostility, deactivation, vigilance and introversion. In addition, somatic symptoms and the quality of sleep were measured. Statistics were performed using multivariate analysis of variance. RESULTS: No differing effects of zolpidem and dipotassium clorazepate on preoperative mood were found. There was also no difference compared with placebo. Compared with placebo, promethazin leads to greater deactivation. Specific emotions were not affected. In somatic aspects there was a greater amount of cholinergic effects under promethazine, which was mainly expressed by a higher intensity of a dry mouth and weakness in general. Compared with placebo all of the tested drugs led to a better quality of sleep. CONCLUSIONS: Using multidimensional rating scales and considering emotions as a multifactorial construct, the study shows no different effects of benzodiazepines or benzodiazepin-like drugs on preoperative mood. No differences were also found on comparing these drugs with placebo. However, a better quality of sleep was seen under zolpidem and dipotassium clorazepate compared with placebo. The study shows that a combination with promethazine is recommended, because promethazine has a selective deactivating effect. The study stresses the significance of multidimensional rating scales for the measurement of emotions before anaesthesia.

Safety and effectiveness of an oral premedication regimen before cardiac surgery.

Thirty-five adult cardiac surgical patients received 20 mg dipotassium clorazepate orally the evening before surgery and 2 mg flunitrazepam 60 min before induction of anaesthesia. If anaesthesia was to be induced after 08.30 hours patients received an additional 20 mg dipotassium clorazepate at 06.15 hours. The following measurements were made: peripheral arterial oxygen saturation (Spo2) breathing room air; anxiety by visual analogue scale; degree of sedation; and haemodynamic variables. Mean (Spo2) was 95.9% (SD 1.8%) on the day before surgery and 95.4% (SD 1.5%) on arrival at the operating room. When the operation started after 08.30 hours, mean (Spo2) at 09.00 hours was 96.0% (SD 1.4%). There were no detected episodes of hypoxaemia after premedication. Mean anxiety score decreased significantly from 3.9 (SD 2.6) on the day before surgery to 3.3 (SD 2.1) on arrival at the operating room (patients' score; P < 0.002) and from 4.6 (SD 2.4) to 3.3 (SD 2.0) (anaesthesiologists' score; P < 0.001). Nearly all patients were considered well sedated, which was reflected by normal haemodynamic variables on arrival at the operating room. The combination of clorazepate and flunitrazepam is effective oral premedication for adult cardiac surgery, causing no obvious desaturation even when supplemental oxygen is not given.

[Comparison of the effectiveness of orally administered clorazepate dipotassium and nordiazepam on preoperative anxiety]. / Vergleich der Wirkung von oral appliziertem Dikaliumclorazepat und Nordiazepam auf die präoperative Angst.

Clorazepate dipotassium (Tranxilium) is one of the benzodiazepines which is widely used for oral premedication. After oral administration it is decarboxylated to its active metabolite nordiazepam (desmethyldiazepam). Nordiazepam is also commercially available in the form of drops (Tranxilium N). The aim of the present study was to compare the effect of these drugs on preoperative anxiety. One hundred and eight patients scheduled for orthopaedic surgery (ASA I-II) were studied. Medication was administered at 10 p.m. the evening before surgery (E) and at 7 a.m. on the morning of surgery (M). There were four groups: 1) E no medication; M clorazepate dipotassium; 2) E no medication; M nordiazepam; 3) E clorazepate dipotassium; M clorazepate dipotassium, 4) E clorazepate dipotassium; M nordiazepam. Dosages were: clorazepate dipotassium: body weight < 55 kg: 10 mg; body weight > 55 kg: 20 mg; nordiazepam: 1 gtt/kg; 5 mg = 24 gtt). Anxiety was measured by using the self-evaluating Erlangen anxiety scales, which measure both background and situational anxiety. Background anxiety (EAS-H) was evaluated during the evening before surgery; situational anxiety (EAS-S) was evaluated at the same time and also on the day of surgery before premedication and immediately before surgery. Pulse rate was measured each time the test was administered. There were no differences between the groups in sex, age, weight or the intervals between premedication and anaesthesia induction (p > 0.05). There were no statistically significant differences between the groups with respect to background anxiety. Situational anxiety did not significantly increase or decrease at any of the testing times, nor were there any differences between the groups (p > 0.05). Heart rate did not vary between the groups or with time (p > 0.05). In this group of patients undergoing elective orthopaedic procedures, clorazepate prevented a rise in anxiety in the immediate preoperative period. Since clorazepate is rapidly metabolized to nordiazepam when administered orally it might be predicted that the two drugs have similar properties. This hypothesis is confirmed by the results of the present study. We conclude that orally administered clorazepate dipotassium and nordiazepam have a similar effect on preoperative anxiety.

Oral clonidine premedication prevents the rise in intraocular pressure following succinylcholine administration.

The objective of the study was to assess the effects of premedication with clonidine on intraocular pressure (IOP) after the administration of succinylcholine. Fifty elderly patients undergoing ophthalmic surgery were randomly allocated to two study groups. Group 1 patients (n = 25) received clonidine, 300 micrograms p.o. In group 2 (n = 25), the benzodiazepine dipotassium clorazepate was given p.o. at a dose of 0.3 mg.kg-1. Anesthesia was induced with thiopental 3-4 mg.kg-1, alfentanil 10 micrograms.kg-1, atracurium 0.07 mg.kg-1, and succinylcholine 1 mg.kg-1. Nine IOP measurements were taken in each patient starting before premedication and ending 3 min after endotracheal intubation. In both groups, there was a decrease in IOP after induction of anesthesia with thiopental and alfentanil. Succinylcholine administration and endotracheal intubation had no further effect on IOP in the clonidine group. In group 2, succinylcholine caused an increase in IOP when compared with the post induction value. We conclude that clonidine premedication can prevent the increase in IOP following succinylcholine administration.

[Oral premedication with clorazepate dipotassium. Comparison with oral premedication with flunitrazepam and intramuscular premedication with promethazine, pethidine and atropine in adults]. / Die orale Prämedikation mit Dikaliumclorazepat. Vergleich zur oralen Prämedikation mit Flunitrazepam und der intramuskulären Prämedikation mit Promethazin, Pethidin und Atropin beim Erwachsenen.

UNLABELLED: The purpose of premedication and the best form have been frequent subjects of controversy among anaesthetists in the past few years. Anxiolysis is now accepted as the main purpose. The preferred route of administration is by mouth. The intention of this study was to examine whether clorazepate dipotassium has the same sedative-hypnotic and anxiolytic effects as i.m. premedication with promethazine, pethidine and atropine. METHODS: A total of 100 patients aged 20-65 years and due to undergo arthroscopy took part in this study. Patients in group I were given 1 mg flunitrazepam p.o. on the evening before the operation and the i.m. premedication described above. The premedication for group II consisted in clorazepate dipotassium, 50 mg on the evening before operation and 25 mg on the morning of the day of the operation. The sedative-hypnotic effects were measured on a four-point scale. The Erlangen anxiety scale (EAS) and a visual analogue scale (VAS) were used to evaluate the anxiolytic effects according to the patient's own and the observer's evaluation of mood. In addition to this, we measured amnesia, heart rate and blood pressure. RESULTS: Clorazepate dipotassium or flunitrazepam p.o. significantly reduces anxiety 1 h after administration as measured by the EAS (P < 0.05) on the evening before the operation. This result was not, however, confirmed by the VAS for self-assessment. Patients who received premedication with clorazepate dipotassium are less anxious on the morning of the operation than patients given flunitrazepam the evening before the operation (P < 0.05); this, however, does not correspond to the VAS results. There were no differences in the other parameters compared. DISCUSSION: Oral premedication with clorazepate dipotassium has the same sedative-hypnotic, anxiolytic and amnestic effects as i.m. premedication with promethazine, pethidine and atropine. The results of this study are better than those obtained by Tolksdorf et al., owing to the higher dosage used in our study (50 mg as against 20 mg). Tolksdorf et al. [21] failed to show any improvement on a placebo. Our results correspond to those of Drautz et al. [2] who used 50 mg of clorazepate dipotassium on the evening before and 25 mg on the morning of the day of the operation.

[A comparative study of the efficacy and tolerance of dipotassium clorazepate and flunitrazepam for oral premedication]. / Vergleichende Untersuchung der Wirksamkeit und Verträglichkeit von Dikaliumchlorazepat und Flunitrazepam zur oralen Prämedikation.

The literature shows that benzodiazepines, in view of their anxiolytic, sedative, amnesic, muscle relaxant and anticonvulsive action, are the most important substances for premedication. Eminent workers regard anxiolysis as the most important aim of premedication. In the present clinical study, oral administration of the two different benzodiazepine derivatives, flunitrazepam (F) and chlorazepate dipotassium (CD) have been explored with a view to side effects, tolerance, quality of sleep during the night, anxiolytic effect and sedation. The study involved 108 women patients aged from 20 to 60 years (ASA class I or II), all scheduled to undergo gynecological surgery in general anesthesia. There were also 20 women who received no premedication. The three groups of patients were further divided into early (operation started before 10:30 a.m.) and late-operation (operation started after 10:30 a.m.) groups. The test drugs were administered as follows: 43 women received 50 mg CD p.o. on the evening before the operation, followed by 25 mg p.o. in the morning; 45 women received 2 mg F p.o. on the evening before the operation, followed by 1 mg p.o. in the morning. All patients took the preoperative premedication at 7 o'clock in the morning. Following this medication, the anxiolytic, sedative, and amnesic effects, side effects, vigilance and O2 saturation (SaO2) were determined at defined points during the day of the operation and the 1st postoperative day. Blood pressure and heart rate were recorded and interpreted as physiological stress parameters. Anxiolysis was determined using the Erlangen Anxiety Scale (EAS) of Galster and Spörl; the degree of sedation was assessed by the anesthesiologist; amnesia was determined by the patients' recognition of picture cards; vigilance and side-effects were assessed by standardized questionnaires. Both active drugs clearly improved the quality of sleep in the night before the operation over that experienced with no premedication. There were no significant differences among the three groups in the physiological stress parameters. The preoperative SaO2 saturation was decreased significantly by oral F, but it was always more than 95%. CD had little influence on the SaO2. Unwanted somatic symptoms were found a little more frequently in the group without any premedication. There were no signs of restricted tolerance for either of the test drugs. In the premedicated groups, pre- and postoperative anxiety decreased significantly.(ABSTRACT TRUNCATED AT 400 WORDS)

[The influence of premedication with dipotassium chlorazepate on preoperative stress and postoperative pain]. / Der Einfluss der Prämedikation mit Dikaliumchlorazepat auf den präoperativen Stress und den postoperativen Schmerz.

Despite the fact that dipotassium chlorazepate (DC) is widely used for oral premedication there are few studies demonstrating the effects of this drug reliably in the preoperative patient. Therefore, we investigated the influence of DC on preoperative sleep, stress and postoperative pain, which is presumed to be influenced by the long-acting anxiolytic property of DC compared to a placebo in a double-blind study. Sixty patients undergoing dental surgery received either 20 mg DC or a placebo in the evening and at 7 o'clock in the morning before the operation, both administered orally. The quality of sleep, preoperative anxiety, depression, asthenia and postoperative pain were assessed, using nominal and visual analogous scales. The degree of sedation and the quality of premedication were assessed by the anesthesiologist. Blood pressure and heart rate were registered and interpreted as physiological stress parameters. The 2 groups were comparable with respect to the anthropometric data as well as the initial values of all other parameters. Patients receiving DC reported significantly better quality of sleep in the night before the operation. There was no difference between DC and P concerning preoperative stress either emotionally or physiologically. The postoperative pain intensity did not differ between the two groups. The quality of premedication, assessed by the observer, was comparable in both groups. Whereas DC has a positive effect on the quality of sleep in preoperative patients, it does not influence the preoperative stress on the day of operation. This might be dose-dependent, but 20 mg is recommended for premedication.(ABSTRACT TRUNCATED AT 250 WORDS)

[A phase III trial comparing the antiemetic activity of tetracosactide with dexamethasone in combination with metoclopramide, diphenhydramine and clorazepate during chemotherapy including cisplatin]. / Essai phase III comparant l'activité anti-émétique du tétracosactide à la dexaméthasone employés en association avec le metoclopramide, la diphénhydramine et le clorazépate au cours de chimiothérapies comportant du cisplatine.

In order to compare the safety and the antiemetic effectiveness of tetracosactide (TCS) or beta 1,24 ACTH with those of dexamethasone (DXM) as an adjunct to high-dose metoclopramide, diphenhydramine and clorazepate, 33 patients receiving cisplatin based cancer chemotherapy were enrolled in a double-blind cross-over clinical trial. TCS and DXM were given intravenously, respectively at a dose of 2 mg and 20 mg, and concurrently to the cisplatin infusion. No statistically significant difference was noted between the two drugs with regard to efficacy or side effects. We conclude that TCS can serve as a substitute for DXM in combination antiemetic regimens for management of cisplatin-induced nausea and vomiting.

Pharmacokinetics of N-desmethyldiazepam after a single oral dose of clorazepate: the effect of smoking.

The pharmacokinetics of N-desmethyldiazepam was evaluated after oral administration of clorazepate 20 mg to 12 healthy male volunteers (6 smokers; 6 non-smokers), aged 23-29 years. Plasma levels of desmethyldiazepam were measured by gas liquid chromatography. The half life of elimination (t1/2 beta) was significantly longer in the non-smoking volunteers than in the smokers: 54.7 +17.7 versus 29.8 +9.9 h (p less than 0.05). Peak plasma concentrations (Cmax) were higher in non-smokers than in smokers, 413 +106 micrograms/l and 245 +50 micrograms/l, respectively (p less than 0.05). The sedative effect of clorazepate was less severe in smokers than in non-smokers.