Analysis of the effect of oral midazolam and triazolam premedication before general anesthesia in patients with disabilities with difficulty in cooperation

BACKGROUND: When performing dental treatment under general anesthesia in adult patients who have difficulty cooperating due to intellectual disabilities, anesthesia induction may be difficult as well. In particular, patients who refuse to come into the dental office or sit in the dental chair may have to be forced to do so. However, for adult patients with a large physique, physical restraint may be difficult, while oral sedatives as premedication may be helpful. Here, a retrospective analysis was performed to investigate the effect of oral sedatives. METHODS: A hospital-based medical information database was searched for patients who were prescribed oral midazolam or triazolam between January 2009 and December 2017. Pre-anesthesia evaluation, anesthesia, and anesthesia recovery records of all patients were analyzed, and information on disability type, reason for prescribing oral sedatives, prescribed medication and dose, cooperation level during anesthesia induction, anesthesia duration, length of recovery room stay, and complications was retrieved. RESULTS: A total of 97 patients were identified, of whom 50 and 47 received midazolam and triazolam, respectively. The major types of disability were intellectual disabilities, autism, Down syndrome, blindness, cerebral palsy, and epilepsy. Analyses of changes in cooperation levels after drug administration showed that anesthesia induction without physical restraint was possible in 56.0% of patients in the midazolam group and in 46.8% of patients in the triazolam group (P = 0.312). CONCLUSIONS: With administration of oral midazolam or triazolam, general anesthesia induction without any physical restraint was possible in approximately 50% of patients, with no difference between the drugs.

The effect of triazolam premedication on anxiety, sedation, and amnesia in general anesthesia / 대한마취과학회지

BACKGROUND: Benzodiazepines have been used preoperatively as part of an anesthesia regimen to attenuate the anxiety of patients. In this study, we aimed to examine the effect of oral triazolam, a short-acting benzodiazepine, on anxiety, sedation, and amnesia. METHODS: Ninety patients, aged 20–55 years, were randomly assigned to receive no premedication, or to receive triazolam 0.25 mg or 0.375 mg 1 h before anesthesia. Anxiety score, sedation score, blood pressure, heart rate and psychomotor performance were measured on the evening before surgery and on the day of surgery. Additional tests of psychomotor performance were performed in the postanesthesia care unit and on the next day of surgery. The occurrence of amnesia, bispectral index (BIS), recovery profiles and patient satisfaction with overall anesthesia care were also evaluated. RESULTS: Changes in the anxiety and sedation scores on the day of surgery were not significantly different among groups, whereas the increases in systolic blood pressure and heart rate were significantly less in both triazolam groups. The triazolam groups both showed a higher incidence of high satisfaction scores (≥ 2). The two triazolam groups also showed similar outcomes, except for a dose-dependent increase in the number of patients with amnesia and BIS values < 90. Delayed recovery from general anesthesia and psychomotor impairment were not observed in the triazolam groups. CONCLUSIONS: Triazolam 0.25 mg or 0.375 mg reduced the hemodynamic changes associated with anxiety, produced potent amnesia, and improved patient satisfaction. We suggest that triazolam can be used effectively as anesthetic premedication in adults.

Use of triazolam and alprazolam as premedication for general anesthesia / 대한마취과학회지

BACKGROUND: Triazolam has similar pharmacological properties as other benzodiazepines and is generally used as a sedative to treat insomnia. Alprazolam represents a possible alternative to midazolam for the premedication of surgical patients. The purpose of this study was to evaluate the anxiolytic, sedative, and amnestic properties of triazolam and alprazolam as pre-anesthetic medications. METHODS: Sixty adult patients were randomly allocated to receive oral triazolam 0.25 mg or alprazolam 0.5 mg one hour prior to surgery. A structured assessment interview was performed in the operating room (OR), the recovery room, and the ward. The levels of anxiety and sedation were assessed on a 7-point scale (0 = relaxation to 6 = very severe anxiety) and a 5-point scale (0 = alert to 4 = lack of responsiveness), respectively. The psychomotor performance was estimated using a digit symbol substitution test. As a memory test, we asked the patients the day after the surgery if they remembered being moved from the ward to the OR, and what object we had shown them in the OR. RESULTS: There were no significant differences between the groups with respect to anxiety and sedation. The postoperative interviews showed that 22.2% of the triazolam-treated patients experienced a loss of memory in the OR, against a 0% memory loss in the alprazolam-treated patients. In comparison with alprazolam 0.5 mg, triazolam 0.25 mg produced a higher incidence of amnesia without causing respiratory depression. CONCLUSIONS: Oral triazolam 0.25 mg can be an effective preanesthetic medication for psychomotor performance.

Triazolam Withdrawal Presented as Muscle Cramp

No abstract available.

Sleep-Related Eating Disorder / 수면정신생리

Sleep-related eating disorder (SRED) is a newly recognized parasomnia that describes a clinical condition of compulsive eating under an altered level of consciousness during sleep. Recently, it is increasingly recognized in clinical practice. The exact etiology of SRED is unclear, but it is assumed that SRED might share features of both sleepwalking and eating disorder. There have been also accumulating reports of SRED related to the administration of various psychotropic drugs, such as zolpidem, triazolam, olanzapine, and combinations of psychotropics. Especially, zolpidem in patients with underlying sleep disorders that cause frequent arousals, may cause or augment sleep related eating behavior. A thorough sleep history is essential to recognition and diagnosis of SRED. The timing, frequency, and description of food ingested during eating episodes should be elicited, and a history of concurrent psychiatric, medical, sleep disorders must also be sought and evaluated. Interestingly, dopaminergic agents as monotherapy were effective in some trials. Success with combinations of dopaminergic and opioid drugs, with the addition of sedatives, has also been reported in some case reports.

Sedação consciente com triazolam em odontologia / Conscious sedation with triazolam in dentistry

O Triazolam, quando administrado por via oral, possui um rápido início de ação, duração dos efeitos relativamente curta e boa margem de segurança clínica. Desde que utilizado na dose adequada, torna-se um dos benzodiazepínicos de escolha para a sedação consciente em odontologia. O objetivo deste trabalho foi apresentar dados relacionados aos parâmetros farmacocinéticos, reações adversas, preucauções e contra-indicações e posologia do Triazolam, dando suporte ao seu uso na clínica odontológica.

[First Case of Trichoderma longibrachiatum infection in a renal transplant recipient in Tunisia and review of the literature]

Trichoderma species are filamentous fungi that were previously considered to be culture contaminants. Recently, with the increasing number of risk population, they are described as an emerging pathogen in immunocompromised patients. Trichoderma longibrachiatum is the most common species involved in Trichoderma infections. Here, we report the first case in Tunisia of skin infection caused by Trichoderma longibrachiatum in a renal transplant recipient. The fungus was isolated from fluid puncture of an inguinal abscess and from skin biopsy from a 46-year-old male patient who had been receiving immunosuppressive therapy. Species identification benefited from a molecular approach. Susceptibility tests performed with the use of the European Committee on Antimicrobial Susceptibility Testing standardized methodology revealed that the organism is resistant to itraconazole, intermediate to amphotericin B and sensitive to voriconazole, posaconazole and caspofungin. The infection was successfully treated with voriconazole

On the sleep promoting effects of BR-16A: interaction with GABAergic modulators.

Pentobarbitone-induced hypnosis test was used as an animal model to explore the role of BR-16A, a polyherbal formulation in sleep. Pentobarbitone produces quick sleep latency (onset) and prolongation of total sleep time (duration). Sleep latency and total sleep time were used as a parameters for the evaluation. BR-16A potentiated the effect of triazolam (0.1 mg/kg, ip) and alprazolam (0.25 mg/kg, ip). Melatonin (5.0 mg/kg, ip) and zolpidem (0.5 mg/kg, ip) did not produce any significant effect on sleep parameters. However, alprazolam (0.25mg/kg, ip) potentiated the effect of BR-16A (100 mg/ kg, po) in higher dose only. Sleep promoting effect of BR-16A in combination with GABAergic drugs (triazolam and alprazolam,) suggested that these drugs have common mechanism in sleep promoting effect of pentobarbitone and could be used along with other GABAergic hypnotics for the treatment of insomnia. This may reduce the dose of the latter drug(s). BR-16A can be used for the treatment of sleep and sleep-related disorders.

Identification of estazolam, alprazolam and triazolam in human urine by LC/MSn / 药学学报

<p><b>AIM</b>To investigate the fragmentation behavior of triazolobenzodiazepines and to develop a specific, sensitive and rapid LC/MSn assay for simultaneous determination of estazolam, alprazolam and triazolam in human urine.</p><p><b>METHODS</b>After oral administration of a single 4 mg dose of the drugs to each of three healthy volunteers, urine samples were purified by solid-phase extraction, and then injected into an ODS column (150 mm x 4.6 mm) with a mobile phase of methanol-water (8:2) for LC/MSn analysis. The structures of estazolam, alprazolam and triazolam in human urine were identified by direct comparison of the observed mass spectra and the chromatographic retention time with those of the reference substance. The mass spectrometer (Finnigan LCQ) was operated in positive mode and in two scan modes including SIM and full scan MS/MS mode. The obtained mass spectra was analyzed assisted with the software Mass Frontier 1.0 for their fragmentation pathways.</p><p><b>RESULTS</b>The full scan MS/MS spectra of each compound gave characteristic fragment ions of [M + H - N2]+ and [M + H - Cl]+. The detection limit was below 0.5 ng.mL-1 for estazolam, alprazolam and triazolam in human urine.</p><p><b>CONCLUSION</b>The method is useful in forensic and clinical toxicology in which unequivocal identification of eatazolam, alprazolam and triazolam is desired.</p>

Half life of Alprazolam in hepatic insufficient patients

Alprazolam is a triazolobenzodiazepine which is primarily metabolized by the liver. To see its half life in hepatic insufficient patients tab. Alprazolam in a dose of 0.25 mg, B.D. was given orally to 15 such patients and 5 normal subjects taken as control. Drug was given for a period of 21 days to both groups. Blood samples were drawn at day 7 and 21. There was no remarkable change in half life on day 7 and 21, among control group. Same results were seen among hepatic group on both days but half life increased to about double on day 7 and 21, when compared to control ones. Thus, it was concluded that in hepatic insufficient patients, half life increases significantly due to alteration in hepatic biotransformation mechanism

A Case Report of Triazolam Dependence: Focusing Anxiety Symptoms and Treatment / 신경정신의학

Benzodiazepines, which used to and would be prescribed frequently as anxiolytic sedative hypnotics not only in psychiatric field but also in almost all clinical departments, are prone to develop tolerance, physical and psychological dependence, and withdrawal symptoms after abrupt discontinuation. Owing to shorter plasma half life, severe degree of tolerance, physical and psychological dependence, and withdrawal symptoms after abrupt discontinuation have been developed in a case of triazolam dependence. Nevertheless, no single case of triazolam dependence was reported yet in Korea. The authors experienced a single case of triazolam dependence, so report with literature review.

Estudo duplo-cego comparativo da eficácia e segurança da nefazodona e amitriptilina / A comparative double-blind study of efficacy and safety between nefazodone and amiryptiline

O estudo compreendeu o tratamento duplo-cego de 40 pacientes ambulatoriais nao-responsivos ao placebo, com depressao moderada a grave, diagnosticados segundo o DSM-IV, durante 8 semanas, com a nefazodona e a amitriptilina. A eficácia revelou-se significativa e semelhante para ambos os fármacos, tanto no que concerne aos sintomas depressivos como aos ansiosos. A incidência de eventos adversos foi semelhante, em que pese a exclusao de pacientes portadores de enfermidades clínicas onde o uso da amitriptilina é contra-indicado ou potencialmente perigoso. Nenhum evento adverso grave foi observado

Treatment of One Case of Elderly Manic Episode Developed after Retirement

The authers reported one case of manic episode that occured after retirement in a 63 year old male patient. There was no psychiatric past history and family history. Also there was no abnormal finding on laboratory examination. This patient had received small doses of antidepressants anxiolytic and hypnotic (amitriptyline 10 mg, lorazepam 0.5 mg, triazolam 0.25 mg) to control insomnia since 3 months ago before admission. This patient showed manic symptoms such as grandious idea, expansive and irritable mood, increased psychomotor activity and insomnia after retirement. Pharmacotherapy (lithium and chloropromazine) supportive psychotherapy and family therapy were administered. Excessive motivation for work after retirement and small dose of antidepressant were suspected to trigger a manic episode in this elderly patient. We also reviewed literatures about pathophysiology of elderly manic disorder.

Uso racional de psicofármacos y papel de la comunicación social / Rational use of psychotropic drugs and social communication role

Se pasa revista a factores extraclínicos qua afectan la prescripción y el uso de los psicofármacos. Se pone particular atención en la participación de las autoridades de aplicación, la industria farmacéutica y los medios de comunicación. En América latina son pocos los documentos acerca de problemas ocasionados por el uso no racional de los psicfármacos, y sus consecuencias en la salud pública. Indagar este problema, verificar las fuentes y promover el uso racional exigirán múltiples estrategias (principalmente en materia de comunicación social y formulación de políticas) que ayuden a definir y lograr los siguientes objetivos: mejorar la información destinados a la población, influir en la toma de decisión por parte de los médicos y de la población, permitir la participación de los consumidores para, así, conseguir que cunda un uso más racional de los psicotrópicos

Programa de ansiedade e Depressäo - UFRJ. Série Psicofarmacologia - 20: Segurança e tolerância aos efeitos dos benzodiazepínicos: parte 3 / Safety and tolerability to the effects of benzodiazepines

Neste artigo, o terceiro e último de uma série, nós descrevemos três síndromes dismnésticas associadas ao uso de benzodiazepínicos: esquecimento benigno, confabulaçöes e amnésia transitória global. Em seguida, apresentamos um levantamento de algumas modalidades de efeitos adversos encontradas em uma amostra de 70 pacientes com fobia social submetidos a tratamento prolongado com clonazepam

Psychophysiological effects and dose equivalence of zopiclone and triazolam administered to healthy volunteers. Methodological considerations

1. Dose-equivalence studies of zopiclone and triazolam were out. 2. Zopiclone (6.25, 8.75 and 11.25 mg), triazolam (0.1875, 0.275 and 0.5 mg) and placebo were given in the morining to 14 healty male volinteers aged 20-25 years under double-blind conditions according to an incomplete block design. Each patient received three of the seven possible treatment at intervals of at least 1 week. Subjects were evaluated using physiological measures, rating scales and memory taskes before and 1.5h after drug administration. 3. The sedative and amnestic effects of zopiclone were qualitatively similar to those of triazolam, with the highest dose of each havin the greatest effect. 4. On the basis of the digit symbol substitution test, 10 mg of zopiclone is equivalent to 0.5 mg of triazolam. Methodological problems of the experimetnal design of dose-equivalence studies are discussed