Abstract
Purpose
To compare the effects of two premedication regimens on cardiorespiratory vanables, sedation, and anxiety in patients scheduled for coronary artery bypass graft (CABG) surgery.
Methods
This was a prospective randomized, double-blind clinical trial. Sixty-eight patients were monitored for 1.5 hr before and 2.0 hr after premedication with lorazepam (0.03 mg·kg−1 sl). morphine (0.15 mg·kg−1im), and perphenazine (0.05 mg·kg im) [Group 1]. or with lorazepam (0.03 mg-kg−1sl) and saline (1.5 ml im) [Group 2]. All were continuously monitored with a 12-lead ECG ST monitors, respiratory inductive plethysmography (RIP). digital pulse oximetry, intra-arterial blood pressure, and artenal blood gas analysis. Sedation and anxiety scores were also recorded.
Results
The incidence and duration of myocardial ischaemia was low and similar in Groups 1 and 2. Patients in Group 1, but not m Group 2, had a greater number of events (P < 0.04) and duration (P < 0.02) of O2 desaturation; higher PaCO2 (P < 0.001), and more haemodynamic events (P < 0.006) after premedication when compared with baseline. There was no difference in RIP or ECG vanables between the two groups. Following premedication. both groups reported reduced anxiety scores and elevated sedation scores (P < 0.01), with sedation greater in Group 1 than in Group 2 (P < 0.0l).
Conclusion
In CABG patients, premedication with lorazepam provides adequate anxiolysis and sedation, and the addition of morphine and perphenazine results in elevated PaCO2, artenal haemoglobin desaturation, and potentially adverse haemodynamic changes.
Résumé
Objectif
Comparer les effets de deux régimes de prémédication sur les paramètres cardiorespiratoires, la sédation, et l’anxiété chez des patients programmés pour une chirurgie de revasculansation myocardique (CVRM).
Méthodes
Cette étude clinique était aléatoire et à double aveugle. Soixante-huit patients ont été suivis pendant 1.5 h et 2,0 h après une prémédication constituée de lorazepam (0,03 mg·kg−1 sl), de morphine (0,15 mg · kg im) et de perphénazine (0.05 mg · kg−1 im) [groupe 1] ou de lorazepam (0,03 mg · kf−1 sl) avec du sol.phys. (1,5 mg im) [groupe 2]. Tous ont été surveillés en continu avec un moniteur ECG du segment ST à 12 dérivations, pléthysmographie respiratoire à induction (PRI), oxymétne de pouls, pression arténelle sanglante et analyse des gaz artériels. Les scores de sédation et d’anxiété étaient aussi enregistrés.
Résultats
L’incidence et la durée de l’ischémie myocardique, tout en étant peu élevées, étaient identiques chez les patients du groupe 1 et 2. Après la prémédication, les patients du groupe 1 présentaient comparativement à ceux du groupe 2 un plus grand nombre d’épisodes (P < 0,04) de désaturation dont la durée était plus longue (P < 0.02); des PaCO2 plus élevées (P < 0,00l) et plus d’événements de nature hémodynamique (P < 0.005). ll n’y avait pas de différence en ce qui concerne les paramètres enregistrés sur la PRI et sur l’ECG entre les deux groupes. Après la prémédication, les deux groupes ont présenté des scores d’anxiété bas et de sédation élevés (P < 0,0l). avec une sédation plus importante dans le groupe 1 que dans le groupe 2 (P < 0,0l).
Conclusion
Chez des patients programmés pour une CRVM, la prémédication au lorazepam produit une anxiolyse et un sédation adéquates, alors que l’addition de morphine et de perphénazine augmente la PaCO2, la désaturation de l’hémoglobine et produit des effets hémodynamiques potentiellement néfastes.
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Saccomanno, P.M., Kavanagh, B.P., Cheng, D.C.H. et al. Comparison of lorazepam alone vs lorazepam, morphine, and perphenazine for cardiac premedication. Can J Anaesth 44, 146–153 (1997). https://doi.org/10.1007/BF03013002
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DOI: https://doi.org/10.1007/BF03013002