Alprazolam 0 50 pictures of bal krishna

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A total of 64 healthy volunteers were included in a double-blinded randomized trial comparing the effect of co-administration of midazolam with AZM or ERY. Melatonin N-acetylmethoxytryptamine , an endogenous pineal hormone when given orally as premedicant, also results in preoperative anxiolysis and sedation [ 4 , 5 ]. Atazanavir combined with RIF was examined in two studies. In a small study of four patients, RIF significantly decreased cyclosporine A serum trough concentrations through induction of CYP enzyme mediated metabolism [ 65 ]. Several fluoroquinolones appear to inhibit CYP1A2, albeit to different extents. Antihistamines A randomized open-label cross-over study of 24 healthy individuals found an interaction between AZM and the antiallergic agent rupatadine. Studies with ovarian hormones on auditory brainstem response ABR have conflicting reports although women have ABR shorter than men.

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ALPRAZOLAM WITHDRAWAL SYMPTOMS HTML TABLE This test requires the patient to be in sitting position for airway evaluation. The number bal arrows indicates the extent of the inhibition or induction: Objectives We aimed to find out the antiemetic effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block. Krishna prospective observational study was conducted to alprazolam knowledge, concerns, and expectations about anaesthesia and perioperative care in patients undergoing surgery in mobile surgical camps in remote mountainous districts of Eastern Pictures. Quality of anaesthetic care can be improved only alprazolam medication for cats identifying the factors contributing to patients' discomforts and dissatisfaction. Pain score was measured before and 10, 45 and 90 minutes after the injections.
Alprazolam 0 50 pictures of bal krishna Alprazolam for insomnia dosage
XANAX ALPRAZOLAM 1MG BRANDED PFIZER (UPJOHN-90) PICTURE EDITOR 376
ALPRAZOLAM FOR SEIZURES IN DOGS The limitations of our study include a small sample size considering the factorial trial of the two premedicant drugs and limited tests of the orientation alprazolam 2mg dosage for dogs and the delayed visual episodic memory in place of the detailed psychomotor and battery of memory tests. Introduction Antimicrobial drugs krishna a wide variety of drug interactions, which can differ greatly in their extent of bal and clinical relevance. This article has been cited alprazolam other articles in PMC. But pictures tube comes in limited number with the Ilma, and also the cost of buying it, limits its use. The combination group required one third Those who opted for laparoscopic repair were included in the study. Complications of pubic resection are now rarely seen.

Addition of melatonin to alprazolam had superior anxiolysis compared with either drugs alone or placebo. Adding melatonin neither worsened sedation score nor the amnesic effect of alprazolam alone. This study was registered, approved, and released from ClinicalTrials. Successful intubation with McCoy laryngoscope in a patient with ankylosing spondylitis.

Involvement of cervical spine in ankylosing spondylitis limits neck movement resulting in difficult intubation. We report a case of yr-old lady of ankylosing spondylitis with restricted neck movement planned for emergency laparotomy. Grade 3 Cormack and Lehane laryngoscopic view was observed with Macintosh laryngoscope and gum elastic bougie could not be negotiated. At second attempt with McCoy blade, the posterior commissure of the vocal cord could be visualized and intubation was successful.

Thus, in absence of flexible laryngoscopes and when awake intubation is not feasible, McCoy blade should be considered an alternative than Macintosh blade to attempt intubation in patients of ankylosing spondylitis with restricted neck movement. Nepalese patients anxiety and concerns before surgery Journal of Clinical Anesthesia 23 Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?

As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome AWS is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal anesthesia, fascia iliaca compartmental block with 0.

Later, in the intraoperative period the patient developed AWS; however, the features were similar to that of local anesthetic toxicity. The case was successfully managed with intravenous midazolam, esmolol, and propofol infusion. Due to similarity of clinical features of AWS and mild local anesthetic toxicity, an anesthetist should be in a position to differentiate the condition promptly and manage it aggressively. The objective of this study was to review the available literature on the drugs causing ocular hypertension and glaucoma.

Electronic literature search was carried out using the Web sites www. The articles published or translated into English were studied. Quite a significant number of drugs commonly prescribed by various physicians of different specialties can induce ocular hypertension or glaucoma. A brief account of various drugs that can induce ocular hypertension has been given in this article.

Those drugs are parasympatholytics; steroids; anticholinergics, adrenergics, and antidepressants; cholinomimetics; antineoplastic agents; antipsychotic and antiparkinsonism agents; H1 and H2 receptor blockers; botulinum toxin, cardiac agents, and anticoagulants; silicone oil; sulfa drugs; and anesthetic agents. Rational use of these drugs and knowledge of their potential adverse effects can help prevent the devastating complications resulting in loss of vision and compromised quality of life.

Straight versus flex back: Does it matter in spinal anaesthesia? May Indian journal of anaesthesia. It is sometimes difficult for our patients to acquire recommended flexion of their back to perform subarachnoid block upon them. The aim of this study was to find out the degree of procedural success and patient preference when subarachnoid blocks were performed on patients with suboptimal flexion of the back.

Subarachnoid blocks were performed on adult patients from both sexes without any spinal deformity. Procedures were performed with patients in the lateral or seated position with the back either straight or flexed. This approach divided the study population into 4 equal groups: The primary endpoint was correct needle placement. Numbers of attempts, needle redirections and patients' preferred posture were determined to compare the outcome in different groups.

Most patients preferred the straight back position With a higher preference by patients for the straight back posture, the overall success rate of correct spinal needle placement was comparable among the groups who had their back placed in a straight or in a flexed posture for subarachnoid block. The practice of blood ordering before surgery is usually excessive.

Hazards of over ordering include burden to blood banking, outdating of blood, unnecessary wastage of hospital resources, mental and physical stress to patient party. To find out the ratio between cross-matched and transfused blood units C: Data of 94 patients undergoing elective surgery with potential need for blood transfusion over the period of one month were collected and analyzed prospectively. The variables noted include age, gender, body weight, blood group, hemoglobin level, diagnosis, type of surgery, maximum allowable blood loss, actual blood loss; number of blood units cross-matched and actually transfused.

Altogether, blood units were cross matched and only 24 of them were transfused making the C: T ratio of 6. A Randomized Study of Dexamethasone Prophylaxis. Apr Kathmandu University Medical Journal. Background Postoperative nausea and vomiting is a common distressing problem in patients undergoing gynaecological surgery under anaesthesia including central neuraxial blockade, which requires frequent medical interventions. Objectives We aimed to find out the antiemetic effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block.

Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives. This study involved 80 American Society of Anaesthesiologist Physical Status I and II patients undergoing total abdominal hysterectomy under subarachnoid block. Patients were divided into two groups of 40 each to receive either 4 mg of dexamethasone group D or normal saline group N in volume of 2 ml intravenously 1 hour prior to subarachnoid block.

Surgery was allowed to start with block height of at least T8 dermatome. Intraoperative and postoperative nausea and vomiting was observed using nausea and vomiting scale every 4 hour for 24 hours. Further, only 15 Conclusions Use of dexamethasone prior to subarachnoid block in patients undergoing total abdominal hysterectomy significantly reduces the incidence of nausea and vomiting and the requirement of antiemetic in the postoperative period, with better patient satisfaction.

Comparison of modified Mallampati test between sitting and supine positions for prediction of difficult intubation. Modified Mallampati test is a standard method of assessing the airway for predicting potentially difficult laryngoscopy and intubation. This test requires the patient to be in sitting position for airway evaluation.

Although applicable to the majority of patients, airway evaluation in sitting position may not always be convenient or advisable. To compare modified Mallampati grades between sitting and supine position and to find out their corelation to Cormack and Lehane laryngoscopy grade. The airway assessment was done using modified Mallampati grade in sitting and supine positions.

The laryngoscopy grade was assessed using the Cormack and Lehane grading scale. Grade III or IV of Cormack and Lehane grades was defined as the difficult laryngoscopy and assumed as the predictor of difficult intubation. Statistical measures including sensitivity, specificity, positive and negative predictive values and accuracy were used for comparing the two positions for predicting difficult or ease of intubation.

Mallampati grade III or IV was observed in more patients in supine position compared to sitting position Modified Mallampati grade significantly worsens in supine position compared to sitting. However, airway evaluation in both the positions almost equally predicts for difficult intubation. Introduction Airway evaluation is of paramount importance for safe perioperative care. Intra-operative change of gastric pH during laparotomic cholecystectomy under general anaesthesia: A prospective case-control study.

Mar Indian journal of anaesthesia. Possible intraoperative regurgitation of duodenal contents into stomach because of surgical manipulation may be the reason for such alteration in colour of the gastric secretions. We conducted this study to determine whether there were any pH changes of gastric secretions during laparotomic cholecystectomy operation to confirm our hypothesis of regurgitation of duodenal contents into the stomach.

Prospective observational controlled study in the Department of Anaesthesiology and Critical Care in a tertiary care university teaching hospital. Fifty adult ASA I and II patients scheduled for open cholecystectomy operation under GA were included in the study group and another 50 non-abdominal surgical patients without any gall bladder disease were taken as controls. Three to five milliliters of gastric secretions were aspirated just after intubation and also before reversal of residual neuromuscular blockade for analysis of pH.

Analysis of variance test and Chi-square test with Fisher's exact correction were used for statistical analysis. Post-operative values of pH in the study group were significantly higher than their pre-operative values 2. A significant change in gastric pH takes place during laparotomic cholecystectomy due to reflux of duodenal content into the stomach. Preparedness for patient safety in orbital regional anesthesia in Nepal.

Feb Nepalese journal of ophthalmology: Studies with ovarian hormones on auditory brainstem response ABR have conflicting reports although women have ABR shorter than men. Ears were stimulated simultaneously using standard protocol. ABR was recorded in pre- and postovulatory phases. Ovulation was estimated by measuring basal body temperature. The postovulatory phase had shorter WL V 5. ABR is better in postovulatory phase as compared to preovulatory phase probably due to progesterone hormone which might be involved in modulating auditory hearing pathway at postovulatory phase.

Nepalese patients' anxiety and concerns before surgery. Aug Journal of clinical anesthesia. To determine the changes in anxiety level and need for information at three different time points before surgery. Ward T 1 , preoperative holding area T 2 , and operating room T 3 of a university hospital. The frequency of patients with high preoperative anxiety peaked at the preoperative holding area. The characteristics, general anesthesia OR 3.

The frequency of anxious patients is variable at different time points before surgery. The factors correlating with anxiety before surgery are nonmodifiable. Providing information to those individuals is the only modifiable option. Routine preoperative electrocardiogram in patients over 40 years of age: Preoperative laboratory tests should actually be ordered only based on defined indications such as positive findings on history and physical exam.

At the outset, screening ECG preoperatively in all adult patients may be cumbersome and probably unnecessary. Furthermore, the recommendations for preoperative testing including ECG have mostly been based on the experiences of affluent developed world with different population characteristics from developing countries like ours. Preoperative lead electrocardiogram ECG can provide important information on the state of the patient's myocardium and coronary circulation.

Routine screening ECG preoperatively in all adult patients seems cumbersome and unnecessary. To find out the incidence of ECG abnormality of patients above 40 years of age presenting in the preanaesthetic check up PAC clinic and to observe any associated co-morbid conditions. The study enrolled patients aged 40 years and above.

Laboratory investigations such as hemoglobin, blood grouping, urine routine and microscopic examinations along with biochemical parameters like blood urea, serum creatinine, fasting and post prandial blood sugar were reviewed. A lead ECG was obtained for all patients included in the study. Out of patients, were male and female. Abnormal ECG was observed in 38 Frequency of abnormal ECG increased with increasing age.

Diabetic, hypertensive and smokers had higher incidence of abnormal ECG. A preoperative screening ECG for all adult patients aged 40years visiting PAC clinic is relevant and desirable for risk-stratification. ICU admission and outcomes in a community-based tertiary care hospital: The most serious patients requiring advanced organ system support are admitted in the Intensive Care Unit ICU of hospitals for achieving better outcome. Medical audit of ICU provides important feedback for improvement in care and policy making.

Data of all the ICU admitted patients for the period of one year were analyzed retrospectively from the ICU register and patients' folder. The variables analysed included age, gender, diagnosis, duration of ICU stay and outcome. Altogether patients were admitted in the study period; Mean duration of stay was 8 days. Thirteen percent of the patients left against medical advice LAMA. Admission from operation theatre and emergency ward was associated with better outcome while admission from general wards was associated with poor outcome.

Peritonitis with sepsis was associated with the worst outcome; organo-phosphorous poisoning was associated with good outcome. Significant fractions of the patients admitted in the ICU are taken home by their relatives against medical advice. Jul Kathmandu University Medical Journal. It is important to be able to measure and maintain a specific sedation level to compare outcomes of different levels of sedation during anesthesia and the aims include general patient comfort, freedom from specific discomfort, and some amnesia for both the block procedure and the surgical operation, in order to meet the patient preference and safety.

In this prospective randomized clinical study, we compared the three different infusion doses of propofol. To find out the appropriate infusion dose of propofol for optimal sedation without causing undue side effects in patients undergoing spinal anaesthesia. They were observed for sedation score, hemodynamic parameters and satisfaction level. The adverse effects like respiratory depression, nausea and vomiting score were assessed. Median sedation score increased in a dose dependent manner, with significantly higher scores in group 2 and 3 compared with group 1.

Hemodynamic parameters were better in group 1 and 2 as judged by mephentermine requirement. Respiratory depression, nausea and vomiting were comparable clinically. Almost three fourth of the patients were satisfied with the techniques used. Propofol sedation during sprinal anaesthesia- a dose finding study. Electrocautery has become an indispensable tool in the operating room mainly to achieve bloodless surgical field. However, it does carry several risks including fire burn. Abundant fuels and oxidizer in operation theatre in the presence of electrocautery can easily get ignited, imposing serious risk to the patient and health professionals.

This report of a case of surgical site burn injury due to unintentional reuse of a spirit soaked gauze piece intends to create awareness among health professionals and staff regarding such serious complication. Jun The Korean journal of pain. Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity.

Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations.

The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section. A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine 0. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed.

Nausea and vomiting were more pronounced in Group FD patients. The bupivacaine dose was significantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fixed compared with the dose use.

Topical anaesthesia of the vocal cords by nebulized lignocaine inhalation to facilitate fibreoptic nasotracheal intubation in a head-size parotid tumour patient. This case report describes a successful fibreoptic naso-tracheal intubation in a patient with difficult airway due to a nearly head-size right parotid swelling. The topical anaesthesia was achieved by keeping the scope in close proximity of the vocal cords and in the centre of view of the scope.

This case emphasizes the possibility of fibreoptic intubation in a sedated yet spontaneously breathing patient by allowing inhalation of nebulized lignocaine during fibreoptic intubation. Curved knife "Khukuri" injury in the back and anaesthesia induction in lateral position for thoracotomy. Penetrating injury in the back with knife Khukri demands induction of anaesthesia and intubation in lateral position. In thoracic injury a double lumen tube placement is required to facilitate one lung ventilation during thoracotomy.

In emerging situation, we could successfully execute induction of patient in right lateral position using right sided DLT for left thoracotomy. Its correct placement was confirmed by fiberoptic bronchoscopy. In conclusion right-DLT intubation can be performed without difficulty by conventional direct laryngoscopy using Macintosh blade in lateral position. Identifying patients' concerns and expectations regarding anaesthesia and perioperative care in mobile surgical camps is relevant for the camp workers.

This prospective observational study was conducted to assess knowledge, concerns, and expectations about anaesthesia and perioperative care in patients undergoing surgery in mobile surgical camps in remote mountainous districts of Eastern Nepal. Data of two patients were lost leaving only 78 individuals for analysis. The mean age of the subjects was Pain was the main concern for Of the 25 patients expressing fear of GA, death or not being able to wake up anymore was the main concern for Surgical experience was distressing for 17 The overall experience of the anaesthesia and surgery was worse than expected for Patients presenting to these health camps have limited knowledge regarding anaesthesia and perioperative care but have valid concerns and expectations in respect of their safety, comfort and outcome.

Hypotension is common following spinal anesthesia. Various vasopressors have been indicated to prevent it. The study compares three such agents namely phenylephrine, ephedrine and mephentermine. The study included 90 patients undergoing elective and emergency cesarean section who developed hypotension following subarachnoid blockade. Parturient were randomly divided into three groups each group had 30 patients. It was found that rise of blood pressure was significantly higher in case of phenylephrine group in first six minutes, after the bolus, there was significant reduction in the heart rate in phenylephrine group, but there was tachycardia following administration of bolus ephedrine and mephenteramine.

All three drugs maintained hemodynamics within 20 percent of the baseline values on intravenous administration. Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore. Sep Indian Journal of Medical Sciences. Mechanical ventilation with positive end expiratory pressure PEEP is associated with unequal aeration of lungs in acute respiratory distress syndrome ARDS patients.

Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning. To validate proposed lung infiltration score LIS based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients. Prospective, observational study of consecutive patients. On chest x-ray, 6 segments were identified on each lung. The proposed LIS points 0- normal; 1- patchy infiltrates; 2- white infiltrates matching heart shadow were assigned to each segment.

Without changing ventilation parameters, supine, left and right lateral positions at 45 degrees tilt were randomly changed. At the end of 20 minutes of ventilation in each position, we observed arterial oxygen saturation, hemodynamic and arterial blood gases. Later, position change protocol 4 hourly was practiced in ICU, and skin pressure sore grading was noted within a week of ICU stay.

The LIS mapping on chest x-ray was useful to differentiate between asymmetric lung disease and postural hypoxemia in ICU patients, which predisposed patients to early skin sore changes on higher LIS side. A comparative study of early vs. To compare the outcome in early vs delayed laparoscopic cholecystectomy in terms of frequency of intra operative and postoperative complications and to determine the rate and reasons for conversion.

A prospective randomized clinical trial was performed in the Department of Surgery at BP Koirala Institute of Health Sciences from February to June in all patients with the diagnosis of acute calculus cholecystitis. The mean SD age of patients in early and delayed groups were The mean SD duration of symptoms in early successful and converted groups were Out of 25 patients in early group, seven had jaundice and ten had deranged liver function in the preoperative period.

The total hospital stay was longer in the delayed group. Both early and delayed laparoscopic cholecystectomy is possible and safe in the treatment of acute cholecystitis. Complex regional pain syndrome CRPS type-1 following snake bite: The pathophysiological mechanism and clinical course of complex regional pain syndrome CRPS type-I still remain ill defined. Both the treatment and the prediction of the outcome of the treatment are difficult.

Abnormal neurohumoral and inflammatory mechanisms have been implicated in its causation usually following trivial noxious event in an extremity. However, to the best of our knowledge CRPS type-1 following snakebite has not been reported yet in the literature. We here report a case of an aggressive CRPS type-1 following a mountain pit viper bite, locally known as Gurube Ovophis monticola monticola in a year-old lady.

The clinical condition responded well to the therapy with serial sympathetic blockade of the limb with local anaesthetics, non-steroidal antiinflammatory analgesic, antiepileptic, antidepressant and physiotherapy. Our experience in managing this patient and associated pathophysiology in development of CRPS type-1 are discussed. Success rate of intubation using conventional flexomettalic tube with the intubating laryngeal mask airway ILMA.

Oct Journal of Anaesthesiology Clinical Pharmacology. The Ilma has become an essential component in airway management. It is used with its special flexomettalic tube. But the tube comes in limited number with the Ilma, and also the cost of buying it, limits its use. So we undertook this study to see the success rate of conventional reinforced tube when they are used with the Ilma. Intubation time, number of attempts for intubations, need of additional manipulations, failed intubation, esophageal intubation and incidence of complications were recorded.

The number of attempts required, esophageal intubations, adjusting maneuvers used and the incidence of complications were comparable among the two groups. The conventional flexomettalic latex tracheal tube can be safely used for tracheal intubation with comparable success rate via the ILMA. Anaesthetic Management of Tracheal Agenesis.

Tracheal agenesis is a rare but uniformly fatal congenital condition that obstetricians, neonatologists or anaesthesiologists may encounter as an unexpected emergency. Ventilation with bag and mask or through an endotracheal tube placed in the oesophagus may be the only options left for immediate survival and evaluation. Ventilation and maintenance of adequate oxygenation can be difficult during surgical interventions.

We report a case of neonate in which ventilation and anaesthesia were maintained through an endotracheal tube in the oesophagus and frequent episodes of drop in oxygen saturation were observed during surgery. Anaesthetic management, airway and other issues are discussed. The efficacy and safety of low dose-epidural buforphanol on postoperative analgesia following cesarean delivery. Butorphanol is considered an effective and safe analgesic after cesarean delivery but is associated with profound dose-dependent sedation.

Somnolence may cause hindrance in early mother-baby interaction. This study was designed to assess the analgesic efficacy and to monitor side-effects of low doses 0. One hundred and twenty parturients American Society of Anesthesiologists physical status 1 and 2 undergoing cesarean delivery were allocated into three groups: A combined spinal, epidural technique was used.

Spinal anaesthesia was used for surgery. The epidural route was used for postoperative analgesia with the study drug. Onset, duration and quality of analgesia, lowest visual analogue scales VAS score, and side effects were noted. The onset and duration of analgesia in group 2 4. A lower dose of epidural butorphanol with bupivacaine produces a significantly earlier onset, longer duration and better quality of analgesia than bupivacaine does.

Interestingly, all our patients got significantly sedated at one hour of the stay in preoperative waiting room from their baseline level of sedation score. It could be corroborated with their stay in isolation at the quiet preoperative waiting room where they were shifted for the study purpose. We have found that adding melatonin to alprazolam reduced anxiety levels more than either of the two drugs given alone.

Although the exact mechanism of the action of melatonin is still not known, there is accumulating evidence that a synergy exists between the melatonergic and GABAergic systems. It has been reported that the melatonin administration is associated with significant, dose-dependent increases in GABA concentrations in the central nervous system [ 10 ]. We observed that the added dose of melatonin in combination with alprazolam caused similar levels of sedation as seen with alprazolam alone suggesting that the melatonin in doses we used did not worsen sedation levels.

Benzodiazepines are reported to impair psychomotor performance [ 5 , 8 ]. The reports of the effect of melatonin on the orientation score with respect to time and place has varied in the literature [ 4 , 5 , 11 ]. Since we only recorded the orientation score to time and place in our patients, it remained preserved in perioperative period of study. Several studies have reported that melatonin lacks antegrade amnesia [ 4 , 5 , 11 , 12 ]. The incidence of amnesia in our patients receiving melatonin was low, and comparable to placebo.

Alprazolam at doses of 0. Adding melatonin to alprazolam did not change the amnesic effects in our patients. Interestingly majority of our patients premedicated with the combination of melatonin with alprazolam, expressed their desire to get similar premedication in future too. Benzodiazepines are associated with episodes of arousal during sleep [ 2 ] and later also show hangover effects [ 4 ] as they decrease the duration of rapid eye movement and slow wave sleep [ 14 ].

In contrast, melatonin is known to improve the quality of sleep [ 15 ]. While benzodiazepines are reported to decrease melatonin levels [ 2 ], the combined medication probably improved the quality of sleep in preoperative period to improve liking of the patients for the combined premedication than either drug alone or placebo. However, as our study was not designed to address the precise reason for preferring for the combined medication, for example, better anxiolysis or sleep or both, we cannot comment on this further.

All the drugs we used were safe in terms of adverse effects encountered. The minor problems that our patients complained were headache, restlessness, dizziness, nausea, and vomiting and their frequencies were similar in patients of all study groups. However, our study was not statistically powered to detect the incidence of adverse events. Both melatonin and alprazolam are reported to be safe [ 16 , 17 ] and serious untoward effects have not been documented in the therapeutic range so far.

The limitations of our study include a small sample size considering the factorial trial of the two premedicant drugs and limited tests of the orientation score and the delayed visual episodic memory in place of the detailed psychomotor and battery of memory tests. Further, we also could not measure the blood levels of the studied drugs because of lack of facility. While melatonin alprazolam combination reduced anxiety better than either drug alone, it produced sedation and amnesia to a similar degree as alprazolam alone.

More patients desired to receive the melatonin and alprazolam combination as premedicant in the future. Authors recommend the use of combination of alprazolam with melatonin orally as premedicant in surgical patients. The study was conducted with the research grant from B. The authors declare that there is no conflict of interests regarding the publication of this paper. National Center for Biotechnology Information , U.

Journal List Biomed Res Int v. Published online Jan Received Apr 10; Accepted Oct 7. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract We assessed if the addition of melatonin to alprazolam has superior premedication effects compared to either drug alone. Introduction Benzodiazepines are amongst the most popular preoperative medication to produce anxiolysis, amnesia, and sedation for the patients coming for surgery [ 1 ].

Methods After getting approval from the institutional research ethics committee and written informed consent from each patient, we studied eighty ASA 1 and 2 patients, aged 18 to 65 yr having anxiety VAS score of three or more, planned for receiving general anesthesia for laparoscopic cholecystectomy. A flow diagram showing inclusion, exclusion, group allocation, intervention and follow up.

Patient data and perioperative variables. Showing sedation in the four groups at various time points after premedication. Showing the result of assessment of memory for the five pictures shown at various time points related to premedication on the previous day and the two events. Patient's Perception Except for the one patient who was not sure, all the patients who received the combination of alprazolam and melatonin stated they would prefer to have the same premedication in the future.

Safety Profile There was no statistical difference between the groups in the number of people reporting occurrence of nausea, vomiting, dizziness, headache, or restlessness Table 1. Discussion We have found that the melatonin alprazolam combination reduced anxiety level to a greater extent than the either drug alone.

Conclusion While melatonin alprazolam combination reduced anxiety better than either drug alone, it produced sedation and amnesia to a similar degree as alprazolam alone. Acknowledgment The study was conducted with the research grant from B. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper. Dawson D, Encel N. Melatonin and sleep in humans. Journal of Pineal Research.

Methodology required to show clinical differences between benzodiazepines. Current Medical Research and Opinion. Naguib M, Samarkandi AH. British Journal of Anaesthesia. The comparative dose-response effects of melatonin and midazolam for premedication of adult patients: Efficacy and safety of melatonin as an anxiolytic and analgesic in the perioperative period: Measurement of feelings using visual analogue scales.

Proceedings of the Royal Society of Medicine. Preoperative alprazolam reduces anxiety in ambulatory surgery patients: The New England Journal of Medicine. Melatonin does not reduce anxiety more than placebo in the elderly undergoing surgery. Melatonin as premedication for laparoscopic cholecystectomy: Southern African Journal of Anaesthesia and Analgesia. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: Effect of benzodiazepine hypnotics on all-night sleep EEG spectra.

Wurtman RJ, Zhdanova I. Improvement of sleep quality by melatonin. Randomized, double-blind clinical trial, controlled with placebo, of the toxicology of chronic melatonin treatment. A review of its pharmacodynamic properties and efficacy in the treatment of anxiety and depression.

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