Control of the anxiety-pain complex in dentistry. Intravenous psychosedation with techniques using diazepam

Poloxamer 188 as vehicle for injectable diazepam

The significant occurrence of thrombophlebitis in patients administered diazepam intravenously was described recently. This side effect has been attributed to the crystallization of diazepam and its subsequent precipitation upon contact with blood or intravenous fluids. The current study was designed to reveal whether the solubilizing capability of poloxamer 188 reduces the incidence of thrombotic and inflammatory effects of diazepam in rabbits. The incidence of early (3-hr) ear vein necrosis was 72% in the diazepam-treated ears, while the incidence of necrosis in the ears that received poloxamer 188 as a vehicle for diazepam was 25%. The occurrence of thrombosis and loss of vessel integrity also was higher in diazepam-treated ears than in those treated with diazepam plus poloxamer 188. Solubilization of diazepam with poloxamer 188 may decrease the incidence of the tested side effects.

Benzodiazepine blockade of passive-avoidance task in mice: a state-dependent phenomenon

Four benzodiazepines (diazepam, chlordiazepoxide, halazepam, lorazepam) were tested for their effects on the acquisition of a passive-avoidance task in mice. This was done to determine whether amnesic effects, as reported in humans after diazepam and lorazepam, could be demonstrated by blockade of passive-avoidance responding in mice and, if so, to investigate the possible causes of the blockade by studying the relationships between the blockade and times of drug administration. Each of these benzodiazepines, at doses that did not alter overt behavior, blocked acquisition of the passive-avoidance response when they were administered to mice prior to the training session, but not when they were administered after the training session or prior to testing 24 h later. The block of avoidance responding was reversed, however, when the drugs were administered prior to both training and test sessions. These results suggest that state-dependent learning occurred; i.e., apparent amnesia occurred in the test session with untreated mice that had undergone passive-avoidance learning 24 h earlier under the influence of drug.

Periodontal surgery for the apprehensive patient with anesthetic management. A review of 150 patients

Full mouth periodontal surgery, while not a routine procedure, is invaluable in treating a sizable population that otherwise could not be treated. A series of 150 cases has been analyzed to determine who utilizes these procedures and why. The author feels that this is a valuable modality that will become more common.

A technique for investigating the intensity and duration of human psychomotor impairment after intravenous diazepam

The objective of this study was to evaluate the impairment of both psychomotor function and memory after intravenous administration of 17 to 28 mg. of diazepam to normal volunteers. A battery of tests, including word memory, Seguin form board, digit symbol, digit span, block design, and reaction time, was administered at set intervals to both drug and nondrug subjects. The diazepam group demonstrated both psychomotor and anterograde memory deficits which persisted throughout the 150-minute evaluation; but relative to the control group, the diazepam group had enhanced retrograde memory. These preliminary results indicate that even after subjects appear to be recovered from the effect;s of diazepam, residual psychomotor and memory impairment remain.

Clinical and psychological effects of intravenous diazepam related to plasma levels. A controlled, double-blind, cross-over study in oral surgery involving local analgesia

In a controlled, double-blind, cross-over study with diazepam (DZ) and placebo (PL) various clinical, psychological, and pharmacological parameters were studied in 33 patients having identical impacted third molars removed. The patients were admitted to the study consecutively and nonparametric statistics were used throughout the study for the evaluation (Wilcoxon's matched-pairs signed test). The following aspects were examined: Continous reaction times (CRT), rating scales (a.m. Beecher), blood pressure, pulse, plasma concentration of DZ and of N-desmethyldiazepam, visual changes, amnesia, adverse reactions, recalling of duration of surgery, orientation in time, phlebitis, and final evaluation performed by the patient. The operative conditions were found to be excellent, and only a few adverse effects were noticed. The patients expressed an overall enthusiasm about the sedation. In the rating scales only the predominantly sedative items were affected and not the anxiolytic ones. Neither the heart rate nor the systolic blood pressure were significantly changed; on the contrary, the DZ-group was less affected than the PL-group when maximum increases in the systolic blood pressure were compared in the two groups. The continuous reaction times were significantly correlated to the plasma concentrations of diazepam, especially 1 hour after sedation. The reported recurrence of initial clinical symptoms 6 hours after sedation due to the N-desmethyldiazepam could not be demonstrated in this study. The CRT has proved itself to be of great value in discriminating between different kinds of cerebral affections; the patients with DZ-intoxication showed significantly faster CRT 1 hour after injection than did patients suffering from well-documented cerebral disorders such as organic brain damage or hepatic encephalopathia.