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Kurdi MS, AS A, Ladhad DA, Mitragotri MV, Baiju A. Comparison Between Efficacy of Oral Melatonin and Oral L-theanine in Improving Sleep in Cancer Patients Suffering From Insomnia: A Randomised Double-blinded Placebo-controlled Study. Indian J Palliat Care 2024; 30:176-181. [PMID: 38846134 PMCID: PMC11152521 DOI: 10.25259/ijpc_89_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/05/2024] [Indexed: 06/09/2024] Open
Abstract
Objectives The primary objective was to compare the hypnotic efficacy of oral melatonin, oral L-theanine, and placebo in improving sleep in cancer patients with insomnia by the Athens Insomnia Scale (AIS). The secondary objective was to know the prevalence of insomnia in patients with cancer. Materials and Methods A prospective, double-blinded, placebo-controlled study was conducted after obtaining Institutional Ethics Committee approval. One hundred and twenty patients were randomly assigned to either Group A (melatonin), Group B (L-theanine), or Group C (placebo). They were instructed to take the tablets for 14 consecutive days, two h (hours) before bedtime, and evaluated with AIS on the 1st day, 7th day, and 14th day. Results There were seven dropouts: Two in Group A, two in Group B, and three in Group C. Significant differences in favour of melatonin treatment were found. There were statistically significant improvements in insomnia in cancer patients on melatonin intake compared to L-theanine. L-theanine had statistically significant improvements in insomnia in comparison to placebo. The mean ± standard deviation AIS on day one in Group A was 14.82 ± 1.29; on day seven was 10.92 ± 1.12; and on day 14 was 5.00 ± 0.70. Similarly, in Group B, the mean ± standard deviation AIS was 15.39 ± 1.03, 13.05 ± 1.06, and 9.55 ± 1.01, and in Group C, the mean AIS was 14.92 ± 1.40, 14.54 ± 1.35 and 13.05 ± 1.61 on the 1st, 7th and 10th day, respectively. There was an improvement in sleep from 1 to 7 days, 7 days to 14 days, and 1 day to 14 days in all the groups (P < 0.005). Conclusion The hypnotic efficacy of oral melatonin 3 mg was better than oral L-theanine 200 mg in cancer patients having insomnia. Furthermore, L-theanine had a better hypnotic efficacy when compared to a placebo.
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Affiliation(s)
- Madhuri S. Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Athira AS
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Dharmesh Arvind Ladhad
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Milon V. Mitragotri
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Amritha Baiju
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Hussein HA, Kahloul M, Alhamaidah MF, Alkhfaji HJ. Anxiolytic and Sedative Properties of Melatonin Premedication in Pediatrics Undergoing Elective Cardiac Catheterization: A Randomized Placebo Study. Cureus 2024; 16:e56543. [PMID: 38646369 PMCID: PMC11027787 DOI: 10.7759/cureus.56543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Preoperative anxiety in children has been linked to various postoperative consequences, such as postoperative regressive behavioral issues, extended distress during the recovery period, eating disorders, and bedwetting. The current study aimed to investigate the efficacy of low-dose oral melatonin in alleviating preoperative anxiety among children in the Iraqi population. STUDY DESIGN A randomized, double-blinded comparative study was undertaken, involving children aged four to 14 years scheduled for elective cardiac catheterization under general anesthesia. The study comprised a total of 80 children. The involved individuals were randomly assigned to two groups, each with 40 subjects. Group A received 0.5 mg/kg melatonin as premedication, while Group B received a placebo. RESULTS The two groups demonstrated similarity in mean age, weight, cardiac disease, and gender distribution. Statistically significant reductions in anxiety scores were observed in the melatonin group compared to the placebo group. Particularly, children administered 0.5 mg/kg melatonin exhibited the most substantial anxiolysis and venipuncture compliance (P < 0.05). Additionally, children who were premedicated with melatonin experienced decreased cognition, maximum sedation, successful parental separation, and psychomotor impairment (P < 0.05). CONCLUSIONS Melatonin demonstrated an effective sedation level without significant side effects, making it a preferred choice due to its efficacy, safety, current availability, and cost-effectiveness compared to other anesthetic agents used in premedication procedures.
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Affiliation(s)
- Hussein A Hussein
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Sousse, Sousse, TUN
| | - Mohamed Kahloul
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Sahloul Teaching Hospital, University of Sousse, Sousse, TUN
| | - Majid F Alhamaidah
- Department of Anesthesiology, College of Health and Medical Technology, Al-Ayen Iraqi University, Thi-Qar, IRQ
| | - Hussein J Alkhfaji
- Department of Anesthesiology, College of Health and Medical Technology, Al-Ayen Iraqi University, Thi-Qar, IRQ
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3
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Guo D, Zloty DM, Kossintseva I. Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial. Dermatol Surg 2023; 49:989-994. [PMID: 37606659 DOI: 10.1097/dss.0000000000003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Patient anxiety can complicate surgical outcomes by elevating blood pressure, increasing the need for postoperative pain management, and reducing overall patient satisfaction. Despite the use of anxiolytic medications in outpatient procedures, there is limited comparative evidence on the efficacy and safety of these agents in Mohs micrographic surgery. OBJECTIVE To compare the effectiveness and safety of different preprocedural anxiolytic agents in Mohs surgery on perioperative patient anxiety and patient satisfaction. MATERIALS AND METHODS A double-blinded, randomized, placebo-controlled trial was conducted of 6 different preprocedural anxiolytic agents (lorazepam, diazepam, alprazolam, gabapentin, pregabalin, and melatonin) in 350 patients undergoing Mohs surgery. Anxiety and vital signs were recorded. RESULTS Diazepam demonstrated a statistically significant, sustained reduction in anxiety levels compared with placebo ( p = .03). Gabapentin significantly reduced early anxiety ( p = .02). Alprazolam showed a trend to early anxiety reduction ( p = .08). Lorazepam ( p = .73), pregabalin ( p = .53), and melatonin ( p = .24) failed to reduce patient anxiety compared with placebo at any time point. No anxiolytic significantly impacted any patient vital sign or cognition. CONCLUSION Although short-acting benzodiazepines and gamma-aminobutyric acid medications may have transient anxiolytic effects, a single oral dose of 5 mg of diazepam can provide a sustained anxiolytic effect in Mohs surgery, with excellent patient safety.
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Affiliation(s)
- Danny Guo
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - David M Zloty
- Department of Dermatology and Skin Science, UBC, Vancouver, British Columbia, Canada
| | - Irèn Kossintseva
- Department of Dermatology and Skin Science, UBC, Vancouver, British Columbia, Canada
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Bagheri F, Goudarzi I. Postnatal melatonin administration to stressed dams for ameliorating risk-taking behaviour in rat pups through maternal care improvement. Int J Dev Neurosci 2023. [PMID: 37114289 DOI: 10.1002/jdn.10265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND AIM Anxiety often occurs both concurrently and sequentially in childhood and adolescence in association with prenatal stress, which may reduce the quality of maternal care and then cause mood disorders among children in later life. Against this background, melatonin, as a powerful antioxidant, was used in the present study to ameliorate risk-taking behaviour induced by pure maternal care in rat pups. MATERIALS AND METHODS The Wistar rat dams recruited in this study were exposed to restraint stress from gestational day (GD) 11 until delivery. They further received melatonin (10 mg/kg) during the postnatal days (PNDs) 0-7 by intraperitoneal (IP) injections at 4:00 PM. The pregnant rats were then divided into four groups, namely, control, stress, stress + melatonin and melatonin, and their maternal behaviour and corticosterone levels were measured. In the offspring, the outcomes of some behavioural tasks, including the elevated plus-maze (EPM) and open-field (OF) tests were ultimately assessed. RESULTS The study results revealed that the quantity and quality of maternal care significantly declined and the plasma corticosterone levels compounded in the stressed dams. Melatonin treatment, however, improved their nursing behaviour and reduced their plasma corticosterone levels. The offspring performance in two tasks also showed an upward trend in risk-taking behaviour in the stress group, and melatonin administration ameliorated the effects of stress and lessened their anxiety-like behaviour. CONCLUSION It was concluded that prenatal restraint stress could impair stress responses and quality of maternal care, whereas postnatal melatonin administration potentially contributed to the normalization of stress reaction and anxiolysis.
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Affiliation(s)
| | - Iran Goudarzi
- School of Biology, Damghan University, Damghan, Iran
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Abo-El-Ata GA, Abdelghany FHA, Ahmed MF, Abdelgwad M, Ramadan MA. Assessing neuropsychological disorders affecting pottery workers occupationally exposed to air pollutants. Neurotoxicology 2023; 95:164-172. [PMID: 36736786 DOI: 10.1016/j.neuro.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/17/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pottery-related activities are characterized by the emission of multiple air pollutants in the form of particulate matter, gases, and organic compounds. These pollutants are associated with adverse neuropsychological effects. This study aimed at investigating the effect of occupational exposure to air pollutants on the neuropsychiatric health. METHODS A total of 180 male workers (90 exposed workers and 90 administrative employees) were recruited from pottery-making activities in the Fawakher region located in old Cairo (Misr Al-Kadema); the administrative employees were the control group. Personal, medical, and family histories, general and neurological clinical examination, and neuropsychological assessments were recorded. Serum levels of 4-hydroxy-2-nonenal levels (4HNE) were measured by ELISA. Environmental measurement of workplace air pollutants was performed. RESULTS Environmental monitoring of the workplace revealed that workers are exposed to high levels of SO2 and NO2 as these exceeded the national standard levels. Compared to the control group, the exposed workers' group demonstrated a significant decrease in digit forwards score, digit backward score, and symbol digit score and a significant higher Hamilton Depression Scale score, and Benton Visual Retention score. The level of 4HNE was significantly increased among the exposed workers' group compared to that of the control group. CONCLUSION Occupational exposure to air pollutants is associated with impairment in neuropsychological functions, with a corresponding increase in the serum level of 4HNE, which is a biomarker for oxidative stress among Egyptian pottery workers.
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Affiliation(s)
- Gehad Ahmed Abo-El-Ata
- Occupational and Environmental Medicine Department, Faculty of Medicine, Cairo University, Egypt.
| | | | | | - Marwa Abdelgwad
- Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Egypt.
| | - Mona Abdallah Ramadan
- Occupational and Environmental Medicine Department, Faculty of Medicine, Cairo University, Egypt.
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Melatonin alleviates PTSD-like behaviors and restores serum GABA and cortisol levels in mice. Psychopharmacology (Berl) 2023; 240:259-269. [PMID: 36642730 DOI: 10.1007/s00213-023-06312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/04/2023] [Indexed: 01/17/2023]
Abstract
RATIONALE Melatonin is an endogenous hormone which modulates sleep-wake cycles. Previous studies have found a close correlation between melatonin and post-traumatic stress disorder (PTSD), a trauma- and stress-related psychiatric disorder with symptoms of sleep disturbance. However, it is still unclear if melatonin can have a therapeutic effect on PTSD. OBJECTIVE This study aimed to investigate the effects of melatonin on foot shocks induced PTSD-like behaviors and abnormal neuroendocrine levels in mice. RESULTS As compared to no-shock controls, PTSD-like mice spent significantly more time freezing and displayed less rearing in a contextual fear test, spent significantly less time in and had fewer entries into open arms in an elevated maze test, and spent significantly less time in and had fewer entries into a light box in a light-dark transition task. In addition, serum GABA and cortisol levels were both found to be significantly decreased, whereas epinephrine levels were significantly increased in the PTSD-like mice. Our results showed that intraperitoneal injections of melatonin (2 mM, but not 0.2 nor 20 mM, 0.1 ml/day for two consecutive weeks) alleviated PTSD-like behaviors and restored serum GABA and cortisol levels. Further, it was found that melatonin receptor 1/2 antagonist luzindole significantly blocked the beneficial effects of melatonin for PTSD-like behaviors and serum GABA and cortisol levels, whereas melatonin receptor 2 antagonist 4-P-PDOT slightly blocked these effects. CONCLUSIONS These results indicate that melatonin has a potential therapeutic effect on PTSD-like symptoms in mice, and melatonin receptor 1 mediated the effect.
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Repova K, Baka T, Krajcirovicova K, Stanko P, Aziriova S, Reiter RJ, Simko F. Melatonin as a Potential Approach to Anxiety Treatment. Int J Mol Sci 2022; 23:ijms232416187. [PMID: 36555831 PMCID: PMC9788115 DOI: 10.3390/ijms232416187] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/02/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Anxiety disorders are the most common mental diseases. Anxiety and the associated physical symptoms may disturb social and occupational life and increase the risk of somatic diseases. The pathophysiology of anxiety development is complex and involves alterations in stress hormone production, neurosignaling pathways or free radical production. The various manifestations of anxiety, its complex pathophysiological background and the side effects of available treatments underlie the quest for constantly seeking therapies for these conditions. Melatonin, an indolamine produced in the pineal gland and released into the blood on a nightly basis, has been demonstrated to exert anxiolytic action in animal experiments and different clinical conditions. This hormone influences a number of physiological actions either via specific melatonin receptors or by receptor-independent pleiotropic effects. The underlying pathomechanism of melatonin's benefit in anxiety may reside in its sympatholytic action, interaction with the renin-angiotensin and glucocorticoid systems, modulation of interneuronal signaling and its extraordinary antioxidant and radical scavenging nature. Of importance, the concentration of this indolamine is significantly higher in cerebrospinal fluid than in the blood. Thus, ensuring sufficient melatonin production by reducing light pollution, which suppresses melatonin levels, may represent an endogenous neuroprotective and anxiolytic treatment. Since melatonin is freely available, economically undemanding and has limited side effects, it may be considered an additional or alternative treatment for various conditions associated with anxiety.
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Affiliation(s)
- Kristina Repova
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia
| | - Tomas Baka
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia
| | - Kristina Krajcirovicova
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia
| | - Peter Stanko
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia
| | - Silvia Aziriova
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia
| | - Russel J. Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio, Long School of Medicine, San Antonio, TX 78229, USA
| | - Fedor Simko
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Sasinkova 4, 81108 Bratislava, Slovakia
- 3rd Department of Internal Medicine, Faculty of Medicine, Comenius University, 83305 Bratislava, Slovakia
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, 84505 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-(0)2-59357276
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The Zebrafish, an Outstanding Model for Biomedical Research in the Field of Melatonin and Human Diseases. Int J Mol Sci 2022; 23:ijms23137438. [PMID: 35806441 PMCID: PMC9267299 DOI: 10.3390/ijms23137438] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/06/2023] Open
Abstract
The zebrafish has become an excellent model for the study of human diseases because it offers many advantages over other vertebrate animal models. The pineal gland, as well as the biological clock and circadian rhythms, are highly conserved in zebrafish, and melatonin is produced in the pineal gland and in most organs and tissues of the body. Zebrafish have several copies of the clock genes and of aanat and asmt genes, the latter involved in melatonin synthesis. As in mammals, melatonin can act through its membrane receptors, as with zebrafish, and through mechanisms that are independent of receptors. Pineal melatonin regulates peripheral clocks and the circadian rhythms of the body, such as the sleep/wake rhythm, among others. Extrapineal melatonin functions include antioxidant activity, inducing the endogenous antioxidants enzymes, scavenging activity, removing free radicals, anti-inflammatory activity through the regulation of the NF-κB/NLRP3 inflammasome pathway, and a homeostatic role in mitochondria. In this review, we introduce the utility of zebrafish to analyze the mechanisms of action of melatonin. The data here presented showed that the zebrafish is a useful model to study human diseases and that melatonin exerts beneficial effects on many pathophysiological processes involved in these diseases.
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Favre-Félix J, Laurent V, Branche P, Huissoud C, Raffin M, Pradat P, Aubrun F, Dziadzko M. Auricular Acupuncture for Preoperative Anxiety in Parturient Women with Scheduled Cesarean Section: A Randomized Placebo-Controlled Blind Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:569-578. [PMID: 35394895 DOI: 10.1089/jicm.2021.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Preoperative anxiety before cesarean section is a major issue. Nonpharmacologic anxiety control is believed to be more suitable in pregnant women. Auricular acupuncture (AA) is an inexpensive, easy-to-use, and validated intervention to reduce anxiety in different surgical settings. We evaluated the effect of AA on preoperative cesarean section anxiety. Methods: In a prospective, blind, controlled trial, pregnant women with a scheduled cesarean section under spinal anesthesia were randomized to receive AA with needle, AA without needle (sham), or usual care (no intervention). Anxiety level was assessed by using a visual analogue scale for anxiety (VAS-A; 0-minimal anxiety, 100-maximal anxiety) at three time points: inclusion (pre-induction room-T0), when entering the operating room (T1), and before incision (T2). The primary outcome was the VAS-A variation (percentage changes) between T0 and T1 in the AAe group compared with that in the sham AA group. The secondary outcomes were the VAS-A variation between T0 and T1 in the AA group compared with that in the control group, and the variation between T0 and T2 compared between the three groups, the effect of AA on parasympathetic tone, and the incidence of adverse effects. Results: In women immediately before anesthesia for cesarean section, the AA produced a 19% decrease of anxiety, compared with a 21% anxiety increase in sham AA, which is significantly different. The effect of AA was more present in women with low initial anxiety. The proportion of patients reaching clinically significant anxiety reduction (>33% from the initial level) was 2.5 times higher in the AA group (p = 0.02) compared with the sham group. No differences in anxiety variations were found compared with the no-intervention group. No effect of AA was noted on parasympathetic tone. Conclusion: Compared with sham, AA decreased maternal anxiety level when arriving in the operation room and just before the beginning of the cesarean section, with a trend toward improvement compared with usual care.
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Affiliation(s)
- Jeremy Favre-Félix
- Service d'Anesthésie, Réanimation, Douleur, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Virginie Laurent
- Service d'Anesthésie, Réanimation, Douleur, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Patricia Branche
- Service d'Anesthésie, Réanimation, Douleur, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Cyril Huissoud
- Service de Gynécologie-Obstétrique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stem Cell and Brain Research Institute, U846-INSERM, Bron, France
| | - Mahé Raffin
- Centre de Recherche Clinique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Frederic Aubrun
- Service d'Anesthésie, Réanimation, Douleur, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), U1290-INSERM et Université Claude Bernard Lyon 1, Lyon, France
| | - Mikhail Dziadzko
- Service d'Anesthésie, Réanimation, Douleur, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), U1290-INSERM et Université Claude Bernard Lyon 1, Lyon, France
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Cerne R, Lippa A, Poe MM, Smith JL, Jin X, Ping X, Golani LK, Cook JM, Witkin JM. GABAkines - Advances in the discovery, development, and commercialization of positive allosteric modulators of GABA A receptors. Pharmacol Ther 2022; 234:108035. [PMID: 34793859 PMCID: PMC9787737 DOI: 10.1016/j.pharmthera.2021.108035] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022]
Abstract
Positive allosteric modulators of γ-aminobutyric acid-A (GABAA) receptors or GABAkines have been widely used medicines for over 70 years for anxiety, epilepsy, sleep, and other disorders. Traditional GABAkines like diazepam have safety and tolerability concerns that include sedation, motor-impairment, respiratory depression, tolerance and dependence. Multiple GABAkines have entered clinical development but the issue of side-effects has not been fully solved. The compounds that are presently being developed and commercialized include several neuroactive steroids (an allopregnanolone formulation (brexanolone), an allopregnanolone prodrug (LYT-300), Sage-324, zuranolone, and ganaxolone), the α2/3-preferring GABAkine, KRM-II-81, and the α2/3/5-preferring GABAkine PF-06372865 (darigabat). The neuroactive steroids are in clinical development for post-partum depression, intractable epilepsy, tremor, status epilepticus, and genetic epilepsy disorders. Darigabat is in development for epilepsy and anxiety. The imidazodiazepine, KRM-II-81 is efficacious in animal models for the treatment of epilepsy and post-traumatic epilepsy, acute and chronic pain, as well as anxiety and depression. The efficacy of KRM-II-81 in models of pharmacoresistant epilepsy, preventing the development of seizure sensitization, and in brain tissue of intractable epileptic patients bodes well for improved therapeutics. Medicinal chemistry efforts are also ongoing to identify novel and improved GABAkines. The data document gaps in our understanding of the molecular pharmacology of GABAkines that drive differential pharmacological profiles, but emphasize advancements in the ability to successfully utilize GABAA receptor potentiation for therapeutic gain in neurology and psychiatry.
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Affiliation(s)
- Rok Cerne
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN USA,Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, Ljubljana, Slovenia.,RespireRx Pharmaceuticals Inc, Glen Rock, NJ, USA,Department of Anatomy and Cell Biology, Indiana University/Purdue University, Indianapolis, IN, USA
| | - Arnold Lippa
- RespireRx Pharmaceuticals Inc, Glen Rock, NJ, USA
| | | | - Jodi L. Smith
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN USA
| | - Xiaoming Jin
- Department of Anatomy and Cell Biology, Indiana University/Purdue University, Indianapolis, IN, USA
| | - Xingjie Ping
- Department of Anatomy and Cell Biology, Indiana University/Purdue University, Indianapolis, IN, USA
| | - Lalit K. Golani
- Department of Chemistry and Biochemistry, Milwaukee Institute of Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - James M. Cook
- RespireRx Pharmaceuticals Inc, Glen Rock, NJ, USA,Department of Chemistry and Biochemistry, Milwaukee Institute of Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jeffrey M. Witkin
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN USA,RespireRx Pharmaceuticals Inc, Glen Rock, NJ, USA,Department of Chemistry and Biochemistry, Milwaukee Institute of Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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11
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Kumar R, Kumari K, Janweja S, Kumar R, Verma M, Sharma A, Paliwal B, Kishan R. Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study. Braz J Anesthesiol 2021:S0104-0014(21)00339-0. [PMID: 34560112 PMCID: PMC10362446 DOI: 10.1016/j.bjane.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/18/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. METHODS Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. RESULTS Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p < 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p < 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. CONCLUSION Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.
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Affiliation(s)
- Rakesh Kumar
- Apex Multispecialty Hospital, Sriganganagar, India
| | - Kamlesh Kumari
- All India Institute of Medical Sciences, Department of Anesthesiology and Critical Care, Jodhpur, India.
| | - Sarita Janweja
- Dr. S.N. Medical College, Department of Anesthesiology and Critical Care, Jodhpur, India
| | - Rakesh Kumar
- All India Institute of Medical Sciences, Department of Anesthesiology and Critical Care, Jodhpur, India
| | - Manoj Verma
- Dr. S.N. Medical College, Department of Community Medicine, Jodhpur, India
| | - Ankur Sharma
- All India Institute of Medical Sciences, Department of Anesthesiology and Critical Care, Jodhpur, India
| | - Bharat Paliwal
- All India Institute of Medical Sciences, Department of Anesthesiology and Critical Care, Jodhpur, India
| | - Rama Kishan
- Dr. S.N. Medical College, Department of Orthopedics, Jodhpur, India
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Li XR, Zhang WH, Williams JP, Li T, Yuan JH, Du Y, Liu JD, Wu Z, Xiao ZY, Zhang R, Liu GK, Zheng GR, Zhang DY, Ma H, Guo QL, An JX. A multicenter survey of perioperative anxiety in China: Pre- and postoperative associations. J Psychosom Res 2021; 147:110528. [PMID: 34034140 DOI: 10.1016/j.jpsychores.2021.110528] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To describe patient characteristics associated with preoperative anxiety and subsequently assess the relationship between preoperative anxiety and postoperative anxiety, pain, sleep quality, nausea and vomiting. METHODS The study collected data from patients undergoing elective operation from 12 hospitals in China. The State-Trait Anxiety Inventory (STAI) and the Athens Insomnia Scale (AIS) were used to assess anxiety and sleep quality before surgery. Evaluations of anxiety, pain, sleep quality, nausea and vomiting were quantified using the Visual Analogue Scale on postoperative days 1 and 2. RESULTS Data from 997 patients were analyzed. Preoperatively, 258 (25.9%) patients had high anxiety (STAI-State>44). Multivariate analyses showed a significant relationship between high anxiety and female gender (OR: 1.66, 95% CI: 1.08-2.57, p = 0.02), highly invasive surgery (OR: 2.29, 95% CI: 1.29-4.06, p = 0.005), higher trait anxiety (OR: 1.24, 95% CI: 1.20-1.28, p < 0.001) and insomnia (AIS ≥ 6, OR: 1.79, 95% CI: 1.17-2.76, p = 0.008). Preoperative anxiety demonstrated a negative correlation with postoperative anxiety following highly invasive surgery; this became a positive relationship following less invasive surgery. Preoperative anxiety was also positively related to postoperative pain and poor sleep quality. The correlation between preoperative anxiety and postoperative nausea and vomiting was not statistically significant. CONCLUSION Female gender, highly invasive surgery, higher trait anxiety and insomnia are independent risk factors for high preoperative anxiety. Surgical invasiveness influences association between pre- and postoperative anxiety. Higher preoperative anxiety is related to poorer sleep quality and more severe pain postoperatively.
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Affiliation(s)
- Xi-Rong Li
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; School of Anesthesiology, Weifang Medical University, Weifang, Shangdong, China
| | - Wen-Hao Zhang
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - John P Williams
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tong Li
- Department of Pain, Lanzhou Maternity and Child Healthcare Hospital, Lanzhou, Gansu, China
| | - Jian-Hu Yuan
- Department of Anesthesiology, Beijing Rectum Hospital, Beijing, China
| | - Yun Du
- Department of Anesthesiology, University of Chinese Academy of Sciences Affiliated Chongqing Hospital, Chongqing, China
| | - Jin-De Liu
- Department of Anesthesiology, University of Chinese Academy of Sciences Affiliated North China Hospital, Renqiu, Hebei, China
| | - Zhe Wu
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - Zhao-Yang Xiao
- Department of Anesthesiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rui Zhang
- School of Anesthesiology, Weifang Medical University, Weifang, Shangdong, China
| | - Guo-Kai Liu
- Department of Anesthesiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guan-Rong Zheng
- Department of Anesthesiology, Shengli Oilfield Central Hospital, Dongying, Shangdong, China
| | - Dong-Ya Zhang
- Department of Anesthesiology, Beijing Huaxin Hospital, The First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Hong Ma
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qu-Lian Guo
- Department of Anesthesiology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jian-Xiong An
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; School of Anesthesiology, Weifang Medical University, Weifang, Shangdong, China.
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Sriramka B, Mallik D, Singh J, Khetan M. Effect of hand-holding and conversation alone or with midazolam premedication on preoperative anxiety in adult patients-A randomised controlled trial. Indian J Anaesth 2021; 65:128-132. [PMID: 33776087 PMCID: PMC7983819 DOI: 10.4103/ija.ija_705_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/26/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Anxiety causing stress is most profound before surgery. Anxiolytics are used routinely to combat perioperative anxiety. Studies have shown that hand-holding and communication are useful in reducing anxiety levels intraoperatively. This study compares the effectiveness of the same with pharmacological interventions in allaying preoperative anxiety. Material and Methods: This is a three-arm parallel-group randomised controlled trial. A total of 90 adult patients aged <45 years and of American Society of Anesthesiologists (ASA) grade 1–2, undergoing laparoscopic surgery were enroled in this study. Patients received either intravenous (IV) midazolam (group M) or hand-holding and conversation (group HC), or a combination of IV midazolam and holding and conversation (group HCM) in the preoperative room. Anxiety, heart rate (HR) and mean blood pressure (MBP) were recorded before and 20 minutes after the intervention. Anxiety was measured using the Amsterdam preoperative anxiety and information scale. The analysis of covariance (ANCOVA) test was done to analyse the difference between the groups. Results: The mean anxiety scores were significantly different in the three groups (p = 0.04) after intervention, with the lowest score in group HCM, followed by group HC and the highest score in group M. The mean heart rates were also significantly different in the three groups after intervention but MBP was not significantly different in the three groups. Conclusion: A combination of hand-holding and conversation and midazolam is best for allaying preoperative anxiety in patients undergoing laparoscopic surgeries than either method alone.
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Affiliation(s)
- Bhavna Sriramka
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Diptimayee Mallik
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Jayanti Singh
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Megha Khetan
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
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Duruk G, Kuru R, Özkan AS. Impact of Dental Rehabilitation Under General Anesthesia on Oral Health-Related Quality-of-Life and Dental Anxiety in Turkish Children. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Madsen BK, Zetner D, Møller AM, Rosenberg J. Melatonin for preoperative and postoperative anxiety in adults. Cochrane Database Syst Rev 2020; 12:CD009861. [PMID: 33319916 PMCID: PMC8092422 DOI: 10.1002/14651858.cd009861.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety in relation to surgery is a well-known problem. Melatonin offers an alternative treatment to benzodiazepines for ameliorating this condition in the preoperative and postoperative periods. OBJECTIVES To assess the effects of melatonin on preoperative and postoperative anxiety compared to placebo or benzodiazepines. SEARCH METHODS We searched the following databases on 10 July 2020: CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science. For ongoing trials and protocols, we searched clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomized, placebo-controlled or standard treatment-controlled (or both) studies that evaluated the effects of preoperatively administered melatonin on preoperative or postoperative anxiety. We included adult patients of both sexes (15 to 90 years of age) undergoing any kind of surgical procedure for which it was necessary to use general, regional, or topical anaesthesia. DATA COLLECTION AND ANALYSIS One review author conducted data extraction in duplicate. Data extracted included information about study design, country of origin, number of participants and demographic details, type of surgery, type of anaesthesia, intervention and dosing regimens, preoperative anxiety outcome measures, and postoperative anxiety outcome measures. MAIN RESULTS We included 27 randomized controlled trials (RCTs), involving 2319 participants, that assessed melatonin for treating preoperative anxiety, postoperative anxiety, or both. Twenty-four studies compared melatonin with placebo. Eleven studies compared melatonin to a benzodiazepine (seven studies with midazolam, three studies with alprazolam, and one study with oxazepam). Other comparators in a small number of studies were gabapentin, clonidine, and pregabalin. No studies were judged to be at low risk of bias for all domains. Most studies were judged to be at unclear risk of bias overall. Eight studies were judged to be at high risk of bias in one or more domain, and thus, to be at high risk of bias overall. Melatonin versus placebo Melatonin probably results in a reduction in preoperative anxiety measured by a visual analogue scale (VAS, 0 to 100 mm) compared to placebo (mean difference (MD) -11.69, 95% confidence interval (CI) -13.80 to -9.59; 18 studies, 1264 participants; moderate-certainty evidence), based on a meta-analysis of 18 studies. Melatonin may reduce immediate postoperative anxiety measured on a 0 to 100 mm VAS compared to placebo (MD -5.04, 95% CI -9.52 to -0.55; 7 studies, 524 participants; low-certainty evidence), and may reduce delayed postoperative anxiety measured six hours after surgery using the State-Trait Anxiety Inventory (STAI) (MD -5.31, 95% CI -8.78 to -1.84; 2 studies; 73 participants; low-certainty evidence). Melatonin versus benzodiazepines (midazolam and alprazolam) Melatonin probably results in little or no difference in preoperative anxiety measured on a 0 to 100 mm VAS (MD 0.78, 95% CI -2.02 to 3.58; 7 studies, 409 participants; moderate-certainty evidence) and there may be little or no difference in immediate postoperative anxiety (MD -2.12, 95% CI -4.61 to 0.36; 3 studies, 176 participants; low-certainty evidence). Adverse events Fourteen studies did not report on adverse events. Six studies specifically reported that no side effects were observed, and the remaining seven studies reported cases of nausea, sleepiness, dizziness, and headache; however, no serious adverse events were reported. Eleven studies measured psychomotor and cognitive function, or both, and in general, these studies found that benzodiazepines impaired psychomotor and cognitive function more than placebo and melatonin. Fourteen studies evaluated sedation and generally found that benzodiazepine caused the highest degree of sedation, but melatonin also showed sedative properties compared to placebo. Several studies did not report on adverse events; therefore, it is not possible to conclude with certainty, from the data on adverse effects collected in this review, that melatonin is better tolerated than benzodiazepines. AUTHORS' CONCLUSIONS When compared with placebo, melatonin given as premedication (as tablets or sublingually) probably reduces preoperative anxiety in adults (measured 50 to 120 minutes after administration), which is potentially clinically relevant. The effect of melatonin on postoperative anxiety compared to placebo (measured in the recovery room and six hours after surgery) was also evident but was much smaller, and the clinical relevance of this finding is uncertain. There was little or no difference in anxiety when melatonin was compared with benzodiazepines. Thus, melatonin may have a similar effect to benzodiazepines in reducing preoperative and postoperative anxiety in adults.
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Affiliation(s)
- Bennedikte K Madsen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Dennis Zetner
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Ann Merete Møller
- Cochrane Anaesthesia, Critical and Emergency Care Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
- Cochrane Colorectal Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Ray A, Sharma S, Sadasivam B. Exploring digital psychiatry through a pilot study: Pencil-and-paper versus digital neuropsychological testing. Asian J Psychiatr 2020; 53:102236. [PMID: 32574938 DOI: 10.1016/j.ajp.2020.102236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Avik Ray
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India.
| | - Swati Sharma
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India
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17
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Choudhary S, Sharma S, Kumari I, Kalluraya S, Meena K, Dave T. Comparative evaluation of oral melatonin and oral clonidine for the attenuation of haemodynamic response to laryngoscopy and tracheal intubation-A prospective randomised double blind study. Indian J Anaesth 2020; 64:696-703. [PMID: 32934404 PMCID: PMC7457986 DOI: 10.4103/ija.ija_76_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/09/2020] [Accepted: 06/06/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Laryngoscopy and endotracheal intubation cause significant derangement of the haemodynamic parameters proving detrimental for some patients. Clonidine, an α-2 adrenoreceptor agonist, and melatonin, the pineal hormone, have been used for the attenuation of these haemodynamic responses. This study was designed to evaluate the effect of oral melatonin and clonidine in attenuating the haemodynamic responses to laryngoscopy and intubation. MATERIALS AND METHODS In this prospective randomised double-blind study, 60 American Society of Anaesthesiologists (ASA) grade I and II patients aged 20-60 years of either gender scheduled to undergo elective surgery under general anaesthesia were randomly divided into Group M and Group C and orally received 6 mg of melatonin and 0.2 mg of clonidine, respectively, 120 min before the induction of anaesthesia. The haemodynamic parameters-heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate -pressure product(RPP) were recorded before and 120 min after the administration of the study drug, before induction, immediately after intubation and at 1, 3, 5 and 10 min following intubation. Sedation was assessed using the Ramsay Sedation Scale. The qualitative and quantitative variables were analysed using Chi square test and unpaired student t test, respectively. For intragroup comparison of quantitative data, paired t test was applied. A P value <0.05 was considered as statistically significant. RESULTS A significant difference was noted between the groups regarding HR and RPP 0, 1, 3 and 5 min after intubation. The Ramsay sedation score ranged between 2 and 3 at all time intervals. CONCLUSION Although both the drugs are effective, oral melatonin proved superior to oral clonidine in attenuating the haemodynamic response to laryngoscopy and tracheal intubation without any side effects.
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Affiliation(s)
- Santosh Choudhary
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Sandeep Sharma
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Indira Kumari
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Swathi Kalluraya
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Khemraj Meena
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
| | - Tanuj Dave
- Department of Anaesthesiology, RNT Medical College, Udaipur, Rajasthan, India
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Barbosa-Méndez S, Salazar-Juarez A. Melatonin does not produce sedation in rats: A chronobiological study. Chronobiol Int 2019; 37:353-374. [DOI: 10.1080/07420528.2019.1702554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Susana Barbosa-Méndez
- Molecular Neurobiology and Neurochemistry of Addiction, Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México, México
| | - Alberto Salazar-Juarez
- Molecular Neurobiology and Neurochemistry of Addiction, Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México, México
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Cho I, Cohen AS. Explaining age-related decline in theory of mind: Evidence for intact competence but compromised executive function. PLoS One 2019; 14:e0222890. [PMID: 31539418 PMCID: PMC6754124 DOI: 10.1371/journal.pone.0222890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/08/2019] [Indexed: 01/01/2023] Open
Abstract
Previous studies suggest theory of mind (ToM) ability declines with age. However, prior tasks not only required ToM competence but also imposed high executive function (EF) demands, so decline in ToM ability could be caused by deterioration in ToM competence, EF, or both. It was predicted that if the elderly have intact ToM competence but compromised EF, then they should perform similarly to younger adults when using ToM tasks that lower executive demands, such as spontaneous-response tasks. Results showed that on tasks with reduced demands, older adults tracked belief to the same extent as younger adults, despite their declining EF. The findings support a model in which age-related decline in ToM ability is primarily caused by compromised EF, not ToM competence, suggesting that underlying ToM mechanisms are still intact in the elderly. We discuss implications of this work for competence-performance issues in ToM processing and the underlying sources of age-related deterioration of ToM.
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Affiliation(s)
- Isu Cho
- Department of Psychology and Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Adam S. Cohen
- Department of Psychology and Brain and Mind Institute, Western University, London, Ontario, Canada
- * E-mail:
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Assessment of Valeriana officinalis l. (Valerian) for Conscious Sedation of Patients During the Extraction of Impacted Mandibular Third Molars: A Randomized, Split-Mouth, Double-Blind, Crossover Study. J Oral Maxillofac Surg 2019; 77:1796.e1-1796.e8. [DOI: 10.1016/j.joms.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023]
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Torun AC, Yüceer E. Should Melatonin Be Used as an Alternative Sedative and Anxiolytic Agent in Mandibular Third Molar Surgery? J Oral Maxillofac Surg 2019; 77:1790-1795. [PMID: 30959006 DOI: 10.1016/j.joms.2019.02.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Melatonin is a natural hormone that regulates circadian rhythms. The aim of this study was to compare the anxiolytic effects of oral melatonin and oral midazolam in patients undergoing third molar surgery. The study also sought to investigate the effects of these drugs on cognitive and psychomotor functions. MATERIALS AND METHODS This was a double-blinded, prospective, randomized clinical study. Patients scheduled for impacted third molar surgery were included in the study. Anxiety was evaluated with the visual analog scale (VAS). To measure psychomotor and cognitive functions before the procedure, all patients were asked to complete the digit symbol substitution test (DSST) and the trail making test (TMT parts A and B). Then, all patients were allocated to 1 of 3 groups to receive oral midazolam 0.2 mg/kg (group MD), oral melatonin 0.4 mg/kg (group M), or an oral multivitamin tablet as placebo (group P). After 60 minutes, patients were reassessed using the same 3 tests. The difference between the pre- and post-drug VAS values was calculated and the anxiolytic effects of the drugs were evaluated. RESULTS Ninety patients participated in the study. No relevant differences were observed among groups for age, gender, or duration of operation. The results suggested that anxiety decreased most in group MD (P < .001), but anxiety in group M also decreased significantly compared with group P (P = .016). Similarly, the greatest increase in TMT-A and -B score differences was in group MD compared with the other groups (P < .001), whereas there was no significant difference between groups M and P for TMT-A and -B scores (P = .913 and P = .964, respectively). CONCLUSION Melatonin showed sufficient anxiolytic effect in third molar surgery without affecting cognitive and psychomotor functions.
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Affiliation(s)
- Aysun Caglar Torun
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.
| | - Ezgi Yüceer
- Research Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
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Mahmood D, Muhammad BY, Alghani M, Anwar J, el-Lebban N, Haider M. Advancing role of melatonin in the treatment of neuropsychiatric disorders. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.ejbas.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Danish Mahmood
- Department of Pharmacology & Toxicology Unaizah College of Pharmacy, Qassim University, Saudi Arabia
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Abstract
PURPOSE/BACKGROUND Development of the Digit Symbol Substitution Test (DSST) was initiated over a century ago as an experimental tool to understand human associative learning. Its clinical utility, owing to its brevity and high discriminant validity, was first recognized in the 1940s, and now the DSST is among the most commonly used tests in clinical neuropsychology. METHODS Specific studies and articles were reviewed to illustrate what the test measures, to evaluate its sensitivity to change, and to discuss its use in clinical practice. RESULTS The DSST is a valid and sensitive measure of cognitive dysfunction impacted by many domains. Performance on the DSST correlates with real-world functional outcomes (eg, the ability to accomplish everyday tasks) and recovery from functional disability in a range of psychiatric conditions including schizophrenia and major depressive disorder. Importantly, the DSST has been demonstrated to be sensitive to changes in cognitive functioning in patients with major depressive disorder and offers promise as a clinical decision-making tool for monitoring treatment effects in this and other disorders affecting cognition. IMPLICATIONS/CONCLUSIONS The DSST is sensitive to the presence of cognitive dysfunction as well as to change in cognitive function across a wide range of clinical populations but has low specificity to determine exactly which cognitive domain has been affected. However, the DSST offers a practical and effective method to monitor cognitive functions over time in clinical practice.
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Affiliation(s)
- Judith Jaeger
- From CognitionMetrics, LLC, Wilmington, DE; and Albert Einstein College of Medicine, Bronx, NY
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Ansari G, Fathi M, Ghajari MF, Bargrizan M, Eghbali A. Oral Melatonin Versus Midazolam as Premedication for Intravenous Sedation in Pediatric Dental Patients. JOURNAL OF DENTISTRY (TEHRAN, IRAN) 2018; 15:317-324. [PMID: 30833978 PMCID: PMC6397733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of oral melatonin and oral midazolam as premedication for intravenous (IV) sedation of pediatric dental patients. MATERIALS AND METHODS This crossover, double-blind randomized clinical trial was conducted on 23 uncooperative 2-6-year-olds with definitely negative behaviors according to the Frankl's scale. Each child served as their own control. The children were randomly divided into two groups: group I received 0.5mg/kg of oral melatonin one hour before IV sedation, while group II received 0.5mg/kg of oral midazolam 30 minutes before IV sedation on their first visit. Every child received the other premedication on their second visit. The degree of sedation was judged according to the Houpt scale. Physiologic parameters including blood pressure (PB), heart rate (HR), and blood oxygen saturation (SpO2) and side effects including dizziness, nausea, vomiting, and sleepiness were assessed. The parents' and the operator's satisfaction rates were scored. Data were analyzed using paired t-test and Wilcoxon signed-rank test. RESULTS There were significant differences in sedation scores between the two sessions (P<0.05). However, there were no significant differences in alterations of physiologic parameters between the two sessions (P>0.05). Nausea and vomiting were more common during the first two hours in the midazolam group (P=0.002). Tremors were more common in the melatonin group (P=0.013). Dizziness was more evident when melatonin was used (P<0.001). The clinician and the parents were more satisfied with the results of midazolam intake (P<0.05). CONCLUSIONS Premedication with oral midazolam in pediatric patients is superior to that with melatonin with a higher parents' and operator's satisfaction.
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Affiliation(s)
- Ghassem Ansari
- Professor, Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Fathi
- Fellow Graduate, Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Fallahinejad Ghajari
- Professor, Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Bargrizan
- Associate Professor, Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Eghbali
- Assistant Professor, Department of Anesthesiology, Mofid Children Hospital, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author: A. Eghbali, Department of Anesthesiology, Mofid Children Hospital, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Gagnon K, Godbout R. Melatonin and Comorbidities in Children with Autism Spectrum Disorder. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:197-206. [PMID: 30148039 PMCID: PMC6096870 DOI: 10.1007/s40474-018-0147-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Melatonin is used to treat sleep difficulties associated with autism spectrum disorder (ASD). There are growing evidence that melatonin could have an effect on other symptoms than sleep, such as anxiety, depression, pain, and gastrointestinal dysfunctions. Interestingly, these symptoms frequently are found as comorbid conditions in individuals with ASD. We aimed to highlight the potential effect of melatonin on these symptoms. RECENT FINDINGS Animal and human studies show that melatonin reduces anxiety. Regarding the effect of melatonin on pain, animal studies are promising, but results remain heterogeneous in humans. Both animal and human studies have found that melatonin can have a positive effect on gastrointestinal dysfunction. SUMMARY Melatonin has the potential to act on a wide variety of symptoms associated with ASD. However, other than sleep difficulties, no studies exist on melatonin as a treatment for ASD comorbid conditions. Such investigations should be on the research agenda because melatonin could improve a multitude of ASD comorbidities and, consequently, improve well-being.
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Affiliation(s)
- Katia Gagnon
- Sleep Laboratory & Clinic, Hôpital Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, 7070 Boul. Perras, Montréal, Québec H1E 1A4 Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
| | - Roger Godbout
- Sleep Laboratory & Clinic, Hôpital Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, 7070 Boul. Perras, Montréal, Québec H1E 1A4 Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
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Wunsch JK, Klausenitz C, Janner H, Hesse T, Mustea A, Hahnenkamp K, Petersmann A, Usichenko TI. Auricular acupuncture for treatment of preoperative anxiety in patients scheduled for ambulatory gynaecological surgery: a prospective controlled investigation with a non-randomised arm. Acupunct Med 2018; 36:222-227. [PMID: 29986900 DOI: 10.1136/acupmed-2017-011456] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Auricular acupuncture (AA) is a promising alternative treatment for situational anxiety. The aim of this pilot investigation was to test the acceptability and feasibility of AA as a treatment for preoperative anxiety (PA) in preparation for a subsequent randomised controlled trial. METHODS AA was offered for treatment of PA to female patients who were scheduled for ambulatory gynaecological surgery. In patients who agreed, indwelling fixed needles were applied bilaterally at the points MA-IC1, MA-TF1, MA-SC, MA-AH7 and MA-T the day before surgery. Patients who declined AA but agreed to be examined constituted the control group (no intervention). State anxiety (primary outcome) was measured using the State-Trait-Anxiety Inventory (STAI) before AA (time I), the evening before surgery (time II) and immediately before surgery (time III). Anxiety was measured with a 100 mm visual analogue scale (VAS-100); heart rate, blood pressure and serum cortisol were also quantified. RESULTS Data from 62 patients (32 with AA and 30 with no intervention) were analysed. Whereas preoperative anxiety was reduced after AA the evening before surgery (P<0.01), anxiety levels in the control group increased from the first to the last measurement (P<0.001). Secondary outcomes were comparable between the patients from both groups. CONCLUSIONS AA was acceptable and feasible as a treatment for preoperative anxiety. The results were used for the sample size calculation of a subsequent randomised controlled clinical trial. TRIAL REGISTRATION NUMBER NCT02656966; Results.
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Affiliation(s)
- Jakub K Wunsch
- Department of Anaesthesiology, University Medicine of Greifswald, Greifswald, Germany
| | - Catharina Klausenitz
- Institute of Diagnostic Radiology, Universitatsmedizin Greifswald, Greifswald, Germany
| | - Henriette Janner
- Department of Anaesthesiology, University Medicine of Greifswald, Greifswald, Germany
| | - Thomas Hesse
- Department of Anaesthesiology, University Medicine of Greifswald, Greifswald, Germany
| | - Alexander Mustea
- Department of Gynaecology and Obstetrics, University Medicine of Greifswald, Greifswald, Germany
| | - Klaus Hahnenkamp
- Department of Anaesthesiology, University Medicine of Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry, University Medicine of Greifswald, Greifswald, Germany
| | - Taras I Usichenko
- Department of Anaesthesiology, University Medicine of Greifswald, Greifswald, Germany.,Department of Anesthesia, McMaster University, Hamilton, Canada
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Khare A, Thada B, Jain N, Singh D, Singh M, Sethi SK. Comparison of Effects of Oral Melatonin with Oral Alprazolam used as a Premedicant in Adult Patients Undergoing Various Surgical Procedures under General Anesthesia: A Prospective Randomized Placebo-Controlled Study. Anesth Essays Res 2018; 12:657-662. [PMID: 30283171 PMCID: PMC6157235 DOI: 10.4103/aer.aer_90_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Preoperative anxiety is a major concern in patients undergoing any surgical procedure. Various drugs have been used to alleviate it. This study aims to compare the effects of oral melatonin versus oral alprazolam on preoperative anxiety, sedation, orientation, and cognitive function. MATERIALS AND METHODS A total of 90 adult patients were randomly allocated into three groups. Group M (n = 30) received oral melatonin 3 mg (2 tablets); Group A (n = 30) received oral alprazolam 0.25 mg (2 tablets), and Group P (n = 30) received placebo, multivitamin tablet (2 tablets) as premedication. The objectives of our study were to compare anxiety, sedation, orientation, and cognitive function using visual analog scale (VAS) anxiety score, Ramsay Sedation Score (RSS), orientation score, and Digit symbol substitution test (DSST) score before and after 120 min of giving premedication. For statistical analysis, paired t-test, Chi-square test, analysis of variance, and post hoc bonferroni test were used. RESULTS Mean VAS scores for anxiety (after 120 min) were significantly reduced in Group M (3.9 ± 1.53) and Group A (4.43 ± 1.67) when compared to Group P (4.73 ± 0.82) (P < 0.05). RSS was higher in Group A as compared to Group M and Group P (P < 0.05). No significant difference in orientation score was observed in all the three groups before and after premedication (P > 0.05). DSST score (cognitive function) was better in Group M when compared to both Group A and Group P (P < 0.05). CONCLUSION Oral melatonin (6 mg) when used as a premedicant is an effective alternative to alprazolam regarding providing better anxiolysis, lesser sedation along with maintenance of cognitive, and psychomotor function.
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Affiliation(s)
- Arvind Khare
- Department of Anaesthesiology, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India
| | - Beena Thada
- Department of Anaesthesiology, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India
| | - Neena Jain
- Department of Anaesthesiology, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India
| | - Deepak Singh
- Department of Anaesthesiology, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India
| | - Maina Singh
- Department of Anaesthesiology, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India
| | - Surendra Kumar Sethi
- Department of Anaesthesiology, J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India
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Faghihian R, Eshghi A, Faghihian H, Kaviani N. Comparison of Oral Melatonin and Midazolam as Premedication in Children Undergoing General Anesthesia for Dental Treatment. Anesth Pain Med 2018; 8:e64236. [PMID: 30009151 PMCID: PMC6035375 DOI: 10.5812/aapm.64236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/07/2018] [Accepted: 03/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background Dental anxiety is prevalent in children. This condition may cause uncooperative behavior and need a treatment under general anesthesia. The perioperative period, especially for children, is a stressing event. Premedication is commonly used to reduce perioperative anxiety and facilitate the induction of anesthesia. Methods 132 children candidates for dental treatment under GA were enrolled in this study and randomly divided into 3 groups. Oral melatonin, midazolam, and normal saline were administered as premedication. Patient's sedation score before GA, the ease of intravenous line establishment, patient's need for painkillers, and duration of recovery were evaluated and compared. Results Regarding the sedation score and response to IV access establishment, comparisons showed statistically significant differences between melatonin and midazolam groups (P < 0.05) as well as between midazolam and placebo groups (P < 0.001). The difference between melatonin and placebo groups was not significant (P > 0.05). The need for painkiller administration was statistically different between midazolam and placebo, melatonin and placebo, and midazolam and melatonin groups (P < 0.05). A statistically significant difference was also found between melatonin and midazolam as well as between melatonin and placebo groups (P < 0.05) with regard to the recovery duration while no significant difference was observed between midazolam and placebo groups (P > 0.05). Conclusion Midazolam is superior to melatonin for premedication regarding the patients' sedation score before anesthesia and the ease of IV access establishment. Premedication with midazolam decreases the need for painkillers and increases the rate of recovery in children undergoing GA for dental treatment.
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Affiliation(s)
- Reyhaneh Faghihian
- Dental Research Center, Department of Pediatric Dentistry, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Eshghi
- Dental Research Center, Department of Pediatric Dentistry, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hessamoddin Faghihian
- Dental Student, Dental Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasser Kaviani
- Dental Research Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Corresponding Author: Dr. Nasser Kaviani, Dental Research Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Melatonin: A New-Generation Therapy for Reducing Chronic Pain and Improving Sleep Disorder-Related Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1099:229-251. [DOI: 10.1007/978-981-13-1756-9_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Grilo Bensusan I, Herrera Martín P, Aguado Álvarez MV. Prospective study of anxiety in patients undergoing an outpatient colonoscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:765-769. [PMID: 27785915 DOI: 10.17235/reed.2016.4104/2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Undergoing a colonoscopy can cause anxiety in patients and this is something which has not been closely studied. OBJECTIVE To determine the frequency and intensity of anxiety prior to a colonoscopy and the factors which are related to the procedure. METHODS This is a prospective study of patients undergoing outpatient colonoscopy in our hospital. Anxiety was assessed using a visual analogue scale of 0 to 100. The severity of anxiety was rated as mild (1-29), moderate (30-79) or severe (80-100). RESULTS Three hundred and twenty-seven patients completed the study, of whom 154 (47.1%) were men with a median age of 54 years (p25-75: 45-65). Three hundred and nine (94.5%) patients were found to suffer a certain degree of anxiety. The median value on the visual analogue scale was 31 (p25-75: 10-53). Anxiety levels were mild in 136 patients (44%), moderate in 141 (45.6%) and severe in 32 (10.4%). Greater anxiety was associated with female patients (mean 40.38 vs 31.99, p = 0.01) and a poorly tolerated previous colonoscopy (mean 50.67 vs 28.44, p = 0.01) and correlated inversely with age (r = -0.170, p = 0.02). CONCLUSIONS Colonoscopy causes some degree of anxiety in most patients. Being female, younger and having experienced poor tolerance to a previous scan are associated with greater degrees of anxiety. These findings should be taken into account in the implementation of measures to improve the quality and tolerance of colonoscopy.
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Premedication with melatonin vs midazolam: efficacy on anxiety and compliance in paediatric surgical patients. Eur J Pediatr 2017; 176:947-953. [PMID: 28540436 DOI: 10.1007/s00431-017-2933-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Preoperative anxiety is a major problem in paediatric surgical patients. Melatonin has been used as a premedicant agent and data regarding effectiveness are controversial. The primary outcome of this randomized clinical trial was to evaluate the effectiveness of oral melatonin premedication, in comparison to midazolam, in reducing preoperative anxiety in children undergoing elective surgery. As secondary outcome, compliance to intravenous induction anaesthesia was assessed. There were 80 children undergoing surgery randomly assigned, 40 per group, to receive oral midazolam (0.5 mg/kg, max 20 mg) or oral melatonin (0.5 mg/kg, max 20 mg). Trait anxiety of children and their mothers (State-Trait Anxiety Inventory) at admission, preoperative anxiety and during anaesthesia induction (Modified Yale Pre-operative Anxiety Scale), and children's compliance with anaesthesia induction (Induction Compliance Checklist) were all assessed. Children premedicated with melatonin and midazolam did not show significant differences in preoperative anxiety levels, either in the preoperative room or during anaesthesia induction. Moreover, compliance during anaesthesia induction was similar in both groups. CONCLUSIONS This study adds new encouraging data, further supporting the potential use of melatonin premedication in reducing anxiety and improving compliance to induction of anaesthesia in children undergoing surgery. Nevertheless, further larger controlled clinical trials are needed to confirm the real effectiveness of melatonin as a premedicant agent in paediatric population. What is Known: • Although midazolam represents the preferred treatment as a premedication for children before induction of anaesthesia, it has several side effects. • Melatonin has been successfully used as a premedicant agent in adults, while data regarding effectiveness in children are controversial. What is New: • In this study, melatonin was as effective as midazolam in reducing children's anxiety in both preoperative room and at induction of anaesthesia.
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Gupta P, Jethava D, Choudhary R, Jethava DD. Role of melatonin in attenuation of haemodynamic responses to laryngoscopy and intubation. Indian J Anaesth 2016; 60:712-718. [PMID: 27761033 PMCID: PMC5064694 DOI: 10.4103/0019-5049.191667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine) has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure. METHODS Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20-45 years old, 40-65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control) and Group M (melatonin). They received oral placebo or melatonin tablets 6 mg, respectively, 120 min before surgery. The haemodynamic parameters were recorded preoperatively, during laryngoscopy and endotracheal intubation and thereafter at 1, 3, 5 and 10 min. Unpaired t-test was used for between-group comparison of ratio and interval scale data. For within-group comparison of ratio and interval scale data, repeated-measures ANOVA and post hoc Bonferroni t-tests were used. RESULTS It was observed that in the control group, there was a significant increase in heart rate and blood pressure at laryngoscopy and intubation and persisted till 10 min post-intubation. In melatonin group, there was an insignificant increase in heart rate at the time of laryngoscopy and intubation which however settled within 1 min post-intubation. CONCLUSION Melatonin is an effective drug for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation.
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Affiliation(s)
- Priyamvada Gupta
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Durga Jethava
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ruchika Choudhary
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Dharam Das Jethava
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Kurdi MS, Muthukalai SP. The Efficacy of Oral Melatonin in Improving Sleep in Cancer Patients with Insomnia: A Randomized Double-Blind Placebo-Controlled Study. Indian J Palliat Care 2016; 22:295-300. [PMID: 27559258 PMCID: PMC4973490 DOI: 10.4103/0973-1075.185039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The natural hormone melatonin has sleep inducing properties. Insomnia in cancer patients is common. So far, melatonin has been seldom tried for the improvement of sleep in patients with malignancies. Keeping this in mind, we planned and conducted a double-blind study to test the efficacy of melatonin in promoting sleep in patients with malignancies suffering from insomnia. Objective: To assess the hypnotic efficacy of oral melatonin in cancer patients with insomnia. Materials and Methods: After Ethical Committee approval, 50 patients (age range 20-65 years) from our pain clinic NIVARANE who met the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria for primary insomnia were randomized to receive melatonin 3 mg or placebo at 7 pm orally every day for 14 days from our pharmacist. After 1, 7, 14 days, the patients were reviewed with the Athens insomnia scale oral questionnaire to document the subjective sleep quality. The patients and we, the investigators were blinded to the study drug. Results: There were 2 drop outs (one from each group) as they failed to complete visit on day 14. Significant differences in favor of melatonin treatment were found in clinically relevant improvements in insomnia (46.53%; P = 0.00001 vs. 11.30%; P = 0.1026) There was improvement in sleep from 1 to 7 days (19.91%; P = 0.00001 vs. 0.98%; P = 0.2563). More significant improvements were seen between 7 and 14 days (33.24%; P = 0.00001 vs. 10.42%; P = 0.1469). Conclusion: We conclude that daily intake of oral melatonin 2 h before bedtime improves sleep induction and quality in cancer patients with insomnia.
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Affiliation(s)
- Madhuri S Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Sindhu Priya Muthukalai
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Kurdi MS, Muthukalai SP. A comparison of the effect of two doses of oral melatonin with oral midazolam and placebo on pre-operative anxiety, cognition and psychomotor function in children: A randomised double-blind study. Indian J Anaesth 2016; 60:744-750. [PMID: 27761038 PMCID: PMC5064699 DOI: 10.4103/0019-5049.191688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Aims: Melatonin (MT), a naturally occurring pituitary hormone has a sleep promoting effect. There are very few studies on pre-operative oral MT (0.2–0.5 mg/kg) in children. We planned a study to assess the efficacy of oral MT in two doses and compare it with oral midazolam and placebo for pre-operative anxiolysis, sedation, maintenance of cognition and psychomotor skills, parental separation behaviour and venepuncture compliance. Methods: This prospective double-blind randomised study was conducted after ethical committee approval on 100 children aged 5–15 years, American Society of Anaesthesiologists physical status I and II undergoing elective surgery at our hospital from January 1, 2014, to December 31, 2014. Mentally disordered children were excluded from the study. They were randomised into four groups of 25 each (A, B, C, D) to receive either oral MT 0.5 mg/kg or 0.75 mg/kg or oral midazolam 0.5 mg/kg or placebo 45–60 min, respectively, before induction. The child's anxiety, cognition and psychomotor function before and after pre-medication, behaviour during the parental separation and venepuncture were appropriately scored. Kruskal–Wallis analysis of variance for intergroup and Wilcoxon matched pairs tests for intragroup comparisons of data were applied. Results: The four groups were comparable regarding mean age, weight and sex. The anxiety score reductions in the three groups when compared to placebo were statistically significant. Children receiving MT 0.75 mg/kg had maximum anxiolysis and venepuncture compliance (P < 0.05). Cognition was decreased with maximum sedation, successful parental separation and psychomotor impairment in the midazolam group (P < 0.05). Conclusion: Oral MT (0.5 mg/kg and 0.75 mg/kg) in children decreases pre-operative anxiety without impairing cognitive and psychomotor functions, the 0.75 mg/kg dose being most effective.
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Affiliation(s)
- Madhuri S Kurdi
- Department of Anaesthesia, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Perez-Heredia M, Clavero-González J, Marchena-Rodríguez L. Use of melatonin in oral health and as dental premedication. ACTA ACUST UNITED AC 2015; 22:13. [PMID: 26594638 PMCID: PMC4653916 DOI: 10.1186/s40709-015-0036-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/05/2015] [Indexed: 12/04/2022]
Abstract
Anxiety is a common problem in dentistry which could affect the correct treatment and involve failure. Oral premedication is needed to treat several anxious patients. Many people are so highly anxious that oral sedation is not effective and need to be under deep sedation or even general anaesthesia in order to receive dental care. In these patients, due to a high level of anxiety, even the insertion of an intravenous catheter can be difficult. Benzodiazepines have been the most commonly used anxiolytic in these cases, but many may be associated with paradoxical reactions. Melatonin has a good potential to be used in this field as alternative to benzodiazepines because it may induce a natural sleepiness and improve sedation. The purpose of this paper was to summarize what is known about the use of melatonin in oral health and as dental premedication in anxious dental patients. Databases were searched for the relevant published literature to 30 April 2015. The following search items were used in various combinations: melatonin, premedication, anxiety, dental, sedation and anaesthesia. Few articles were found about this aspect, and the use of melatonin is still a controversial aspect in dental field. More detailed/specific studies are necessary to extend the therapeutic possibilities of melatonin as premedication in dentistry.
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Affiliation(s)
- Mercedes Perez-Heredia
- School of Dentistry, University of Granada, Campus Universitario de Cartuja s/n, Granada, Spain, E-18071 Granada, Spain
| | - Javier Clavero-González
- School of Dentistry, University of Granada, Campus Universitario de Cartuja s/n, Granada, Spain, E-18071 Granada, Spain
| | - Leticia Marchena-Rodríguez
- School of Dentistry, University of Granada, Campus Universitario de Cartuja s/n, Granada, Spain, E-18071 Granada, Spain
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