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Lorazepam and morphine for i.v. surgical premedication
Abstract:
The effect of i.v. lorazepam alone, in doses of 2 mg and 4 mg, and combined with morphine 5 mg, were studied. Sedation, relief of anxiety, lack of recall, patient acceptance, physician acceptance and side-effects were evaluated. The addition of morphine to lorazepam significantly improved sedation and relief of anxiety. Physician acceptance and patient acceptance showed no significant difference between any of the combinations. Lack of recall was enhanced by increasing the dose of lorazepam from 2 mg to 4 mg, independent of the addition of morphine. The only significant side-effect was restlessness which occurred in 15% of patients receiving lorazepam 4 mg and 3% of patients receiving lorazepam 2 mg, again independent of the addition of morphine.
Insights
Adding morphine to lorazepam significantly improved sedation and anxiety relief. Higher lorazepam doses enhanced patient recall, with restlessness as the main side-effect.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Lorazepam is used for anxiety and sedation.
- Morphine is a potent analgesic.
- Combined use may enhance procedural sedation.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous lorazepam alone and combined with morphine for procedural sedation.
- To compare different doses of lorazepam (2 mg vs. 4 mg) in combination with morphine (5 mg).
Main Methods:
- Prospective study evaluating intravenous lorazepam (2 mg and 4 mg) alone and with morphine (5 mg).
- Assessment of sedation, anxiety relief, recall, patient and physician acceptance, and side-effects.
- Statistical analysis to determine significant differences between treatment groups.
Main Results:
- Combination therapy with morphine significantly improved sedation and anxiety relief compared to lorazepam alone.
- Increased lorazepam dose from 2 mg to 4 mg significantly enhanced lack of recall, independent of morphine.
- Patient and physician acceptance showed no significant differences across all tested combinations.
- Restlessness was the primary side-effect, occurring more frequently with 4 mg lorazepam (15%) than 2 mg lorazepam (3%).
Conclusions:
- Intravenous lorazepam combined with morphine offers superior sedation and anxiolysis.
- Higher doses of lorazepam are more effective in preventing recall.
- Restlessness is a dose-dependent side-effect of lorazepam, irrespective of morphine co-administration.