NEUE ASPEKTE DER ANASTHESIOLOGISCHEN PRAMEDIKATION, AUFGEZEIGT AM WIRKUNGSVERGLEICH VON ZOLPIDEM UND PHENOBARBITAL IN KOMBINATION MIT PROMETHAZIN

The following double-blind randomized study dealt with three questions: Are differentiated psychometric test-systems suitable for the measurement of emotions bofore anesthesia? 2. Which effects has Zolpidem compared with Phenobarbital on emotions in premedication? Is the combination with Promethazin suggestive? Methods: 304 patients were assigned to four groups (Group l: Zolpidem 10 mg/Promethazin 50 mg; Group 2: Zolpidem 10 mg/placebo; Group 3: Phenobarbital 100 mg/Promethazin 50 mg; Group 4: Phenobarbital 100 mg/placebo). The tablets/dragees were given in the evening before surgery (09.00 p.m. - 10.00 p.m.). The sample was shifted by age and sex. Emotions were measured by a multidimensional rating-scale, which contents the aspects elated mood, anxiety, hostility, desactivation, vigilance and introversion. Statistics were performed using multivariate analysis of variance. Results: Zolpidem leads to a significant higher expression of hostility (negative mood, irritability, aggressiveness) than Phenobarbital. Younger patients (17-39 years) showed also dysphoric aspects, which were expressed in general agitation, negative mood and sadness. Compared with placebo Promethazin leads to greater desactivation (more tiredness and numbness, lower wakeness). Older patients (40-64 years) profit by Promethazin, which was documented in ratings on irritability and well-being. Specific emotions and somatic aspects were not touched. Patients with Promethazin received a lower dose of Thiopental for induction of anesthesia than patients with placebo. Conclusions: Zolpidem and Phenobarbital have many common effects on preoperative emotions. Differences were found in the unspecific emotional aspects of agitation and hostility. These effects must bo put against the pharmacokinetic and pharmacodynamic advantages of Zolpidem, if this drug is applied for premedication. The study shows, that combination with Promethazin is suggestive, because Promethazin has a selective deactivating effect. The result, that Promethazin lowers the dose of Thiopental for induction of anesthesia is an additional interesting result. The study stresses the significance of multidimensional rating scales for the measurement of emotions before anesthesia.