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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As a preanesthetic medication, lorazepam is available for oral, intravenous, or intramuscular administration. A parenteral dose of 0.04 to 0.06 mg per kg has been shown to be most effective as a preanesthetic medication in terms of antianxiety and antirecall effect (Table 1). Lorazepam has as its predominant advantage over other benzodiazepines the ability to produce anterograde amnesia reliably and for a relatively long duration. From an anesthesia standpoint, the drug finds its major usage as a premedicant or adjuvant (administered in the peri-induction period) to minimize the possibility of recall of unpleasant events during anesthesia and surgery. This is especially germane in patients who are unable to tolerate a sufficient depth of anesthesia to provide this amnesic effect on the basis of anesthetic agent alone. Quite often these patients are critically ill, and from a physiologic standpoint, their cardiovascular systems are unable to tolerate or adapt to moderate to deep anesthetic concentrations of the inhalation anesthetic agents. Even though the metabolic products of lorazepam are not active, the duration of action of this drug dictates that it not be used in the outpatient setting. Indeed, the drug probably should not be used in patients whose expected hospital stay is less than 72 hours. It appears that thrombosis or phlebitis after intravenous injection of lorazepam is less than with diazepam, especially if the drug is injected in small hand or arm veins. Most side effects of lorazepam are associated with central nervous system depression, are dose-related, and fairly predictable. Adverse central nervous system effects may be reversed by administration of physostigmine, but it is worthwhile to note that the duration of action of physostigmine, and repeated administration of physostigmine may be necessary. Lorazepam appears to be acceptable to both physicians and patients. There do not appear to be any obvious adverse interactions between lorazepam and other medications commonly used in anesthesia practice. Nevertheless, it appears that the major value of lorazepam to the anesthesiologist's armamentarium is its ability to prevent recall in appropriate situations.
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PMID:Clinical pharmacology of lorazepam. 613 91

An ideal i.v. sedative for dentistry should provide anti-anxiety and analgesic activity, amnesic action, and patient cooperation without depression of the cardiorespiratory system and with rapid recovery. Lorazepam does not provide any advantages over the currently available agents, but midazolam, a new water-soluble benzodiazepine, and later selective benzodiazepine receptor antagonists may play an important role in outpatient sedation.
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PMID:Clinical effectiveness and untoward effects of new agents and techniques used in intravenous sedation. 614 35

The respiratory effects of lorazepam (a 1, 4 benzodiazepine) were studied using a modified Read rebreathing technique in healthy adult males about to undergo elective surgery. Lorazepam 0.05 mg/kg (IV) produced an increase in slope and a shift to the left of the CO2 response curve. These effects were also detectable but of smaller magnitude when the same lorazepam dose (IV) was given with meperidine (IV). End-expiratory CO2 (PeCO2), which was significantly elevated in all drug groups, is not a sensitive indicator of either the time course or the degree of respiratory depression.
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PMID:The effects of intravenous lorazepam alone and with meperidine on ventilation in man. 663 67

Twenty-one episodes of status epilepticus (SE) were each treated with 1 to 9 mg (mean, 4 mg) of intravenous lorazepam. All patients with generalized tonic-clonic ( GTC ) SE responded within 15 minutes. Nine (82%) of the 11 patients with episodes of partial SE with altered responsiveness responded poorly. Respiratory depression occurred in five instances (two requiring intubation) and was associated with transient loss of brain-stem reflexes, hypotension, and decorticate posturing in three cases. Generalized tonic-clonic SE was transformed into partial SE with altered responsiveness in three patients. In an additional four patients, marked lethargy developed. Lorazepam appears effective in controlling GTC SE but only occasionally effective in partial SE with altered responsiveness.
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PMID:Treatment of status epilepticus with lorazepam. 672 34

Lorazepam was compared with diazepam for the treatment of acute convulsions and status epilepticus in 102 children in a prospective, open, 'odd and even dates' trial. Convulsions were controlled in 76 per cent of patients treated with a single dose of lorazepam and 51 per cent of patients treated with a single dose of diazepam. Significantly fewer patients treated with lorazepam required additional anticonvulsants to terminate the seizure. Respiratory depression occurred in 3 per cent of lorazepam-treated patients and 15 per cent of diazepam-treated patients. No patient who received lorazepam required admission to the intensive care unit for either respiratory depression or persisting status epilepticus. Rectally administered lorazepam appeared to be particularly valuable (100 per cent efficacy) when venous access was not possible.
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PMID:Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. 767 65

Alcohol withdrawal syndrome (AWS) may result in nausea, vomiting, diarrhea, weakness, sweating, tremors, tachycardia, hypertension, agitation, delirium, hallucinations, seizures, and death beginning 6 hours after alcohol cessation in alcoholics. Benzodiazepines are cross-tolerant with ethanol and are considered first-line therapy for treating AWS. Chlordiazepoxide and diazepam are first metabolized by hepatic oxidation, then glucuronidation. Lorazepam and oxazepam undergo only hepatic glucuronidation. Benzodiazepine oxidation is decreased in persons with liver disease and the elderly. Accumulation with resultant excessive sedation and respiratory depression may be significant when administering chlordiazepoxide or diazepam to patients with impaired oxidative metabolism. Lorazepam and oxazepam metabolism is minimally affected by age and liver disease. Chlordiazepoxide and diazepam are erratically absorbed by the intramuscular route. Lorazepam is predictably absorbed by the intramuscular route. Oxazepam is not available in parenteral form. Lorazepam appears to be the safest empiric choice among the various benzodiazepines for treating AWS in the elderly and in patients with liver disease, or those who require therapy by the intramuscular route.
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PMID:Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease. 870 Jul 92

Several advances are likely to benefit the ICU patient requiring sedation, analgesia, and anxiolysis. The cooperative sedation induced by dexmedetomidine is a unique and valuable state that allows patients to be aroused easily and interferes little with ventilation. Remifentanil is the prototype of short-acting drugs, providing fast onset and offset; its relatively high cost may be balanced by limiting the risk for long-lasting respiratory depression. Lorazepam seems to be finding more proponents, especially in long-term ICU sedation where the costs of the newer agents may be prohibitive.
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PMID:New agents for sedation in the intensive care unit. 1176 66

Research on single and rapid transcranial magnetic stimulation (sTMS/rTMS) indicates an antidepressive efficacy of these methods. In our 4 week study of sTMS, 12 patients affected by severe non-psychotic major depression (DSM-III-R) were enrolled and put on standardized combined antidepressant medication with the serotonin re-uptake inhibitor citalopram, and the serotonin modulating drug, trazodone. They underwent sTMS in a specific method as an add-on therapy. Age, gender, illness and episode duration, episode number, Hamilton Rating Depression Scale-24 (HRDS), Mini-Mental State (MMS), drug levels assessed by HPLC, magnesium and thyroid stimulating hormone (TSH) were recorded. For each patient functional brain imaging was performed by (18)FDG and (99m)Tc HMPAO SPECT at the beginning of the study, as were EEG tracings which also were recorded at the end. Lorazepam was allowed as co-medication. Of the patients, 66.7 per cent (N=8) could be identified as sTMS responders. Possible predictors for sTMS response as add-on therapy may be duration, pattern of improvement in global and in specific single items of the HRDS, lorazepam dosage, functional involvement of basal ganglia and cortical temporal lobe and the initially lower mean frequency and lability of the alpha-activity of EEG. These variables possibly predict the clinical outcome of depressed patients treated by sTMS as an add-on therapy. Copyright 2000 John Wiley & Sons, Ltd.
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PMID:Clinical impacts of single transcranial magnetic stimulation (sTMS) as an add-on therapy in severely depressed patients under SSRI treatment. 1240 5

Many patients in the ICU receive mechanical ventilation and require sedative medications. Anxiolysis, hypnosis, and amnesia can be considered the primary objects of sedative therapy. Intravenous benzodiazepines are the drugs most commonly used for sedation in ICU. Proper choice and use of benzodiazepines is based on knowledge of the pharmacology and is an essential component of caring for patients in the intensive care unit. Three benzodiazepines--Diazepam, Lorazepam and Midazolam--are currently available for parenteral use in the ICU. Onset and duration of action are determined by their lipid solubility. Respiratory depression and hypotension are dose-dependent. Midazolam is generally preferred to other benzodiazepines in most ICU. It has the shortest half-life of the benzodiazepines, does not have active metabolites, is water soluble and can be administered by continuous infusion. Despite the relatively short half-life of Midazolam, extensive distribution can cause prolonged sedation. Recovery time is proportional to the infusion's duration. Lorazepam is lipid soluble and dissolved in a propylene glycol carrier, produces a delayed onset and prolonged duration of effect and is preferred for long-term sedation (>48 hours). Propylene glycol toxicity is possible with high-dose or prolonged infusions. Diazepam has become less used with the introduction of the shorter-acting and less irritating benzodiazepine. The recent literature focuses on the differences between Midazolam and Propofol, the most used sedatives in ICU, their sequential use and combination. Relevant studies have been performed about propylene glycol toxicity.
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PMID:Sedation in PACU: the role of benzodiazepines. 1630 52

The purpose of the present study was to shed light on the physiology underlying somatosensory evoked magnetic fields (SEFs) by means of pharmacological manipulation with the GABA A agonist lorazepam and paired-pulse stimulation. SEFs were recorded from the primary (SI) and secondary (SII) somatosensory cortices following median nerve stimulation. Responses were obtained to single stimuli every 2 s and to paired stimuli with interpulse intervals (IPIs) of 20 ms and 100 ms. Recordings were performed in 2 sessions, once after the intravenous injection of lorazepam and once after the injection of placebo. The underlying neural generators of the response components were modelled with single equivalent current dipoles (ECDs). In the single-stimulus condition, lorazepam slightly increased the ECD strength of the 1st excitatory deflection (N20m) from the contralateral SI and reduced the strengths of the following P35m, P60m and N140m deflections from the contralateral SI and the response from the ipsilateral SII. Under placebo, paired-pulse stimulation with the IPI of 20 ms diminished all SEF components compared with single-pulse stimulation. At the IPI of 100 ms, the N20m and the P60m deflections from SI had recovered to nearly baseline levels, being consistent with recovery cycles of excitatory postsynaptic potentials (EPSPs). In contrast, the P35m and N140m, as well as the SII deflections, did not recover at 100 ms. Lorazepam had no effect on the paired-pulse depression (PPD) or recovery thereof for the N20m deflection. The attenuation of the P35m deflection by lorazepam and its lack of recovery in the 100-ms paired-pulse condition are expected behaviours of inhibitory postsynaptic potentials (IPSPs) in intracellular recordings, thus lending further support to our previous suggestion that P35m largely represents IPSPs. The lack of PPD modulation of N20m by lorazepam suggests that paired-pulse depression of the first cortical excitatory response (N20m) may be caused by mechanisms other than GABA A receptor-mediated inhibition.
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PMID:Modulation of somatosensory evoked fields from SI and SII by acute GABA A-agonism and paired-pulse stimulation. 1823 13


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