Premedication

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Premedication

• Management of anesthesia begins with preoperative
  psychological preparation of the patient and
  administration of a drug or drugs selected to
  elicit specific pharmacologic responses
• This initial psychological and pharmacologic
  component of anesthetic management is referred to
  as Premedication

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Psychological Premedication is provided by the
anesthesiologists preoperative visit and
interview with the patient and family members

• Pharmacological Premedication is administration
  of drugs orally or intramuscularly 1 to 2 hours
  before the anticipated induction of anesthesia

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Goals for Pharmacologic Premedication

• Primary Goals for Pharmacologic Premedication
• Anxiety relief ( anxiolysis)
• Sedation
• Analgesia
• Amnesia
• Antisalogogoue effect
• Increase in gastric fluid pH
• Decreased in gastric fluid volume
• Attenuation of sympathetic nervous system reflex
  responses
• Decrease in anesthetic requirements
• Prophylaxis against allergic reactions

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• Secondary Goals for Pharmacologic Premedication
• Decrease in cardiac vagal activity
  anticholinergic (atropine) just before the time
  of anticipated need
• Facilitation of induction of anesthesia . Not
  necessary in view of availability of potent
  intravenous induction drugs
• Postoperative analgesia better achieved
  with opioids or the intravenous injection of an
  opioids just before the time of anticipated need
  ( preemptive analgesia )
• 3. Prevention of postoperative nausea and
  vomiting intravenous injection of an antiemetic
  ( droperidol , ondansetron) just before the time
  of anticipated need

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Drugs and Doses used for Pharmacologic
Premedication before Inaction of Anesthesia
Route of Administration Typical Adult Dose (mg) Drug Classification
PO,IM PO,IM 50-150 50-150 Secobarbital Pentobarbital Barbiturates
IM IM 5-15 50-100 Morphine Meperidine Opioids
IM PO,IM 2.5-5 5-10 Midazolam Diazepam Benzodiazepine
PO,IM PO 2-4 15-30 Lorazepam Temazepam
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PO,IM IM 25-75 25-75 Diphenhydramine Promethazine Antihistamines
PO IV 0.3-0.4 0.4-0.5 Clonidine Dexmedetomidine Alpha-2 agonists
IM IM IM 0.3-0.6 0.3-0.6 0.2-0.3 Atropine Scopolamine Glycopyrrolate Anticholinergics
PO,IM,IV PO,IM PO 300 150 20-40 Cimetidine Ranitidine Famotidine H2 antagonists
PO PO 15-30 ml 10-20ml Particulate Nonparticulate Antacids
PO,IM,IV 10-20 metoclopramide Stimulates of gastric motility
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