anaesthesia.Premedication.(dr.amer)

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anaesthesia.Premedication.(dr.amer)

  1. 1. 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”
  2. 2. Psychological Premedication is provided by the anesthesiologist’s preoperative visit and interview with the patient and family members <ul><li>Pharmacological Premedication is administration of drugs orally or intramuscularly 1 to 2 hours before the anticipated induction of anesthesia </li></ul>
  3. 3. Goals for Pharmacologic Premedication <ul><li>Primary Goals for Pharmacologic Premedication </li></ul><ul><li>Anxiety relief ( anxiolysis) </li></ul><ul><li>Sedation </li></ul><ul><li>Analgesia </li></ul><ul><li>Amnesia </li></ul><ul><li>Antisalogogoue effect </li></ul><ul><li>Increase in gastric fluid pH </li></ul><ul><li>Decreased in gastric fluid volume </li></ul><ul><li>Attenuation of sympathetic nervous system reflex responses </li></ul><ul><li>Decrease in anesthetic requirements </li></ul><ul><li>Prophylaxis against allergic reactions </li></ul>
  4. 4. <ul><li>Secondary Goals for Pharmacologic Premedication </li></ul><ul><li>Decrease in cardiac vagal activity …anticholinergic (atropine) just before the time of anticipated need </li></ul><ul><li>Facilitation of induction of anesthesia …. Not necessary in view of availability of potent intravenous induction drugs </li></ul><ul><li>Postoperative analgesia… better achieved with opioids or the intravenous injection of an opioids just before the time of anticipated need ( preemptive analgesia ) </li></ul><ul><li>3. Prevention of postoperative nausea and vomiting … intravenous injection of an antiemetic ( droperidol , ondansetron) just before the time of anticipated need </li></ul>
  5. 5. Drugs and Doses used for Pharmacologic Premedication before Inaction of Anesthesia PO,IM PO 2-4 15-30 Lorazepam Temazepam IM PO,IM 2.5-5 5-10 Midazolam Diazepam Benzodiazepine IM IM 5-15 50-100 Morphine Meperidine Opioids PO,IM PO,IM 50-150 50-150 Secobarbital Pentobarbital Barbiturates Route of Administration Typical Adult Dose (mg ) Drug Classification
  6. 6. PO,IM,IV 10-20 metoclopramide Stimulates of gastric motility PO PO 15-30 ml 10-20ml Particulate Nonparticulate Antacids PO,IM,IV PO,IM PO 300 150 20-40 Cimetidine Ranitidine Famotidine H2 antagonists IM IM IM 0.3-0.6 0.3-0.6 0.2-0.3 Atropine Scopolamine Glycopyrrolate Anticholinergics PO IV 0.3-0.4 0.4-0.5 Clonidine Dexmedetomidine Alpha-2 agonists PO,IM IM 25-75 25-75 Diphenhydramine Promethazine Antihistamines
  7. 7. Anesthetic Drugs General anesthesia Supportive drugs Local analgesics
  8. 8. General anesthesia Inhalational agents IV agents Muscle Relaxants
  9. 9. <ul><li>Thank you </li></ul>

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