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To make perioperative period smooth. 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
is provided by the anesthesiologist’s preoperative visit and interview with the patient and family members
Pic of tablet injection
Put stars to important one.
Selection of drugs …route of adm.. Dose , timing need to be according What is ASA physical status , Age: peads vs adult
Sedation df: Grade of sedation: When it is called as GA.
Anxiolysis Amnesia Sedation Anti-convulsant All effects are dose-dependent Phenergan antihistamine only more than 2 yr… 1mg/kg
Pre emptive analgesia
Pulmonary aspiration is the entry of material (such as pharyngeal secretions, food or drink, or stomach contents) from the oropharynx or gastrointestinal tract into the larynx (voice box) and lower respiratory tract (the portions of the respiratory system from the trachea—i.e., windpipe—to the lungs). A person may either inhale the material, or it may be delivered into the tracheobronchial tree during positive pressure ventilation. Consequences of pulmonary aspiration range from no injury at all, to chemical pneumonitis or pneumonia, to death within minutes from asphyxiation. These consequences depend in part on the volume, chemical composition, particle size, Mendelson&apos;s syndrome is chemical pneumonitis caused by aspiration during anaesthesia, especially during pregnancy Residual gastric volume of greater than 25ml, with pH of less than 2.5
Any condition which dec gastric emptying or airway reflex
Metoclopramide (INN) /ˌmɛtəˈklɒprəmaɪd/ is a medication used mostly for stomach andesophageal problems. It belongs to the group of medications known as dopamine-receptor antagonists Ondansetron (INN), originally marketed under the brand name Zofran, is a serotonin 5-HT3receptor antagonist used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery. Dexa: These results suggest that dexamethasone exerts its central antiemetic action through an activation of the glucocorticoid receptors in the bilateral nuclei tractus solitarii in the medulla.
Dr.Indubala Maurya MD DNB MNAMS
Department of Anesthesia &Critical care
Administration of drugs before induction of
Nonpharmacological antidote to anxiety
• Consists of administration of the drugs 1 -2 hrs before the induction of
• Route of administration :
• GOALS OF PREMEDICATION:
• Anxiolysis &Sedation
• Increase in gastric fluid ph
and decrease in gastric fluid
• Antisialogogue effect
• Decreased S N S reflex
• Hemodynamic stability
• Decrease in anaesthetic
•Facilitation of induction of
•Facilitation of Postoperative
•Prevention of post operative
nausea and vomiting
Factor to be considered before
• Patient’s Physical status
• Level of anxiety and pain
• Type of Surgery
• Timing of surgery
• History of drug allergy , nausea ,
Anxiolysis & sedation
Sedation is a ranging from minimum anxiolysis to a
state of deep sedation but not including G A .
• To minimize physical
discomfort, and pain.
• To control behavior particularly
• To minimize psychological
disturbances and distress.
• To maximize the potential for
• To guard patient’s safety.
• What is Aspiration ?
• Complications of Aspiration ??
• Extremes of age
• Emergency cases
• Type of surgery
• Recent meal
• Pain and stress
• Depressed level of
• Morbid obesity
• Difficulty airway
• Poor motor control
DISCONTINUATION OF DRUGS
•ACE inhibitors ??
• AT 2 antagonists.
• Reducing the morbidity of surgery.
• Increasing the quality and decreasing the
cost of peri operative care.
• To return the patient to desirable
functioning as quickly as possible.
• Pre operative medical optimisation
significantly reduces the complications.