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PREMEDICATION
Dr.Indubala Maurya MD DNB MNAMS
Assistant Professor
Department of Anesthesia &Critical care
PREMEDICATION
DEFINITION:
Administration of drugs before induction of
Anaesthesia.
Components: Psychological
Pharmacologic...
PSYCHOLOGICAL PREMEDICATION
Nonpharmacological antidote to anxiety
PHARMACOLOGICAL PREMEDICATION
• Consists of administration of the drugs 1 -2 hrs before the induction of
anaesthesia .
• R...
Primary
goals
• Anxiolysis &Sedation
• Analgesia
• Amnesia
• Increase in gastric fluid ph
and decrease in gastric fluid
vo...
Secondary
Goals
•Facilitation of induction of
anaesthesia
•Facilitation of Postoperative
analgesia
•Prevention of post ope...
Factor to be considered before
premedication
• Patient’s Physical status
• Age
• Level of anxiety and pain
• Type of Surge...
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
movements.
• To minimize psychological
dis...
DRUGS USED FOR SEDATION
• Benzodiazepines :
e.g: Diazepam ,midazolam,lorazepam
• Barbiturates :
e.g: phenobarbitone
• Othe...
Factors limiting giving sedatives
• Extremes of age.
• Head injury.
• Altered mental status.
• Minimal cardio- pulmonary r...
ANALGESIA
• OPIOIDS:
• Pethidine
• Morphine
• Fentanyl
• NSAIDS
• Ketorolac
• Diclofenac
ASPIRATION PROPHYLAXIS
• What is Aspiration ?
• Complications of Aspiration ??
RISK FACTORS
FOR ASPIRATION
• Extremes of age
• Emergency cases
• Type of surgery
• Recent meal
• Trauma
• PREGNANCY
• Pai...
PREVENTIVE MEASURES
• FASTING
• Reduce gastric volume ,Increase gastric pHReduce gastric volume ,Increase gastric pH
• H2 ...
ANTISIALOGOGUES
Decreases salivary gland and mucosal gland
secretion .
•GLYCOPYROLATE
•ATROPINE
•SCOPOLAMINE
ANTIEMESIS PROPHYLAXIS
Risk factor for Nausea vomiting ???
Drugs
• Metaclopramide
• Ondensetron
• Dexamethasone.
CONTINUATION AND
DISCONTINUATION OF DRUGS
CONTINUATION
•Beta blocker
•Bronchodilators
•Anti-epileptics
DISCONTINUATION
•MA...
Conclusion
• Reducing the morbidity of surgery.
• Increasing the quality and decreasing the
cost of peri operative care.
•...
Thank you
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Premedication

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Premedication

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Premedication

  1. 1. PREMEDICATION Dr.Indubala Maurya MD DNB MNAMS Assistant Professor Department of Anesthesia &Critical care
  2. 2. PREMEDICATION DEFINITION: Administration of drugs before induction of Anaesthesia. Components: Psychological Pharmacological
  3. 3. PSYCHOLOGICAL PREMEDICATION Nonpharmacological antidote to anxiety
  4. 4. PHARMACOLOGICAL PREMEDICATION • Consists of administration of the drugs 1 -2 hrs before the induction of anaesthesia . • Route of administration : • Orally • Intramuscular • Intravenous • Intranasal • Dermal • GOALS OF PREMEDICATION: • Primary goals • Secondary goals.
  5. 5. Primary goals • Anxiolysis &Sedation • Analgesia • Amnesia • Increase in gastric fluid ph and decrease in gastric fluid volume • Antisialogogue effect • Decreased S N S reflex response • Hemodynamic stability • Decrease in anaesthetic requirement
  6. 6. Secondary Goals •Facilitation of induction of anaesthesia •Facilitation of Postoperative analgesia •Prevention of post operative nausea and vomiting • .
  7. 7. Factor to be considered before premedication • Patient’s Physical status • Age • Level of anxiety and pain • Type of Surgery • Timing of surgery • History of drug allergy , nausea , vomiting.
  8. 8. Anxiolysis & sedation Sedation is a ranging from minimum anxiolysis to a state of deep sedation but not including G A .
  9. 9. • To minimize physical discomfort, and pain. • To control behavior particularly movements. • To minimize psychological disturbances and distress. • To maximize the potential for amnesia. • To guard patient’s safety.
  10. 10. DRUGS USED FOR SEDATION • Benzodiazepines : e.g: Diazepam ,midazolam,lorazepam • Barbiturates : e.g: phenobarbitone • Others : • Promethazine
  11. 11. Factors limiting giving sedatives • Extremes of age. • Head injury. • Altered mental status. • Minimal cardio- pulmonary reserve • Hypovolemia. • Full stomach.
  12. 12. ANALGESIA • OPIOIDS: • Pethidine • Morphine • Fentanyl • NSAIDS • Ketorolac • Diclofenac
  13. 13. ASPIRATION PROPHYLAXIS • What is Aspiration ? • Complications of Aspiration ??
  14. 14. RISK FACTORS FOR ASPIRATION • Extremes of age • Emergency cases • Type of surgery • Recent meal • Trauma • PREGNANCY • Pain and stress • Depressed level of consciousness • Morbid obesity • Difficulty airway • Poor motor control • DM.
  15. 15. PREVENTIVE MEASURES • FASTING • Reduce gastric volume ,Increase gastric pHReduce gastric volume ,Increase gastric pH • H2 receptor antagonist • Proton pump inhibitor • Antacid • Increase gastric motilityIncrease gastric motility • Prokinetic drugs
  16. 16. ANTISIALOGOGUES Decreases salivary gland and mucosal gland secretion . •GLYCOPYROLATE •ATROPINE •SCOPOLAMINE
  17. 17. ANTIEMESIS PROPHYLAXIS Risk factor for Nausea vomiting ??? Drugs • Metaclopramide • Ondensetron • Dexamethasone.
  18. 18. CONTINUATION AND DISCONTINUATION OF DRUGS CONTINUATION •Beta blocker •Bronchodilators •Anti-epileptics DISCONTINUATION •MAO-inhibitors •Anti-coagulants •Oral hypoglycemic •ACE inhibitors ?? • AT 2 antagonists.
  19. 19. Conclusion • 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.
  20. 20. Thank you

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