16: Preoperative Medication

Published on 06/02/2015 by admin

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Last modified 06/02/2015

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CHAPTER 16 Preoperative Medication

Sunil Kumar, MD, FFARCS

1 List the major goals of premedication

Premedication needs to be tailored to the needs of individual patient. Important goals include:

image Sedation and anxiolysis
image Analgesia and amnesia
image Antisialagogue effect
image To maintain hemodynamic stability, including decrease in autonomic response
image To prevent and/or minimize the impact of aspiration
image To decrease postoperative nausea and vomiting
image Prophylaxis against allergic reaction

2 List the most commonly used preoperative medications with the appropriate dose

See Table 16-1.

TABLE 16-1 Common Preoperative Medications, Dosage, and Route*

image

3 What factors should be considered in selecting premedication for a patient?

image Patient age and weight
image Physical status
image Levels of anxiety and pain
image Previous history of drug use or abuse
image History of postoperative nausea, vomiting or motion sickness
image Drug allergies
image Elective or emergency surgery
image Inpatient or outpatient status

4 What factors limit the ability to give depressant medications preoperatively?

image Extremes of age
image Head injuries or altered mental status
image Limited cardiac or pulmonary reserve
image Hypovolemia
image Full stomach

5 What is meant by psychologic premedication?

Most patients are very anxious before surgery. An informative and comforting visit by an anesthesiologist may replace many milligrams of depressant medication and acts as psychologic premedication. During this visit a full description of the planned anesthetic events to anticipate in the perioperative period should be provided to the patient and family members, and all questions the patient or family may have should be answered. However, psychologic preparation cannot accomplish everything and will not relieve all anxiety.

6 Discuss the role of benzodiazepines in premedication

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