Transcript Stop or Continue pre-medication: What is

STOP OR CONTINUE PREMEDICATION
WHAT IS EVIDENCE BASED?
Dr.S.Saravana babu
SALEM
PREMEDICATION
REVISITED
CHANGES IN PREMEDICANT
PRESCRIPTION ARE DUE TO
1.
2.
3.
4.
5.
Increasing use of day care surgery.
Same day admission.
Changes in surgical list.
Advances in anaesthetic agents
Short postoperative stays.
AIMS OF PREMEDICATION
1.
2.
3.
4.
5.
6.
Anxiolysis.
Analgesia.
Anti – emesis.
Antacids.
Anti – secretory.
To reduce the risk specific to the
patient or type of surgery.
ANXIOLYSIS
•
•
•
•
•
•
Very common.
Unpleasant.
Well conducted preoperative visit.
Drugs sedative and cause amnesia.
Timing of drug delivery.
Needed in
(a) particular group of patients –children
(b) Certain types of surgery – cardiac.
ANALGESIA
Preemptive analgesia.
Multimodal analgesia
Paracetamol
 NSAIDS
 Opioids.
Topical anaesthetic creams.
EMLA.
ANTIEMESIS
• PONV.
• Effective when given intravenous at
induction.
• Combination of agents more
effective than monotherapy.
ANTACIDS.
• To reduce the morbidity associated with
pulmonary aspiration of gastric contents.
• Gastric volume   25ml
• PH   2.5
• Oral administration of clear fluids upto 2 hrs
before surgery decreases gastric residual volume
and acidity.
• Indicated in
 Obese
 Pregnant
 Diabetics
 Hiatus hernia.
ANTISECRETORY
• Before awake fibreoptic intubahon.
• Before IV ketamine anaesthesia.
• Prevention of vagal reflexes caused
by surgical stimulation
eg:- squint operations, stretching of
anal sphincter.
DRUGS FOR CONTINUATION OR
DISCONTINUATION IN THE
PERIOPERATIVE PERIOD.
CARDIOVASCULAR DRUGS
• Anti – hypertensives
• Anti – anginal
• Anti – arrythmics
best continued to reduce hemodynamic
instability and reduce risk of MI
AVOID
ACE inhibitors.
Angiotensin II receptor antagonists
Diuretics.
ANTIBIOTICS
• Cardiac Lesions
• Prosthetic Valves
• Procedures associated with
bacteremia for infective endocarditis
prophylaxis
RESPIRATORY DRUGS
• To continue
» Bronchodilators
» inhaled ß2 agonists
CENTRAL NERVOUS
SYSTEM DRUGS
• Tricyclic Antidepressants
– Need to be continued.
– Increased risk of arrythmia and hypotension if
stopped abruptly.
• Lithium
– Potentiates non deplorazing relaxants. stopped 48-72
hrs before surgery
• Monoamine oxidase inhibitors
– Life threatening interactions with pethidine, morphine
and fentanyl
– Should be discontinued 2-3 weeks before elective
surgery
STEROIDS
• Long term steroid therapy calls for steroid
replacement during anaesthesia.
• 10 mg prednisolone or more per day within 3
months of surgery.
• Minor surgery -> usual dose on the morning of
surgery plus 25 mg hydrocortisone at induction.
• Major surgery -> usual dose on the morning of
surgery plus 25mg hydrocortisone at induction.
Then 25mg IV 8th hrly for 48-72 hrs
postoperatively. Resume normal preoperative
dose.