STOP OR CONTINUE PREMEDICATIONSTOP OR CONTINUE PREMEDICATIONSTOP OR CONTINUE PREMEDICATIONSTOP OR CONTINUE PREMEDICATION

WHAT IS EVIDENCE BASED?WHAT IS EVIDENCE BASED?

Dr.S.Saravana babuDr.S.Saravana babuSALEMSALEM

PREMEDICATION PREMEDICATION REVISITEDREVISITED

PREMEDICATION PREMEDICATION REVISITEDREVISITED

CHANGES IN PREMEDICANT PRESCRIPTION ARE DUE TO

1. Increasing use of day care surgery.

2. Same day admission.3. Changes in surgical list.4. Advances in anaesthetic agents5. Short postoperative stays.

AIMS OF PREMEDICATION

1. Anxiolysis.2. Analgesia.3. Anti – emesis.4. Antacids.5. Anti – secretory.6. 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.

ANALGESIAPreemptive 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 stimulationeg:- 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

AVOIDACE 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.