[麻醉讀書筆記 78-day Anesthesia Secrets] Day 16 - PREOPERATIVE MEDICATION

 

Anesthesia Secrets 78-d Chapter, Day 16

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#Day 16 - Common Preoperative Medications

#Ref: Anesthesia Secrets, 4th edition. Chapter 16, Common Preoperative Medications

Common Preoperative Medications

[DOSE]

(Sedation)

• BZD
• Midazolam [iv: 1-2mg]
• most commonly used BZD
• Diazepam [oral, iv: 5-10mg]
• pain on injection, and increased risk of phlebitis
• Ketamine [im: 1-2mg/kg]

(Analgesia)

• Opioid
• Morphine [iv: 2-10mg]
• Meperidine [im: 25-100mg]

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most common S/E used as  OPIODs premedication

• histamine release → pruritus
• delayed gastric emptying → n/v
• stiff chest syndrome → respiratory depression
• sphincter of Oddi spasm → orthostatic hypoTN

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(GI)

• Ranitidine [oral: 150mg, iv: 50mg]
• Metoclopramide [oral, iv: 5-20mg]
• Omeprazole [oral: 20mg]
• Pantoprazole [iv: 40mg]
• Promethazine (1st-G antihistamine) [im: 25-50mg]
• antiemetic effect

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*extremely low incidence of clinically significant aspiration pneumonitis in healthy patients having elective surgery, routine and indiscriminate use of medications is not warranted.

*不過如果是 Morbid obesity 的人, 因為 delayed gastric emptying and the possibility of difficult airway management → 所以前一天晚上給 H2 blocker, 和 OP 早上給 preoperative metoclopramide

*那吃藥可以喝水嗎 → OK 的, with up to 150 ml of water in the hour preceding induction of anesthesia

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(Anticholinergic)

(1) Drying of airway secretions, (2) Prevention of reflex bradycardia when vagal overactivity is anticipated, (3) Sedative and amnestic effect

• Tertiary (3) amines → "CROSS BBB"
• Atropine
• Scopolamine [im, iv: 0.3-0.6mg]
• Quaternary amines 
• Glycopyrrolate [iv: 0.1-0.3mg]
• "doesn't cross BBB" → (-) sedative effect

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most common S/E used as anticholinergic premedication

• drying and thickening of airway secretions
• lower esophageal sphincter tone decrease ↓
• mydriasis ↑ and cycloplegia
• CNS toxicity
• → 怎麼辦? Physostigmine (the only acetylcholinesterase inhibitor that "CROSS" BBB) [iv: 15-60 mcg/kg]
• Sweating (-)
• Hyperthermia ↑

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@ Flower Dome, Singapore. w/ the Family, by Mark. 

By Mark, 馬克

💬 E-mail: mata.assembled@gmail.com