1. Premedication Management of anesthesia begins with preoperative psychological preparation of the patient and administration of a drug or drugs selected to elicit specific pharmacologic responses This initial psychological and pharmacologic component of anesthetic management is referred to as “Premedication”

2. Psychological Premedication is provided by the anesthesiologist’s preoperative visit and interview with the patient and family members Pharmacological Premedication is administration of drugs orally or intramuscularly 1 to 2 hours before the anticipated induction of anesthesia

3. Goals for Pharmacologic Premedication Primary Goals for Pharmacologic Premedication 1.Anxiety relief ( anxiolysis) 2.Sedation 3.Analgesia 4.Amnesia 5.Antisalogogoue effect 6.Increase in gastric fluid pH 7.Decreased in gastric fluid volume 8.Attenuation of sympathetic nervous system reflex responses 9.Decrease in anesthetic requirements 10.Prophylaxis against allergic reactions

4. Secondary Goals for Pharmacologic Premedication 1.Decrease in cardiac vagal activity …anticholinergic (atropine) just before the time of anticipated need 2.Facilitation of induction of anesthesia …. Not necessary in view of availability of potent intravenous induction drugs Postoperative analgesia… better achieved with opioids or the intravenous injection of an opioids just before the time of anticipated need ( preemptive analgesia ) 3. Prevention of postoperative nausea and vomiting … intravenous injection of an antiemetic ( droperidol, ondansetron) just before the time of anticipated need

5. Drugs and Doses used for Pharmacologic Premedication before Inaction of Anesthesia Route of Administration Typical Adult Dose (mg ) Drug Classification PO,IM 50-150 Secobarbital Pentobarbital Barbiturates IM 5-15 50-100 Morphine Meperidine Opioids IM PO,IM 2.5-5 5-10 Midazolam Diazepam Benzodiazepine PO,IM PO 2-4 15-30 Lorazepam Temazepam

6. PO,IM IM 25-75 Diphenhydramine Promethazine Antihistamines PO IV 0.3-0.4 0.4-0.5 Clonidine Dexmedetomidine Alpha-2 agonists IM 0.3-0.6 0.2-0.3 Atropine Scopolamine Glycopyrrolate Anticholinergics PO,IM,IV PO,IM PO 300 150 20-40 Cimetidine Ranitidine Famotidine H2 antagonists PO 15-30 ml 10-20ml Particulate Nonparticulate Antacids PO,IM,IV10-20metoclopramideStimulates of gastric motility

7. Anesthetic Drugs General anesthesia Supportive drugs Local analgesics

8. General anesthesia Inhalational agents IV agents Muscle Relaxants

9. Thank you