STOP OR CONTINUE PREMEDICATION

1
STOP OR CONTINUE PREMEDICATION

• WHAT IS EVIDENCE BASED?
• Dr.S.Saravana babu
• SALEM

2
PREMEDICATION REVISITED
3
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 agents
5. Short postoperative stays.

4
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.

5
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.
  

6
ANALGESIA

• Preemptive analgesia.
• Multimodal analgesia
• ?Paracetamol
• NSAIDS
• Opioids.
• Topical anaesthetic creams.
• EMLA.

7
ANTIEMESIS

• PONV.
• Effective when given intravenous at induction.
• Combination of agents more effective than
  monotherapy.

8
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.

9
ANTISECRETORY

• Before awake fibreoptic intubahon.
• Before IV ketamine anaesthesia.
• Prevention of vagal reflexes caused by surgical
  stimulation
• eg- squint operations, stretching of anal
  sphincter.

10

• DRUGS FOR CONTINUATION OR DISCONTINUATION IN THE
  PERIOPERATIVE PERIOD.

11
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.

12
ANTIBIOTICS

• Cardiac Lesions
• Prosthetic Valves
• Procedures associated with bacteremia for
  infective endocarditis prophylaxis

13
RESPIRATORY DRUGS

• To continue
• Bronchodilators
• inhaled ß2 agonists

14
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

15
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 -gt usual dose on the morning of
  surgery plus 25 mg hydrocortisone at induction.
• Major surgery -gt 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.

16
CONCLUSION
17
THANK YOU