Premedication

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Premedication is using medication before some other therapy (usually surgery or chemotherapy) to prepare for that forthcoming therapy. Typical examples include premedicating with a sedative or analgesic before surgery; using prophylactic (preventive) antibiotics before surgery; and using antiemetics or antihistamines before chemotherapy.

Premedication before chemotherapy for cancer often consists of drug regimens (usually 2 or more drugs, e.g. dexamethasone, diphenhydramine and omeprazole) given to a patient minutes to hours before the chemotherapy to avert side effects or hypersensitivity reactions (i.e. allergic reactions).[ citation needed ]

Melatonin has been found to be effective as a premedication in both adults and children due to its pharmacological properties of hypnotic, antinociceptive and anticonvulsant which produce effective anxiolysis and sedation. Unlike midazolam, melatonin does not impair psychomotor skills or adversely affect the quality of recovery. It has a faster recovery time compared to midazolam and has a reduced incidence of post-operative excitement and results in a reduction in dose required of propofol and thiopental. [1]

Midazolam is effective in children in reducing anxiety associated with separation from parents and induction of anesthesia. [2] Sufentanil is also sometimes used as a premedication. Clonidine is becoming increasingly popular as a premedication for children. One drawback of clonidine is that it can take up to 45 minutes to take full effect. [3] In children, clonidine has been found to be equal to and possibly superior to benzodiazepines as a premedication. It has a more favourable side effect profile. It also reduces the need for an induction agent. It improves post-operative pain relief, is better at inducing sedation at induction, reduces agitated emergence, reduces shivering and post-operative nausea and vomiting and reduces post-operative delirium associated with sevoflurane anaesthesia. Benzodiazepines such as midazolam are more commonly used due largely to a lack of a marketing effort by the pharmaceutical companies. As a result, clonidine is becoming increasingly popular with anesthesiologists. [4] [5] Dexmedetomidine and atypical antipsychotic agents are other premedications which are used particularly in very uncooperative children. [6]

Non-drug interventions for children include playing relaxing music, massages, reducing noise and controlling light to maintain the sleep wake cycle. [7] Other non-pharmacological options for children who refuse or cannot tolerate premedication include clown doctors; low sensory stimulation and hand-held video games may also help reduce anxiety during induction of general anesthesia. [8]

Related Research Articles

General anaesthetics are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma that causes lack of awareness to painful stimuli, sufficient to facilitate surgical applications in clinical and veterinary practice. General anaesthetics do not act as analgesics and should also not be confused with sedatives. General anaesthetics are a structurally diverse group of compounds whose mechanisms encompasses multiple biological targets involved in the control of neuronal pathways. The precise workings are the subject of some debate and ongoing research.

<span class="mw-page-title-main">Hypnotic</span> Drug whose use induces sleep

Hypnotic, or soporific drugs, commonly known as sleeping pills, are a class of psychoactive drugs whose primary function is to induce sleep and to treat insomnia (sleeplessness).

Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam.

<span class="mw-page-title-main">General anaesthesia</span> Medically induced loss of consciousness

General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients.

<span class="mw-page-title-main">Propofol</span> Intravenous medication used in anesthesia

Propofol is the active component of an intravenous anesthetic formulation used for induction and maintenance of general anesthesia. It is chemically termed 2,6-diisopropylphenol. The formulation was originally approved under the brand name Diprivan. Numerous generic offerings of this formulation now exist. Intravenous administration is used to induce unconsciousness after which anesthesia may be maintained using a combination of medications. It is manufactured as part of a sterile injectable emulsion formulation using soybean oil and lecithin, giving it a white milky coloration.

<span class="mw-page-title-main">Midazolam</span> Benzodiazepine used for anesthesia and procedural sedation

Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia and procedural sedation, and to treat severe agitation. It induces sleepiness, decreases anxiety, and causes anterograde amnesia.

<span class="mw-page-title-main">Anesthetic</span> Drug that causes anesthesia

An anesthetic or anaesthetic is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two broad classes: general anesthetics, which result in a reversible loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness.

Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory of the experience, it is also possible for victims to have awareness with explicit recall, where they can remember the events related to their surgery.

In anaesthesia and advanced airway management, rapid sequence induction (RSI) – also referred to as rapid sequence intubation or as rapid sequence induction and intubation (RSII) or as crash induction – is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration. It differs from other techniques for inducing general anesthesia in that several extra precautions are taken to minimize the time between giving the induction drugs and securing the tube, during which period the patient's airway is essentially unprotected.

<span class="mw-page-title-main">Brotizolam</span> Benzodiazepine

Brotizolam is a sedative-hypnotic thienotriazolodiazepine drug which is a benzodiazepine analog. It possesses anxiolytic, anticonvulsant, hypnotic, sedative and skeletal muscle relaxant properties, and is considered to be similar in effect to other short-acting hypnotic benzodiazepines such as triazolam or midazolam. It is used in the short-term treatment of severe insomnia. Brotizolam is a highly potent and short-acting hypnotic, with a typical dose ranging from 0.125 to 0.25 milligrams, which is rapidly eliminated with an average half-life of 4.4 hours.

<span class="mw-page-title-main">Dexmedetomidine</span> Anxiolytic, sedative, and pain medication

Dexmedetomidine, sold under the trade name Precedex among others, is a drug used in humans for sedation. Veterinarians use dexmedetomidine for similar purposes in treating cats, dogs, and horses. It is also used in humans to treat acute agitation associated with schizophrenia or bipolar I or II disorder.

<span class="mw-page-title-main">Alfaxalone</span> Chemical compound

Alfaxalone, also known as alphaxalone or alphaxolone and sold under the brand name Alfaxan, is a neuroactive steroid and general anesthetic which is used currently in veterinary practice as an induction agent for anesthesia and as an injectable anesthetic. Though it is more expensive than other induction agents, it often preferred due to the lack of depressive effects on the cardiovascular system. The most common side effect seen in current veterinary practice is respiratory depression when Alfaxan is administered concurrently with other sedative and anesthetic drugs; when premedications aren't given, veterinary patients also become agitated and hypersensitive when waking up.

<span class="mw-page-title-main">Ro48-6791</span> Chemical compound

Ro48-6791 is a drug, an imidazobenzodiazepine derivative developed by Hoffman-LaRoche in the 1990s.

<span class="mw-page-title-main">Pregnanolone</span> Chemical compound

Pregnanolone, also known as eltanolone, is an endogenous inhibitory neurosteroid which is produced in the body from progesterone. It is closely related to allopregnanolone, which has similar properties.

<span class="mw-page-title-main">Twilight anesthesia</span> Anesthetic technique

Twilight anesthesia is an anesthetic technique where a mild dose of sedation is applied to induce anxiolysis, hypnosis, and anterograde amnesia. The patient is not unconscious, but sedated. During surgery or other medical procedures, the patient is under what is known as a "twilight state", where the patient is relaxed and "sleepy", able to follow simple directions by the doctor, and is responsive. Generally, twilight anesthesia causes the patient to forget the surgery and the time right after. It is used for a variety of surgical procedures and for various reasons. Just like regular anesthesia, twilight anesthesia is designed to help a patient feel more comfortable and to minimize pain associated with the procedure being performed and to allow the medical practitioner to practice without interruptions.

<span class="mw-page-title-main">Remimazolam</span> Chemical compound

Remimazolam, sold under the brand name Byfavo, is a medication for the induction and maintenance of procedural sedation in adults for invasive diagnostic or surgical procedures lasting 30 minutes or less. It is a benzodiazepine drug, developed by PAION AG in collaboration with several regional licensees as an alternative to the short-acting imidazobenzodiazepine midazolam, for use in the induction of anesthesia and conscious sedation for minor invasive procedures. Remimazolam was found to have both a more rapid onset and a shorter duration than midazolam, and human clinical trials showed a faster recovery time and predictable, consistent pharmacokinetics, suggesting some advantages over existing drugs for these applications.

Postanesthetic shivering (PAS) is shivering after anesthesia.

<span class="mw-page-title-main">Coinduction (anesthetics)</span>

Coinduction in anesthesia is a pharmacological tool whereby a combination of sedative drugs may be used to greater effect than a single agent, achieving a smoother onset of general anesthesia. The use of coinduction allows lower doses of the same anesthetic agents to be used which provides enhanced safety, faster recovery, fewer side-effects, and more predictable pharmacodynamics. Coinduction is used in human medicine and veterinary medicine as standard practice to provide optimum anesthetic induction. The onset or induction phase of anesthesia is a critical period involving the loss of consciousness and reactivity in the patient, and is arguably the most dangerous period of a general anesthetic. A great variety of coinduction combinations are in use and selection is dependent on the patient's age and health, the specific situation, and the indication for anesthesia. As with all forms of anesthesia the resources available in the environment are a key factor.

Total intravenous anesthesia (TIVA) refers to the intravenous administration of anesthetic agents to induce a temporary loss of sensation or awareness. The first study of TIVA was done in 1872 using chloral hydrate, and the common anesthetic agent propofol was licensed in 1986. TIVA is currently employed in various procedures as an alternative technique of general anesthesia in order to improve post-operative recovery.

<span class="mw-page-title-main">Caudal anaesthesia</span> Form of neuraxial regional anaesthesia

Caudal anaesthesia is a form of neuraxial regional anaesthesia conducted by accessing the epidural space via the sacral hiatus. It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeries below the umbilicus. In adults it is used for chronic low back pain management.

References

  1. ↑ Naguib, M.; Gottumukkala, V.; Goldstein, PA. (Jan 2007). "Melatonin and anesthesia: a clinical perspective". J Pineal Res. 42 (1): 12–21. doi: 10.1111/j.1600-079X.2006.00384.x . PMID   17198534.
  2. ↑ Cox, RG.; Nemish, U.; Ewen, A.; Crowe, MJ. (Dec 2006). "Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children?". Can J Anaesth. 53 (12): 1213–9. doi: 10.1007/BF03021583 . PMID   17142656.
  3. ↑ Rosenbaum, A.; Kain, ZN.; Larsson, P.; Lönnqvist, PA.; Wolf, AR. (Sep 2009). "The place of premedication in pediatric practice". Paediatr Anaesth. 19 (9): 817–28. doi:10.1111/j.1460-9592.2009.03114.x. PMID   19691689. S2CID   7743205.
  4. ↑ Bergendahl, H.; Lönnqvist, PA.; Eksborg, S. (Feb 2006). "Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication". Acta Anaesthesiol Scand. 50 (2): 135–43. doi: 10.1111/j.1399-6576.2006.00940.x . PMID   16430532. S2CID   25797363. Archived from the original on 2012-12-16.
  5. ↑ Dahmani, S.; Brasher, C.; Stany, I.; Golmard, J.; Skhiri, A.; Bruneau, B.; Nivoche, Y.; Constant, I.; Murat, I. (Jan 2010). "Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies". Acta Anaesthesiol Scand. 54 (4): 397–402. doi: 10.1111/j.1399-6576.2009.02207.x . PMID   20085541. S2CID   205430269.
  6. ↑ Bozkurt, P. (Jun 2007). "Premedication of the pediatric patient - anesthesia for the uncooperative child". Curr Opin Anesthesiol. 20 (3): 211–5. doi:10.1097/ACO.0b013e328105e0dd. PMID   17479023. S2CID   25446995.
  7. ↑ Mencía, SB.; López-Herce, JC.; Freddi, N. (May 2007). "Analgesia and sedation in children: practical approach for the most frequent situations". J Pediatr (Rio J). 83 (2 Suppl): S71–82. doi: 10.2223/JPED.1625 . PMID   17530139.
  8. ↑ Manyande, Anne; Cyna, Allan M.; Yip, Peggy; Chooi, Cheryl; Middleton, Philippa (2015-07-14). "Non-pharmacological interventions for assisting the induction of anaesthesia in children" (PDF). The Cochrane Database of Systematic Reviews. 2015 (7): CD006447. doi:10.1002/14651858.CD006447.pub3. ISSN   1469-493X. PMC   8935979 . PMID   26171895.
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