Premedication

Question 1

What are the patient-related reasons for prescribing a preoperative medication?

Answer 1

o Anxiolysis (to get rid of anxiety)
o Amnesia (to forget)
o Analgesia (to relieve pain) 
o Antisialogogue (decrease the production and flow of saliva)
o Aspiration prophylaxis

Question 2

What are the procedure-related reasons for prescribing a preoperative medication?

Answer 2

o Aspiration prophylaxis
o Corticosteroids for immunosuppression
o Prevent undesirable reflexes (e.g., oculocardiac reflex)
o Antisialogogue to reduce oral secretions for awake intubation

Question 3

What are the reasons for prescribing preoperative medications for coexisting diseases?

Answer 3

o Continuing medications

o Preoperative optimization

Question 4

What are the classes of common preoperative drugs?

Answer 4

• Benzodiazepines
• Melatonin
• Opioids
• Anticholinergics
• Aspiration prophylaxis
• Acetaminophen and NSAIDs

Question 5

Why would we use benzodiazepines as a preoperative drug?

Answer 5

Commonly used to provide sedation, anxiolysis, and amnesia

Question 6

Which benzodiazepine would we use for as a preoperative drug and how would we administer it?

Answer 6

Diazepam 5-10 mg PO with sips of water 1-2 hours prior to surgery

Question 7

Why would we use melantonin as a preoperative drug?

Answer 7

Provides anxiolysis without the hangover effect or decrease in REM sleep seen with
benzodiazepines

Question 8

Why would we use opioids as a preoperative drug? What is its drawback?

Answer 8

Provides sedation and analgesia; does not provide amnesia

Question 9

What are the side effects of using opioids as a preoperative drug?

Answer 9

Side effects: N/V, biliary spasm, respiratory depression, bradycardia, hypotension

Question 10

Why would we provide anticholinergics as a preoperative drug?

Answer 10

Provides antisialogogue effects for awake intubation (decrease production and flow of saliva)

Question 11

Which anticholinergic drug would we use as a preoperative drug? How do we administer it?

Answer 11

Glycopyrrolate 0.2-0.4 mg IM

Question 12

What are the effects of Glycopyrrolate 0.2-0.4 mg IM that we have to be aware of?

Answer 12

Does not cross the BBB and causes less tachycardia than atropine

Question 13

What are the drugs for aspiration prophylaxis that we use as preoperative drugs? What are their effects?

Answer 13

o 0.3 M Sodium citrate 30 ml PO neutralizes gastric acid
o Metoclopramide 10 mg IV hastens gastric emptying
o Ranitidine 150 mg PO 1 hour prior to surgery decreases acid production

Question 14

Why would we use acetaminophen and NSAIDs as preoperative drugs?

Answer 14

o Provides postoperative analgesia and reduces opioid use

Question 15

What are the general contraindicatoins to preoperative medications?

Answer 15

• Allergy or hypersensitivity
• Upper airway compromise or respiratory failure
• Hemodynamic instability
• Decreased LOC or increased ICP
• Severe liver, renal, or thyroid disease
• Elderly patient