Premedication Lecture Flashcards
When and why do we premedicate?
- Before general anesthesia
- Caliming
- ANalgesia
- Smooth induction and recovery
- decreased anesthetic requirement
- decreased sympathetic response to surgery
What kind of drugs are normally included in the premeds?
- Ketamine
- Tiletamine
- Opioids
- Dexmedetomidine
- Acepromazine
- Xyalzine
- Atropine
Discuss sedatives (the basics)
- reduce anxiety and overall repsonse to external stimuli
- analgesia properties (some)
- acepromazine, benzodiazapenes, aplha 2-agonistss
Discuss acepromazine
- sedative with muscle relaxation
- antiemetic
- little effect in heart
- minimal effect on pulmonary function
- decrease inhalant requirement
- DOES NOT cause seizure
- NO analgesic effect
- NO reversal
Discuss the effects that these different receptors cause
Alpha-1 receptors –> vasodilation, decreased thermoreguklation, serotonin blockade (sedation)
Dopamine 2 redeptors –> sedation
muscarinic receptors –> muscle relaxation
Histaminic (H1) receptors –> sedation
- DOES NOT work for cats
Discuss in the indications and contra-iindications of acepromazine
Indications of acepromazine:
- sedation and muscle relaxation
- good for cardiac patients
- when longer sedation is required
- used with opioids and/or other sedatives
Contraindications:
- severely compromised liver disease and/or severe hypovolemic
Discuss midazolam (one of the benzodiazapenes)
- anxiolytic with some muscle relaxation
- antoconvulsant effect
- little effect on pulomnary and cardiovascular systems
- can be reversed
- ## UNRELIABLE sedation
Which drugs are sedatives (benzos!!!!)
Diazepam and midazolam –> agonist
Flumazenil –> antagonist
Discuss the indications and contraindications of midazolam and/.or diazepam
Inidications:
- Anticonvulsant (higher dose)
- sedations in very sick patients (ASA IV- V)
-
When considering sedatives, which one is the best?
Dexmedetomidine (an alpha-2 agoniost) is the best for sedation
Dexmedetomidine (an alpha-2 agonists):
- sedation, analgesia, and muscle relaxation
- vasocnstriction with reflex bradycardia
- Hyperglycemia, platelet agggregation and decreased GI motility
- Can be revrsed
Discuss the indications and contra-indications of Dexmedetomdine
Indications:
- sedation, analgesia, and muscle relaxation
- When short duration sedation is needed (reversal)
Contraindications:
- cardiac diseased patients
- pediatric pateints
- pregant animals
-
Discuss the basics of opioids
Analgesia, anlgesia, and anlagesia
- sedation and muscle relaxation
- antitussive effect
- cardiovacular safe!
- decreased inhalant requirement
- Reliable reversal:
- Naloxone
What are the indications and contraindications of opioids
- Inidications:
- preemptive analgesia
- pain management
- sedation (butorphanol)
- combine with sedatives
- Cardiovascular compormise patients
-
Discuss the indications and contraindications of ketamine
Indications:
- sedatiion with other drugs BUT always include a benzodiazapine
Contra-indications:
- C - section
- cardiac disease patients
- glaucoma patients
- kidney disease patients (caution!)
- very sick poatients
Discuss tthe significance of ketamine when considering how to use it
- ## No - reversal –> liver metabolism dependent
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