stop or continue premedication what is evidence based? dr.s.saravana babu salem
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STOP OR CONTINUE PREMEDICATIONSTOP OR CONTINUE PREMEDICATIONSTOP OR CONTINUE PREMEDICATIONSTOP OR CONTINUE PREMEDICATION
WHAT IS EVIDENCE BASED?WHAT IS EVIDENCE BASED?
Dr.S.Saravana babuDr.S.Saravana babuSALEMSALEM
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PREMEDICATION PREMEDICATION REVISITEDREVISITED
PREMEDICATION PREMEDICATION REVISITEDREVISITED
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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 agents5. Short postoperative stays.
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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.
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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.
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ANALGESIAPreemptive analgesia.Multimodal analgesia
Paracetamol NSAIDS Opioids.
Topical anaesthetic creams.EMLA.
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ANTIEMESIS• PONV.• Effective when given intravenous
at induction.• Combination of agents more
effective than monotherapy.
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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.
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ANTISECRETORY
• Before awake fibreoptic intubahon.• Before IV ketamine anaesthesia.• Prevention of vagal reflexes
caused by surgical stimulationeg:- squint operations, stretching of anal sphincter.
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DRUGS FOR CONTINUATION OR DISCONTINUATION IN THE PERIOPERATIVE PERIOD.
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CARDIOVASCULAR DRUGS• Anti – hypertensives• Anti – anginal• Anti – arrythmics
best continued to reduce hemodynamic instability and reduce risk of MI
AVOIDACE inhibitors.Angiotensin II receptor antagonists Diuretics.
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ANTIBIOTICS
• Cardiac Lesions• Prosthetic Valves• Procedures associated with
bacteremia for infective endocarditis prophylaxis
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RESPIRATORY DRUGS• To continue
» Bronchodilators
» inhaled ß2 agonists
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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
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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 -> usual dose on the morning of surgery plus 25 mg hydrocortisone at induction.
• Major surgery -> 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.
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