Sedation premedication

Patients should be advised to administer interferon in the evening to reduce excessive daytime sedation premedication and scheduled dosing with acetaminophen or an NSAID may alleviate flu-like symptoms... 

Meperidine (Demerol) [C-ll] [Narcotic Analgesic] Uses Moderate/ severe pain Action Narcotic analgesic Dose Adults. 25-50 mg IV, 50-100 mg IM Peds. 1 mg/kg IV/IM (onset w/in 5 min IV and 10 min IM duration about 2 h) Caution [C, ] Contra Convulsive disorders and acute abdomen Disp Prefilled 1 mL syringes 25, 50, 75, 100 mg/mL various amps and vials oral syrup and tabs SE N/V (may be severe), dizziness, weakness, sedation, miosis, resp d ession, xerostomia (dry mouth) Interactions t CNS depression W/ opiates, sedatives/ hypnotics TCNS stimulation W/amphetamines t risk of tox W7 phenytoin EMS Pt should be receiving O2 prior to administration have resuscitation equipment and naloxone available naloxone can be used as an antidote to reverse resp depression aspirate prior to IM administration inadv tent IV admin of IM doses may cause tach and syncope mix w/ NS to make a 10 mg/mL soln and inj very slowly N/V may be sev e may premedicate w/ an antiemetic... 

In anesthesia drugs from several groups are used as premedication. Pre-anesthetic medication can decrease the anesthetic doses which otherwise would be required to induce anesthesia and so decrease the risk for adverse effects. Pre-anesthetic medication will increase the rate of induction of anesthesia and can reduce pre-operative pain and anxiety. Drugs include benzodiazepines for sedation and their muscle relaxant properties, opiates for pain relieve and anticholinergics or histamine Hi receptor antagonists against nausea and vomiting. Neuroleptics are also used as premedication for their antiemetic effects. 

Benzodiazepines are useful as orally administered premedications. They are also used intravenously in doses that produce conscious sedation rather than hypnosis. Sedated patients tolerate unpleasant procedures (e.g., wound repair, bronchoscopy, angiography) while maintaining cardiorespiratory function and the ability to respond to tactile stimulation or verbal commands. 

Perphenazine is now only available in oral formulation. It is used less and less in anaesthetic practice, usually given with premedication (2-4 mg, 1-2 h pre-operatively). The anti-emetic effects are well recognised but there may be marked sedation. It has a role in anxiety states and in the management of psychiatric cases. 

Promethazine has prominent sedative effects as weii as anti-muscarinic and dopamine D2-blocking effects. These make it usefui as an anti-emetic, and it is especially useful for the prevention and treatment of motion sickness. Like other phenothiazines, it has weak al-adrenergic blocking effects and can iower biood pressure if injected rapidly intravenously. Intramuscular injection can be painful. Alimemazine tartrate is a phenothiazine with HI antagonist activity that produces marked sedation. It is used mainiy for its marked relief of pruritus, and is also popular for the premedication of children (dose 2 mg-kg-1). 

The technique typically involves the use of intravenous midazolam for premedication (to provide anxiolysis, amnesia, and mild sedation) followed by a titrated, variable-rate propofol infusion (to provide moderate to deep levels of sedation), and a potent opioid analgesic or ketamine (to minimize the discomfort associated with the injection of local anesthesia and the surgical manipulations). 

In psychotic excitement (agitation), sedation can be achieved with scopolamine. Unlike atropine, scopolamine exerts a calming and amnesiogenic action that can also be used to advantage in anesthetic premedication. 

Hypothermia is common during anesthesia, and adversely affects outcome. It primarily results from internal redistribution of body heat from the core to the periphery. Premedication with sedative agents can affect perioperative heat loss by altering core-to-peripheral heat distribution. This has been analysed in a prospective randomized study in 45 patients undergoing arthroscopic knee ligament reconstruction surgery (47). Heavy premedication caused initial hypothermia. Moderate premedication reduced perioperative heat loss. No premedication was associated with significantly lower intraoperative core temperatures than in sedated patients. 

It is advisable to prepare anxious patients with sedation (e. g. doxepin 10 mg) on the evening prior to laparoscopy. For premedication... 

Fentanyl (0.001 mg/kg i.v.) can be used with xylazine (0.44 mg/kg i.v.) for anesthetic premedication. Fentanyl is sometimes used as an anesthetic adjunct during inhalation anesthesia to improve analgesia. The pharmacokinetics of fentanyl make it ideal for administration by constant rate infusion and it can be administered intra-operatively at a rate of 0.001-0.004 mg/kg/h after a 0.001 mg/kg loading dose. To prevent excitement or locomotory stimulation in recovery, the infusion should be discontinued 30 min prior to recovery or the horse should be sedated with xylazine (0.1 mg/kg i.v.) prior to recovery. 

In adult horses, propofol induction is undesirable without prior sedation (Mama et al 1995). Even with an adequate level of sedation provided by an 2 agonist, induction with propofol is not always smooth. The incorporation of guaifenesin in the induction protocol prior to administration of propofol markedly improves the quality of anesthetic induction (Aguiar et al 1993). Recoveries from propofol-based anesthesia are generally good. The dose rate recommended for anesthetic induction with propofol is 2mg/kg i.v. after premedication with xylazine (0.5mg/kg i.v.) or detomidine (0.015 mg/kg) followed by administration of guaifenesin (50-100 mg/kg i.v.) until muscle relaxation and ataxia are evident. Maintenance... 

A sedative-hypnotic is administered the night before surgery to assist with sleep. An hour before the surgery, premedications are administered to sedate and decrease anxiety. Premedications are an anticholinergic (atropine) to decrease secretions and either a narcotic analgesic or benzodiazepine. 

Lorazepam (la) in 2 or 4 mg doses showed hypnotic activity in insomniacs and good sedation in surgical premedication.41 Flurazepam (2h) is useful in the long term treatment of insomnia42 and shows no rebound effect after withdrawal.43 Flunitrazepam (2 ) has hypnotic activity in man at 2.5 mg, but does not induce physiological sleep.44 Fosazepam (2j) at 60-80 mg decreased sleep onset and awakening in healthy subjects.45 Quazepam (Sch 16134 2k) has been entered in the USAN listing as a sedative, hypnotic.46 Clobazam (9a) at 10—20 mg, but not triflubazam (9b) was useful for limited sleep difficulties in healthy males.47... 

If the peel is to be done without deep sedation, the patient should immediately be given premedication, as per the doctor s usual practice for example, one sublingual tablet of Temesta 2.5 mg (lorazepam) if the patient has not taken any that morning and 15 drops of tilidine (a major analgesic) or any other strong analgesic the doctor usually prescribes. It is best to use an analgesic that the patient can tolerate easily. 

If the peel is to be performed under deep sedation or neuroleptanalgesia, the anesthetist should deal with premedication. 

Various phenol peel formulas can be found on the market that boast of the possibilities of doing a full-face peel without anesthetic . In some cases, this means without general anesthetic and in others the patient is put on strong analgesics, sedation and premedication. Some low-dose phenol peels (around 30%) are no more painful than a trichloroacetic acid to the papillary dermis, but they are not much more effective either. 

Premedication is used to prepare the patient for general anaesthesia. The objective is to reduce feelings of anxiety and lightly sedate the patient. In addition, drugs may be used to prevent parasympathetic effects of some general anaesthetics. 

Breast pathology has a profound symbolic meaning for every woman. Fear of breast cancer and its consequences, regularly fed by the media, induces a particularly critical emotional context within the framework of the interventional procedures available to the breast specialist. Local anesthesia and premedication sedation are sometimes necessary, but usually it is the patient s psychological state that will determine the degree of tolerance of the examination. 

Pharmacological premedication is usually prescribed for patients with planned overnight hospital stay. Low-dose benzodiazepines provide anxiolysis, light sedation and anterograde amnesia. Especially at advanced age, benzodiazepines may elicit paradoxical reactions or predispose to postoperative delirium. Alternatives for oral premedication are clonidin or haloperidol. Ambulatory patients usually do not receive preoperative sedatives. 

Dogs, cats and monkeys receive systematically one drop of tropicamide onto the cornea at the time of premedication or 20 minutes prior to die sedation. Mydriasis is very important to obtain a good ERG, specially with sedated laborato animals because the eyeballs can rotate downward during sedation and it becomes then impossible to record an ERG. 

Fifty acutely anxious and/or agitated patients were treated with intravenous lorazepam in a dose of 5—10 mg (16 ). Since sedation was required it was not considered a side effect in this situation. While the patients were sedated, hypotonia and ataxia were noted. Local toleration of the injections was good. When lorazepam was used intramuscularly as premedication there was impaired memory of cards presented pre-operatively. Over half the patients rated the injection as uncomfortable (23 ). Other clinical studies have paid little attention to the question of side effects (51, 4 ). 

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