Sedation preoperative

Treat insomnia use for sedation, preoperative medication, barbiturate coma (for controlled increased intracranial pressure)... 

The nurse usually gives tiiese drug in die outpatient setting. If the patient is in the hospital or clinic, the nurse observes the patient for die expected effects of die antihistamine and for adverse reactions. The nurse reports adverse reactions to the primary health care provider. In some instances, drowsiness or sedation may occur. When the drug is given to relieve preoperative anxiety, these adverse reactions are expected and are allowed to occur. 

Promethazine Promethazine also is indicated for preoperative, postoperative, or obstetric sedation prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery an adjunct to analgesics for control of postoperative pain sedation and relief of apprehension, and to produce light sleep antiemetic effect in postoperative patients active and prophylactic treatment of motion sickness (oral and rectal only). 

Oral/Rectal If used for preoperative sedation, administer the night before surgery to relieve apprehension and produce guiet sleep. 

IV Relief of severe pain pain of Ml used preoperatively to sedate the patient and allay apprehension, facilitate anesthesia induction, and reduce anesthetic dosage control postoperative pain relieve anxiety and reduce left ventricular work by reducing preload pressure treatment of dyspnea associated with acute left ventricular failure and pulmonary edema produce anesthesia for open-heart surgery. 

Subcutaneous/IM Relief of severe pain relieve preoperative apprehension preoperative sedation control postoperative pain supplement to anesthesia analgesia during labor acute pulmonary edema allay anxiety. 

Preoperative sedation - 100 to 200 mg, IM only, 60 to 90 minutes before surgery. 

Sradycard/a Atropine is used in the suppression of vagally mediated bradycardias. Preoperative medication Atropine, scopolamine, hyoscyamine, and glycopyrrolate are used as preanesthetic medication to control bronchial, nasal, pharyngeal, and salivary secretions and to block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation. Scopolamine is used for preanesthetic sedation and for obstetric amnesia. 

Morphine remains the standard by which other analgesic drugs are compared. The predominant effects of morphine are at the ji-opioid receptor, although it interacts with other opioid receptors as well. Morphine is indicated for the treatment of moderate to severe and chronic pain. It is useful preoperatively for sedation. 

Preoperative sedation IV 0.044 mg/kg 15-20 min before surgery. Maximum total dose 2 mg. IM 0.05 mg/kg 2 hr before procedure. Maximum total dose 4 mg. 

It is indicated for preoperative sedation, conscious sedation prior to short diagnostic or endoscopic procedures, induction of general anaesthesia prior to administration of other anaesthetic agents. 

Chlorpromazine Blockade of D2 receptors >> 5 2 receptors .-Receptor blockade (fluphenazine least) muscarinic (M)-receptor blockade (especially chlorpromazine and thioridazine) Hx-receptor blockade (chlorpromazine, thiothixene) t central nervous system (CNS) depression (sedation) t decreased seizure threshold t QT prolongation (thioridazine) Psychiatric schizophrenia (alleviate positive symptoms), bipolar disorder (manic phase) nonpsychiatric antiemesis, preoperative sedation (promethazine) pruritus Oral and parenteral forms, long half-lives with metabolism-dependent elimination Toxicity Extensions of effects on a - and M- receptors blockade of dopamine receptors may result in akathisia, dystonia, parkinsonian symptoms, tardivedyskinesia, and hyperprolactinemia... 

Wise (1989) missed an extremely important aspect of his own data. Not only were Halcion and Xanax first and second in total reports of hostility, midazolam (Versed) was third in order. Versed, like Halcion and Xanax, is a very short-acting, tightly binding BZ. It is used exclusively as an intravenous injection for preoperative sedation and memory impairment. The total numbers of reports were Halcion (112), Xanax (77), and Versed (46). Valium (34 reports) was fourth. They were followed by Symmetrel (22) and Prozac (20). 

The pharmacology and adverse effects of midazolam in infants and children have been reviewed (4). The optimal dose of intramuscular midazolam for preoperative sedation has been studied in a double-blind prospective study of 600 patients who were age-stratified (51). The patients received intramuscular atropine 0.6 mg and one of five doses of midazolam 15 minutes before induction of anesthesia. For the age groups 20-39, 40-59, and 60-79 years, the optimal sedative and amnesic effects of midazolam were 0.10, 0.08, and 0.04 mg/kg respectively. The frequency with which the undesirable adverse effects of reduced blood pressure, oxygen desaturation, oversedation, loss of eyelash reflex, and tongue root depression occurred increased with age, and optimal doses for a low incidence of adverse effects were 0.08, 0.06, and 0.04 mg/ kg in the same age groups respectively. 

Sometimes preanesthesia agents are used before cataract surgery. These agents help to relieve anxiety and to produce sedation and, in some cases, short-term amnesia. Oral or intravenous diazepam (Valium) or midazolam (Versed) or intravenous fentanyl citrate (Sublimaze) are commonly used for preoperative sedation. 

Preoperative medication and sedation for short-term procedures... 

These data are relevant clinically because of possible wide variation of body temperature in the surgical patient. Body temperature may be lowered as a result of preoperative sedation, by cutaneous vasodilation, by the infusion of cold fluids and by reduced metabolism under operating conditions. The increase in oil/gas partition coefficient with decreasing temperature means that the effective concentration at the hydrophobic site of action is increasing and hence the apparent potency of the anaesthetic increases. 

Anxiolytics are used for preoperative relief of anxiety, for conscious sedation, as hypnotics in the treatment of insomnia, for short-term relief of symptoms of anxiety, or for the management of anxiety disorders. Benzodiazepines (BZDs) are also used for the... 

The long-acting barbiturates are used for insomnia, anxiety, psychosis, preoperative sedation, and control of seizures. Long-acting barbiturates are utilized as drugs of abuse. This abuse peaked in the 1970s, but has since declined with the increased use of other sedatives. 

---