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Pre-anesthetic medication
Preparatory tasks before anesthesia ① Prepare the patient mentally and physically ② Give the patient appropriate pre-anesthesia medication ③ Prepare anesthesia appliances, equipment, testing instruments and drugs, etc. This article includes commonly used drugs for the purpose of pre-anesthetic medication and the basic principles of drug use.
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Pre-anesthetic medication
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Pre-anesthetic medication
The purpose of pre-anesthetic medication
Use appropriate medications to make the anesthesia process comfortable and smooth
calm
Eliminate the patient's fear, tension and anxiety about surgery, make the patient emotionally stable and cooperative, and produce necessary amnesia (amnesia)
analgesia
Increase the patient's pain threshold, enhance anesthesia effect, reduce anesthetic dosage, and relieve pain caused by pre-operative and pre-anesthetic operations
Prevent and reduce the side effects of certain anesthetics
Such as increased respiratory secretions, toxic effects of local anesthetics, etc.
Reduce basal metabolism and nerve reflex stress
Adjust autonomic nervous function to eliminate or avoid adverse neural reflex activities, such as adverse vagal reflexes
other
Such as reducing gastric juice volume and acidity, antiemetics, preventing or combating allergic reactions
Commonly used drugs
sedatives
benzodiazepines
These drugs all have sedative, hypnotic, anti-anxiety, convulsant and central muscle relaxation effects, and have anterograde amnesia effects. Its sedative-hypnotic effect is dose-dependent, but individual differences are large. It has certain preventive and therapeutic effects on the toxic reactions of local anesthetics.
Commonly used drugs
Diazepam (diazepam, diazepam): The usual dose is 5~10mg or 0.1~0.15mg/kg for adults, taken orally 1 hour before induction, and intramuscular injection is not suitable
Flunitrazepar (flunitrazepar): 1~2 mg for adults, taken orally 1 hour before induction
Midazolam (midazolam): 0.05~0.1mg/kg, injected intramuscularly 1/2 hour before induction
Butyrophenones
This type of medicine has strong sedative, stable, anxiety-relieving and anti-emetic effects. It has no effect on myocardial contractility, but has a mild α-adrenergic receptor blocking effect. When administered intravenously, it can slightly lower blood pressure. In patients with hypovolemia, it can significantly lower blood pressure and may cause extrapyramidal symptoms.
Commonly used drugs
Droperidol, adults generally use 2.5~5mg, intramuscular injection
Phenothiazines
This type of drug has strong sedative, antiemetic and antihistamine effects (used for anti-allergic diseases)
Representative medicine
Promethazine, trade name: phenergan The adult dose is 25~50mg intramuscularly 1 hour before anesthesia, usually 25mg. A small number of patients may develop delirium after taking medication
hypnotics
Mainly barbiturates, which have sedative, hypnotic, and anticonvulsant effects and are often used to prevent toxic reactions of local anesthetics
Commonly used drugs include phenobarbital (long-acting), pentobarbital (medium-acting, now less used), secobarbital (short-acting), etc. The role of barbiturates in preventing local anesthetic poisoning has been gradually replaced by benzodiazepines. Those who still use barbiturates mostly use phenobarbital sodium 1~2 mg/kg for intramuscular injection 1 hour before the day of the day.
Narcotic analgesics
Narcotic analgesics (narcotics) are also called central analgesics. Since these drugs are all opioid alkaloids or their semi-synthetic derivatives, they are often called opiates. These drugs all have strong analgesic effects, can increase the pain threshold, and some have obvious sedative effects; they have synergistic effects with general anesthetics, and can also be used as auxiliary drugs to improve the effects of other anesthesia, or for postoperative use. analgesia
morphine
Generally, 0.1mg/kg is injected intramuscularly 1 hour before anesthesia. For patients with heart valves, it is recommended to use 0.05 ~0.07 mg/kg
pethidine or dolantin
The usual dose is 0.6~1.2mg/kg, usually 1mg/kg is injected intramuscularly 1 hour before anesthesia.
methadone
This drug is rarely used. For adults, 2.5~5.0mg or 0.035mg/kg can be injected intramuscularly 1 hour before anesthesia.
anticholinergics
Anticholinergics (anicholinergics) used before anesthesia are all M-choline receptor blockers.
Commonly used drugs: atropine and scopolamine (scopolarnine, hyoscine)
H2 histamine receptor antagonists
This drug is a reversible, competitive H2 histamine receptor antagonist that can inhibit gastric acid secretion caused by histamine, gastrin and M-choline receptor agonists, reducing gastric juice volume and [H+] in gastric juice. It is generally not used as a routine pre-anesthetic medication. It is mainly used for patients with insufficient preoperative preparation and the risk of gastric reflux and laboring women. It can reduce the risk of reflux and aspiration, as well as the severity of aspiration.
Currently used clinically are cimetidine, ranitidine, famotidine and nizatidine
Basic principles of pre-anesthetic medication
Determination of medication before anesthesia
Patient condition
Mainly based on the patient's mental state, presence or absence of pain, and past use of sedative, hypnotic, and analgesic drugs. Medication for comorbidities should also be considered.
Intended anesthetic method and anesthetic agent
Mainly consider the characteristics of various anesthetic methods and the pharmacological properties of anesthetic drugs
Pre-anesthetic medication
① Give oral hypnotics or sedatives and tranquilizers the night before surgery to eliminate the patient’s nervousness and ensure better sleep and rest. ② Pre-anesthetic medication on the day of surgery generally uses sedatives, diazepam or eye drops to eliminate the patient's nervousness, anxiety and fear, so that the patient can be emotionally stable and fully cooperative before anesthesia. If the patient has severe pain or pain, additional sedatives should be used. Analgesics may also be given if the patient is undergoing a painful procedure. Morphine is often used to enhance sedation, especially in patients with heart disease. M-choline receptor blockers are given according to specific circumstances to reduce the secretion of mucus in the trachea and bronchus and reduce the excitability of the vagus nerve.
Precautions for taking medication before anesthesia
Those who need to reduce the dosage of inhibitory drugs such as sedatives, tranquilizers, hypnotics, and central analgesics as appropriate
Poor general condition, old and frail, cachexia, shock, hypothyroidism, etc.; generally not used for infants under 1 year old
Those who need to increase the dose of inhibitory drugs as appropriate
Young and strong, emotionally nervous or excited, hyperthyroidism, etc.
Central analgesics are prohibited or used with caution
Respiratory insufficiency, respiratory obstruction, increased internal pressure, etc. are prohibited. It is best not to be used by women in labor. If it must be used, the time of delivery of the fetus should be considered. It is appropriate to use pethidine within 1 hour or more than 4 hours before the delivery of the fetus. Oral or intramuscular morphine is contraindicated in labor.
The dosage of anticholinergic drugs should be larger
Administer thiopental, ketamine, sodium oxybate, halothane and other anesthetics or perform intraspinal anesthesia (not necessarily used for low block), or the patient has original bradycardia (with atropine), or needs the help of Sedative effects of scopolamine Children's glands secrete vigorously, so the dosage based on body weight is larger than that for adults.
It is advisable not to use or use less anticholinergic drugs
The patient has tachycardia, hyperthyroidism, high fever and other diseases, and the climate is hot or the room temperature is too high. If anticholinergic drugs must be used, scopolamine or penehyclidine hydrochloride is appropriate.
When multiple pre-anesthetic drugs are used together, the dosage should be adjusted accordingly according to the effects of the drugs.
For emergency patients, intravenous medication is appropriate when necessary