Premedication

PREMEDICATION

A classic study showed that a preoperative visit from an anesthesiologist resulted in a greater reduction in patient anxiety than preoperative sedative drugs. Yet, there was a time when virtually every patient received premedication before arriving in the preop-erative area in anticipation of surgery. Despite the evidence, the belief was that all patients benefitted from sedation and anticholinergics, and most patients would benefit from a preoperative opioid. After such premedication, some patients arrived in a nearly anesthetized state. With the move to out-patient surgery and “same-day” hospital admission, the practice has shifted. Today, preoperative sedative-hypnotics or opioids are almost never administered before patients arrive in the preopera-tive holding area (other than for intubated patients who have been previously sedated in the intensive care unit). Children, especially those aged 2–10 years who will experience separation anxiety on being removed from their parent, may benefit from pre-medication administered in the preoperative holding area. Mid-azolam, administered either intravenously or orally, is a common method. Adults often receive intrave-nous midazolam (2–5 mg) once an intravenous line has been established, and if a painful procedure (eg, regional block or a central venous line) will be per-formed while the patient remains awake, small doses of opioid (typically fentanyl) will often be given. Patients who will undergo airway surgery or exten-sive airway manipulations benefit from preoperative administration of an anticholinergic agent (glyco-pyrrolate or atropine) to reduce airway secretions before and during surgery. The fundamental message here is that premedication should begiven purposefully, not as a mindless routine.