Premedication
Encyclopedia
Premedication refer to a drug
treatment given to a patient before a (surgical or invasive) medical procedure. These drugs are typically sedative
or analgesic
.
Premedication before chemotherapy
for cancer often refers to special drug regimens (usually 2 or more drugs, e.g. dexamethasone
, diphenhydramine
and omeprazole
) given to a patient minutes to hours before the chemotherapy to avert side effects or hypersensitivity
reactions (i.e. allergic reactions).
Melatonin
has been found to be effective as a premedication in both adults and children due to its pharmacological properties of hypnotic
, antinociceptive and anticonvulsant
which produce effective anxiolosis and sedation. Unlike midazolam melatonin does not impair psychomotor skills or adversely effect the quality of recovery. It has a faster recovery time compared to midazolam and has a reduced incidence of post-operative excitement and results in a reduction in dose required of propofol
and thiopental.
Midazolam
is effective in children in reducing anxiety associated with separation from parents and induction of anesthesia
. Sufentanil
is also sometimes used as a premedication. Clonidine is becoming increasingly popular as a premedication for children. One drawback of clonidine however, is that it can take up to 45 minutes to take full effect. In children, clonidine
has been found to be equal to and possibly superior to benzodiazepines as a premedication. It has a more favourable side effect profile. It also reduces the need for an induction
agent. It improves post-operative pain relief, is better at inducing sedation at induction, reduces emergence agitation, reduces shivering and post-operative nausea and vomiting and reduces post-operative delirium associated with sevoflurane
anaesthesia. Benzodiazepine
s such as midazolam
are more commonly used due largely to a lack of a marketing effort by the pharmaceutical companies. As a result clonidine is becoming increasingly popular with anesthesiologists. Dexmedetomidine
and atypical antipsychotic agents are other premedications which are used particularly in very uncooperative children.
Non-drug interventions for children include playing relaxing music, massages, reducing noise and controlling light in order to maintain the sleep wake cycle. Other options non-pharmacological options for children who refuse or cannot tolerate premedication include clown doctors, low sensory stimulation and hand held video games may also help reduce anxiety during induction of general anesthesia.
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
treatment given to a patient before a (surgical or invasive) medical procedure. These drugs are typically sedative
Sedative
A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
or analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
.
Premedication before chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
for cancer often refers to special drug regimens (usually 2 or more drugs, e.g. dexamethasone
Dexamethasone
Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant...
, diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
and omeprazole
Omeprazole
Omeprazole is a proton pump inhibitor used in the treatment of dyspepsia, peptic ulcer disease , gastroesophageal reflux disease , laryngopharyngeal reflux and Zollinger–Ellison syndrome...
) given to a patient minutes to hours before the chemotherapy to avert side effects or hypersensitivity
Hypersensitivity
Hypersensitivity refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized state of the host. The four-group classification...
reactions (i.e. allergic reactions).
Melatonin
Melatonin
Melatonin , also known chemically as N-acetyl-5-methoxytryptamine, is a naturally occurring compound found in animals, plants, and microbes...
has been found to be effective as a premedication in both adults and children due to its pharmacological properties of hypnotic
Hypnotic
Hypnotic drugs are a class of psychoactives whose primary function is to induce sleep and to be used in the treatment of insomnia and in surgical anesthesia...
, antinociceptive and anticonvulsant
Anticonvulsant
The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
which produce effective anxiolosis and sedation. Unlike midazolam melatonin does not impair psychomotor skills or adversely effect the quality of recovery. It has a faster recovery time compared to midazolam and has a reduced incidence of post-operative excitement and results in a reduction in dose required of propofol
Propofol
Propofol is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. Propofol is also commonly used in veterinary medicine...
and thiopental.
Midazolam
Midazolam
Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...
is effective in children in reducing anxiety associated with separation from parents and induction of anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
. Sufentanil
Sufentanil
Sufentanil is a powerful synthetic opioid analgesic drug, approximately 5 to 10 times more potent than its analog, fentanyl. Sufentanil is marketed for use by specialist centres under different trade names, such as Sufenta and Sufentil...
is also sometimes used as a premedication. Clonidine is becoming increasingly popular as a premedication for children. One drawback of clonidine however, is that it can take up to 45 minutes to take full effect. In children, clonidine
Clonidine
Clonidine is a sympatholytic medication used to treat medical conditions, such as high blood pressure, some pain conditions, ADHD and anxiety/panic disorder...
has been found to be equal to and possibly superior to benzodiazepines as a premedication. It has a more favourable side effect profile. It also reduces the need for an induction
Induction
-General use:* Induction , induction of childbirth* Rite of passage** Introduction of an individual into a body such as the armed forces** Formal introduction of a priest into possession of the position to which she or he has been presented and instituted...
agent. It improves post-operative pain relief, is better at inducing sedation at induction, reduces emergence agitation, reduces shivering and post-operative nausea and vomiting and reduces post-operative delirium associated with sevoflurane
Sevoflurane
Sevoflurane , also called fluoromethyl hexafluoroisopropyl ether, is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used for induction and maintenance of general anesthesia. Together with desflurane, it is replacing isoflurane and halothane in modern anesthesiology...
anaesthesia. Benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s such as midazolam
Midazolam
Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...
are more commonly used due largely to a lack of a marketing effort by the pharmaceutical companies. As a result clonidine is becoming increasingly popular with anesthesiologists. Dexmedetomidine
Dexmedetomidine
Dexmedetomidine is a sedative medication used by intensive care units and anesthetists. It is relatively unique in its ability to provide sedation without causing respiratory depression...
and atypical antipsychotic agents are other premedications which are used particularly in very uncooperative children.
Non-drug interventions for children include playing relaxing music, massages, reducing noise and controlling light in order to maintain the sleep wake cycle. Other options non-pharmacological options for children who refuse or cannot tolerate premedication include clown doctors, low sensory stimulation and hand held video games may also help reduce anxiety during induction of general anesthesia.