The importance of premedication in dentistry for children and adults. Premedication in dentistry
Premedication
This is direct medical preparation with the aim of preventing the adverse effects of anesthesia and surgery itself. She happens to be the final stage preoperative preparation carried out by a nurse. In each specific case, depending on the age and condition of the patient and the type of anesthesia chosen. However, it must necessarily include the following groups of drugs: sedatives (hypnotics, tranquilizers, neuroleptics ), antihistamines, parasympatholytics (M - anticholinergics, atropine), narcotic analgesics (morphine, promedol, omnopon, etc.). 30 minutes after premedication of the patient on a gurney, the nurse takes him to the preoperative room and hands him over to the operating room staff. (to the nurse, sister - anesthetist).
Premedication is necessary for solving several problems:
· decreased emotional arousal.
· neurovegetative stabilization.
· Creation optimal conditions for the action of anesthetics.
· prevention of allergic reactions to agents used in anesthesia.
· decreased secretion of glands.
Basic drugs- for premedication, use the following groups pharmacological substances:
· sleeping pills (barbiturates: etaminal sodium, phenobarbital, radedorm, nozepam, tozepam).
· tranquilizers (diazepam, phenazepam). These drugs have hypnotic, anticonvulsant, hypnotic and amnesic effects, eliminate anxiety and potentiate the effect of anesthetics, increasing the threshold pain sensitivity. All this makes them the leading means of premedication.
· neuroleptics (aminazine, droperidol).
· antihistamines agents (diphenhydramine, suprastin, tavegil).
· narcotic analgesics (promedol, morphine, omnopon). Eliminate pain, have a sedative and hypnotic effect, potentiate the effect of anesthetics.
· anticholinergic drugs (atropine, metacin). The drugs block vagal reflexes and inhibit gland secretion.
There are a huge number of premedication regimens. Their choice is based on the characteristics of each patient, the type of anesthesia to be performed and the extent of the operation, as well as the habits of the anesthesiologist. The following premedication regimens are most widespread.
Before emergency surgery patients are administered a narcotic analgesic and atropine (promedol 2% - 1.0, atropine - 0.01 mg/kg). According to indications, it is possible to administer droperidol or antihistamines.
Before elective surgery The usual premedication regimen includes: The night before - a sleeping pill (phenobarbital - 2 mg/kg) and a tranquilizer (phenazepam - 0.02 mg/kg).
In the morning at 7 am (2-3 hours before surgery) – droperidol (0.07 mg/kg), diazepam (0.14 mg/kg).
30 minutes before surgery - promedol 2% - 1.0, atropine (0.01 mg/kg), diphenhydramine (0.3 mg/kg).
In some cases, an extended premedication regimen is necessary with the administration of drugs over several days and the use of pharmacological substances of other groups.
The importance of nurse competence when preparing a patient for surgery.
It seems to me that currently competence, professionalism nurse sounds more and more often and sometimes gains more weight due to increasing requirements for the quality of services provided by a nurse. This significantly changes the role of the nurse in the health care system and in relationships with patients. The concept of competence and professionalism significantly expands the possibilities for the nurse to participate in the provision of care and subsequent treatment of the patient. She does not act as a simple executor of the doctor’s will, as was before, but collects anamnesis, makes a preliminary diagnosis and subsequently constantly monitors the patient’s behavior, informs the doctor about all changes, and participates in the doctor’s rounds of patients.
LECTURE.
Topic: Surgical intervention (operation).
The role of knowledge about surgical intervention in the work of a nurse
Today, the time has come for major changes in nursing education; the role of the nurse has grown significantly. This is due to the practical need for professional and competent workers who are able not only to carry out doctor’s orders, but also to monitor patients, make decisions at every stage of treatment and care, that is, we need specialists who think and analyze a specific situation who can concentrate medical services and direct them to achieve a quick and high-quality recovery.
1. The concept of emergency, planned and urgent surgery.
Surgical operation (operatio - work, action) called made by a doctor physical impact on tissues and organs, accompanied by their separation to expose the diseased organ for the purpose of treatment or diagnosis, and the subsequent connection of tissues.
The surgical operation consists of three main stages: operational access, operational reception and final.
Online access called the part of the operation that provides the surgeon with exposure of the organ on which the surgical technique is supposed to be performed.
Some accesses have special names - (laparotomy, lumbotomy, thoracotomy, craniotomy, etc.).
Operational reception- the main stage of the operation, during which surgical intervention is carried out on the pathological focus or affected organ: opening the abscess, removing the affected organ or part of it (gallbladder, appendix, stomach, etc.). In some cases, surgical access is also an operative technique, as, for example, when making incisions to drain cellular spaces or trephination of the mastoid process for mastoiditis.
The name of a surgical operation is often formed from the name of an organ or other anatomical structure and the surgical technique. The following terms are used: " -tomiya" - dissection of an organ, opening its lumen (gastrotomy, enterotomy, choledochotomy, etc.); ""Ectomy" - organ removal (appendectomy, gastrectomy, etc.); "-ostomy" - creation of an artificial connection between the organ cavity and external environment, i.e. fistula (tracheostomy, cystostomy, etc.).
An analysis of the current state of this issue indicates that the problem of surgical intervention (operation) is still far from a final solution.
Whether we like it or not, surgery is expressed form aggression, to which the body reacts with a complex complex reactions, entitled - operational stress!!!
Their basis is high level neuroendocrine tension, accompanied by a significant intensification of metabolism, pronounced shifts in hemodynamics, changes in the function of major organs and systems. Let's try to understand the complex picture of reflex and other reactions during surgery. The first most important target of aggressive influences is the central nervous system; disturbances in activity are no less important endocrine system: increased release of catecholamines, corticosteroids, adrenocorticotropic hormone (ACTH), activation of the kallikrein-kinin and renin-angiotensin systems, increased production of antidiuretic and somatotropic hormones. Metabolic changes are the intensification of carbohydrate metabolism (increased glycolysis). This is an incomplete list of reactions operational stress.
Currently, it is difficult to give a clear definition of a surgical operation, but the most general definition is the following: An operation is a mechanical effect on the patient’s tissues and organs, often accompanied by their separation to expose the diseased organ, carried out for the purpose of treatment or diagnosis.
Before performing surgery, it is necessary to decide a large number of questions, and, above all, establish indications and contraindications to the operation.
Establishing indications for surgery is one of the most difficult tasks, the correct solution of which is determined by comparing the expected result of the operation, possible complications with the results of existing non-operative treatment methods. Exist absolute and relative indications for surgery.
2.Relative and absolute readings to surgical treatment.
Determined when only surgery can prevent death. Without surgery, the patient’s life is called into question (with ongoing massive bleeding, perforation of a hollow organ, with obstruction respiratory tract foreign body).
They are determined when the disease does not pose an immediate threat to the patient’s life, but the results of surgical treatment will be better than without surgery. In this case, both conservative and surgical treatment. With relative indications for surgery, discussion of all aspects of diagnosis should be especially thorough; this group of diseases includes (cosmetic, birth defects, deformities that cause mental suffering ). If it is necessary to perform a surgical operation, contraindications to its implementation are also clarified: cardiac, respiratory, vascular insufficiency, myocardial infarction, stroke, hepatic-renal failure, severe metabolic disorders, severe anemia.
Any surgical intervention is forced therapeutic measure , which, however, is not without reason called “surgical aggression.” Surgical trauma, as a rule, leads to the emergence and development in the patient’s body of a number of certain deviations from normal physiological processes, the severity of which depends on the initial condition of the patient, the nature of the underlying and concomitant pathology and on the type of operation performed. Untimely, poor-quality or incomplete correction of these deviations, both during the surgical intervention itself and during postoperative period can lead to the development of various disorders of hemodynamics, the function of external tissue respiration, water and electrolyte balance, acid-base balance, psyche, gastric and intestinal motility, disorders of various functions of the kidneys and liver. Thus, after an operation, especially a long and traumatic one, the body inevitably falls into depression for some time. V pathological condition –(numbness),he seems to freeze , which the famous French surgeon Rene Leriche called “postoperative stress.”
3. History of the development of the doctrine of surgical intervention.
The first work on operative surgery was written by the Italian surgeon and anatomist B. Jeng in 1672. The founder of topographic surgery and anatomy as a science is the brilliant Russian scientist, anatomist and surgeon N. I. Pirogov. For the first time, the department of operative surgery and topographic anatomy appeared on his initiative at the St. Petersburg Military Academy in 1867, the first head of the department was Professor E. I. Bogdanovsky. Topographic anatomy and operative surgery were particularly developed in our country in the works of V. N. Shevkunenko, V. V. Kovanov, A. V. Melnikov, A. V. Vishnevsky and others.
According to N. N. Burdenko, when performing an operation, a surgeon must be guided by three main principles: anatomical accessibility, technical feasibility and physiological permissibility. This involves knowledge of topographic anatomy to make an anatomically sound incision with minimal damage to blood vessels and nerves; operative surgery to select the most rational intervention on the affected organ, physiology to anticipate possible functional disorders during and after surgery.
One of the main methods for studying operative surgery and clinical anatomy is independent work on a corpse, which allows us to examine the relationships of organs and tissues, and also teaches us to recognize anatomical objects by specific local characteristics(depth of location, direction of muscle fibers, relative position of organs, structure of fascia, etc.). But working on a corpse does not provide mastery a necessary condition– stopping bleeding from damaged vessels, which requires surgical interventions on live animals, performed in compliance with all anesthetic requirements. Working on live animals makes it possible to master the skills and techniques of stopping bleeding, the ability to handle living tissue, and assess the condition of the animal after surgery.
IN last years Thanks to the development of computer graphics, it has become possible to simulate three-dimensional images of complex anatomical areas, reproduce them from different angles, at different stages of surgical intervention.
4. Stages of surgical intervention.
The success of surgical intervention to a certain extent depends on the methodology and sequence of all stages of the intervention. There are three successive stages of the operation:
1. Online access;
2. Surgical procedure;
The purpose of this preparation is to reduce the patient’s anxiety level, reduce gland secretion, and enhance the effect of anesthesia drugs. Premedication is carried out with a combination of drugs and in most cases includes a narcotic analgesic, a sedative and an antihistamine.
Premedication most often consists of two stages. In the evening, on the eve of the operation, sleeping pills are prescribed orally in combination with tranquilizers and antihistamines. For particularly excitable patients, these drugs are repeated 2 hours before surgery. In addition, usually all patients are administered anticholinergics and analgesics 30-40 minutes before surgery. If the anesthesia plan does not include cholinergic drugs, then the administration of atropine before surgery can be neglected, however, the anesthesiologist should always have the opportunity to administer it during anesthesia. It must be remembered that if you plan to use cholinergic drugs (succinylcholine, fluorotane) or instrumental irritation of the respiratory tract (tracheal intubation, bronchoscopy) during anesthesia, then there is a risk of bradycardia with a possible decrease in blood pressure and the development of more serious heart rhythm disturbances. In this case, premedication with anticholinergic drugs (atropine, metacin, glycopyrrolate, hyoscine) to block vagal reflexes is mandatory.
Usually premedications for planned operations administered intramuscularly, orally or rectally. The intravenous route of administration is impractical, since the duration of action of the drugs is shorter, and side effects more pronounced. Only for emergency surgical interventions and special indications they are administered intravenously.
Literature
- Guide to practical classes in anesthesiology, resuscitation and intensive care, Edited by N. M. Fedorovsky, 2002 ISBN 5-225-04766-1
- S. A. Sumin, M. V. Rudenko, I. M. Borodinov, Anesthesiology and resuscitation. In 2 volumes. 2010 ISBN 978-5-8948-1806-1
- E. M. Levite, Brief explanatory dictionary of anesthesiologists and resuscitators. GEOTAR-Media 2006 ISBN 5-9704-0211-7;
Wikimedia Foundation. 2010.
See what “Premedication” is in other dictionaries:
Premedication- pre-narcotic pharmacological preparation of the animal, one of the most important methods modern anesthesia... Source: ORDER of the Moscow Government of the First Deputy Prime Minister dated July 19, 2001 N 403 RZP ON ADDITIONAL MEASURES FOR ORGANIZING AND... ... Official terminology
Noun, number of synonyms: 1 preparation (53) ASIS Dictionary of Synonyms. V.N. Trishin. 2013… Synonym dictionary
- (praemedicatio; pre + lat. medicatio prescription of drugs, treatment) application medicines when preparing a patient for anesthesia or local anesthesia in order to increase their effectiveness and prevent complications... Large medical dictionary
I Premedication (lat. prae in front, before + medicatio treatment) special pharmacological preparation of the patient for surgical intervention in order to ensure psycho-emotional comfort, reduce reflex excitability, pain... ... Medical encyclopedia
PRE-MEDICATION- (from Latin prae before, in advance and medicor I treat, help), pharmacological preparation of an animal before surgery to eliminate harmful influence anesthesia... Veterinary encyclopedic dictionary
PRE-MEDICATION- (predication) the administration before surgery of a medicinal substance (usually one of these drugs is an anesthetic) for preparation. In addition, the patient is given some kind of sedative, as well as atropine to reduce secretion... Dictionary in medicine
Premedication- – preliminary (before anesthesia) pharmacological treatment of animals to prevent side effects and ensuring the course of anesthesia and local anesthesia … Glossary of terms on the physiology of farm animals
The preoperative administration of a drug (usually one of these drugs is an anesthetic) for preparation. In addition, the patient is given some kind of sedative, as well as atropine to reduce the secretion of bronchial secretions... ... Medical terms
I Gastroscopy (Greek gastēr stomach + skopeō observe, examine) visual examination method inner surface stomach using special device gastroscope. Gastroscopy is used to diagnose stomach diseases, as well as... ... Medical encyclopedia
- (synonym general anesthesia) state caused by pharmacological agents and characterized by loss of consciousness, suppression of reflex functions and reactions to external stimuli, which makes it possible to perform surgical interventions... ... Medical encyclopedia
- direct drug preparation, aimed at reducing emotional reactions, facilitating the onset of anesthesia and improving its subsequent course, should be individualized mainly in accordance with the age and preoperative condition of the patient.
In recent years, phenathiazine derivatives have become widely used for premedication before surgery, which enhance the effect of drugs and provide a more favorable course of anesthesia (potentiated anesthesia). The most acceptable scheme turned out to be the following. In the evening, the patient is prescribed sibazon (0.1-0.2 g), diprazine (0.05 g), in the morning, 2-3 hours before anesthesia, these drugs are reintroduced to him in combination with chlorpromazine (0.05 g) or without him; 40 minutes or 1 hour before anesthesia, atropine (1 ml of 0.1% solution) and promedol (1-1.5 ml of 2% solution) are injected subcutaneously.
Aminazine, as a very strong sympatholytic, often causes tachycardia and a pronounced decrease in blood pressure, in some cases it is advisable to replace it with mepazine for premedication before surgery. The latter has a less pronounced side effect on cardiovascular system. Weakened, especially elderly patients are more sensitive to the action of neurolytics. In these cases, the commonly used dose of aminazine (50 mg) can continuously reduce arterial pressure and increase venous pressure. It should also be taken into account that phenathiazine derivatives significantly reduce sputum production, thicken it and thereby complicate its suction and active evacuation when coughing.
Deep neuroplegia (pharmacological hibernation), achieved by repeated administration of a neurolytic mixture, in addition to the adverse effect on the state of the cardiovascular system, after surgery for a long time delays the restoration of the cough reflex and active behavior of the patient in general, which is associated with the risk of atelectasis and the development respiratory failure. Experience has shown that in pulmonary patients it is advisable to use phenathiazine derivatives for premedication in moderate doses. At the same time, their ability to potentiate the effect of drugs and inhibit pathological neuroendocrine reactions without pronounced adverse side effects is sufficiently manifested.
It would be wrong to assume that neurolytics play a leading role in premedication during anesthesia. Proper execution anesthesia using muscle relaxants can be achieved good results and with conventional drug preparation with atropine and pantopon.
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The purpose of premedication is to relieve mental stress, sedate the effect, prevent unwanted neurovegetative reactions, reduce salivation, bronchial secretion, as well as enhance the anesthetic and analgesic properties of narcotic substances. This is achieved by using a complex of pharmacological drugs. In particular, tranquilizers, barbiturates, antipsychotics, etc. are effective for mental sedation. Increased activity vagus nerves, as well as a decrease in the secretion of the mucous membranes of the tracheobronchial tree and salivary glands can be obtained with the help of atropine, metacin or scopolamine. Antihistamines are widely used, which have additional sedative effect.
Premedication most often consists of two stages. In the evening, on the eve of the operation, sleeping pills are prescribed orally in combination with tranquilizers and antihistamines. For particularly excitable patients, these drugs are repeated 2 hours before surgery. In addition, all patients are usually administered anticholinergics and analgesics 30-40 minutes before surgery. If the anesthesia plan does not include cholinergic drugs, then the administration of atropine before surgery can be neglected, however, the anesthesiologist should always have the opportunity to administer it during anesthesia. It must be remembered that if you plan to use cholinergic drugs (succinylcholine, fluorotane) or instrumental irritation of the respiratory tract (tracheal intubation, bronchoscopy) during anesthesia, then there is a risk of bradycardia with possible subsequent hypotension and the development of more serious heart rhythm disturbances. In this case, premedication with anticholinergic drugs (atropine, metacin, glycopyrrolate, hyoscine) to block vagal reflexes is mandatory.
Typically, premedications for elective operations are administered intramuscularly, orally or rectally. The intravenous route of administration is impractical, because At the same time, the duration of action of the drugs is shorter, and the side effects are more pronounced. Only for urgent surgical interventions and special indications are they administered intravenously.
M-anticholinergics
Atropine
For premedication, atropine is administered intramuscularly or intravenously at a dose of 0.01-0.02 mg/kg, usual dose for adults it is 0.4-0.6 mg. The anticholinergic properties of atropine make it possible to effectively block vagal reflexes and reduce the secretion of the bronchial tree (in atropine this effect is less pronounced than in glycopyrrolate and hyoscine - the left-handed isomer).
In emergency cases, in the absence of venous access, a standard dose of atropine diluted in 1 ml of physiological solution ensures achievement quick effect with intratracheal administration.
In children, atropine is used in the same doses. To avoid the negative psycho-emotional impact of intramuscular injection on the child, atropine at a dose of 0.02 mg/kg can be given per os 90 minutes before induction. In combination with barbiturates, atropine can also be administered per rectum when used this method induction anesthesia.
It must be remembered that the onset of action of atropine in children of the first year of life with bradycardia is longer, and in order to achieve a rapid positive chronotropic effect, atropine must be administered as early as possible.
There are few contraindications for the use of atropine. These include heart disease, accompanied by persistent tachycardia, individual intolerance, which is quite rare, as well as glaucoma.
Metacin
Metacin has a stronger effect on peripheral cholinergic receptors than atropine, and is also more active in influencing the bronchial muscles and more strongly suppresses the secretion of the salivary and bronchial glands.
Compared with atropine, metacin is more convenient for use, because, having a smaller mydriatic effect, it makes it possible to monitor changes in pupil diameter during the operation. For premedication, metacin is also preferable because the increase in heart rate is less pronounced, and its bronchodilator effect is significantly superior to atropine.
There is evidence of the successful use of metacin for premedication during operations caesarean section. The use of the drug reduces the amplitude, duration and frequency of uterine contractions.
The drug is contraindicated in glaucoma and prostatic hypertrophy.
Scopolamine (hyoscine)
Its effect on peripheral cholinergic receptors is similar to that of atropine. Causes a sedative effect: reduces motor activity, may have hypnotic effect.
It is necessary to take into account the very wide variation in individual sensitivity to scopolamine: relatively often, usual doses do not cause sedation, but agitation, hallucinations and other side effects.
Contraindications are the same as when prescribing atropine.
Glycopyrrolate
Glycopyrrolate is prescribed in doses that are half the dose of atropine. For premedication, 0.005-0.01 mg/kg is administered, the usual dose for adults is 0.2-0.3 mg. Glycopyrrolate for injection is available in the form of a solution containing 0.2 mg/ml (0.02%).
Of all the m-anticholinergic drugs, glycopyrrolate is the most potent secretion inhibitor. salivary glands and glands of the mucous membrane of the respiratory tract. Tachycardia occurs when the drug is administered intravenously, but not intramuscularly. Glycopyrrolate has a longer duration of action than atropine (2-4 hours after intramuscular injection and 30 minutes after intravenous injection).
Narcotic analgesics
Recently, the attitude towards the use of narcotic analgesics for premedication has changed somewhat. The use of these drugs began to be abandoned if the goal is to achieve a sedative effect. This is due to the fact that when using opiates, sedation and euphoria occur only in some patients. But others may experience unwanted dysphoria, nausea, vomiting, hypotension, or respiratory depression to varying degrees. Therefore, opioids are included in premedication when their use may be beneficial. This primarily applies to patients with severe pain syndrome. In addition, the use of opiates can enhance the potentiating effect of premedication.
Antihistamines
Used as premedication to prevent histamine effects in response to stressful situation. This is especially true for patients with a history of allergies ( bronchial asthma, atopic dermatitis etc.). Of the drugs used in anesthesiology, for example, some muscle relaxants (d-tubocurarine, atracurium, mivacurium hydrochloride, etc.), morphine, iodine-containing X-ray contrast drugs, large-molecular compounds (polyglucin, etc.) have a significant histamine-releasing effect. They are also used for premedication due to their sedative, hypnotic, central and peripheral anticholinergic and anti-inflammatory properties.
Diphenhydramine- has a pronounced antihistamine effect, sedative and hypnotic effects. As a component of premedication, 1% solution is used at a dose of 0.1-0.5 mg/kg intravenously and intramuscularly.
Suprastin- a derivative of ethylenediamine, has pronounced antihistamine and also peripheral anticholinergic activity, the sedative effect is less pronounced. Doses - 2% solution - 0.3-0.5 mg/kg intravenously and intramuscularly.
Tavegil- compared to diphenhydramine, it has a more pronounced and long-lasting antihistamine effect and has a moderate sedative effect. Doses - 0.2% solution - 0.03-0.05 mg/kg intramuscularly and intravenously.
Sleeping pills
Phenobarbital (Luminal, Sedonal, Adonal)
Barbiturate long acting 6-8 hours. Depending on the dose, it has a sedative or hypnotic effect, and an anticonvulsant effect. In anesthesiological practice, phenobarbital is prescribed as a hypnotic on the eve of surgery at night in a dose of 0.1-0.2 g orally, in children a single dose of 0.005-0.01 g/kg.
Tranquilizers
Droperidol
Neuroleptic from the butyrophenone group. Neurovegetative inhibition caused by droperidol lasts 3-24 hours. The drug also has a pronounced antiemetic effect. For premedication purposes, use at a dose of 0.05-0.1 mg/kg IM. Standard doses of droperidol (without combination with other drugs) do not cause respiratory depression: on the contrary, the drug stimulates the reaction of the respiratory system to hypoxia. Although patients appear calm and indifferent after premedication with droperidol, they may actually experience feelings of anxiety and fear. Therefore, premedication cannot be limited to the administration of droperidol alone.
Diazepam (Valium, Seduxen, Sibazon, Relanium)
Belongs to the group of benzodiazepines. The dose for premedication is 0.2-0.5 mg/kg. It has a minimal effect on the cardiovascular system and respiration, and has pronounced sedative, anxiolytic and anticonvulsant effects. However, in combination with other depressants or opioids, it can depress the respiratory center. It is one of the most commonly used sedatives in children. Prescribed 30 minutes before surgery at a dose of 0.1-0.3 mg/kg intramuscularly, 0.1-0.25 mg/kg orally, 0.075 mg/kg rectally. As an option for premedication on the table, perhaps intravenous administration immediately before surgery at a dose of 0.1-0.15 mg/kg together with atropine.
Midazolam (dormicum, flormidal)
Midazolam is a water-soluble benzodiazepine with a faster onset and shorter duration of action than diazepam. For premedication it is used at a dose of 0.05-0.15 mg/kg. After intramuscular administration, plasma concentrations reach a peak after 30 minutes. Midazolam is a drug widely used in pediatric anesthesiology. Its use allows you to quickly and effectively calm the child and prevent psycho-emotional stress associated with separation from parents. Oral administration of midazolam at a dose of 0.5-0.75 mg/kg (with cherry syrup) provides sedation and relieves anxiety by 20-30 minutes. After this time, the effectiveness begins to decrease and after 1 hour its effect ends. The intravenous dose for premedication is 0.02-0.06 mg/kg, intramuscular - 0.06-0.08 mg/kg. Combined administration of midazolam is possible - at a dose of 0.1 mg/kg intravenously or intramuscularly and 0.3 mg/kg rectally. More high doses midazolam may cause respiratory depression.
Rohypnol (flunitrazepam)
A benzodiazepine derivative with sedative, hypnotic and anticonvulsant effects. It is administered intramuscularly at a dose of 0.03 mg/kg, intravenously at a dose of 0.015-0.03 mg/kg.
Summary table of drugs used for premedication
| A drug | I/O | ||
|
Atropine 0.1% |
0.01 mg/kg (0.05 ml/year) |
||
|
Metacin 0.1% |
|||
|
Scopolamine 0.05% |
|||
|
Promedol |
0.1 ml/year of life of 1% solution |
||
|
Fentanyl 0.005% |
1-3 µg/kg |
1-3 µg/kg |
“lollipop” - 15 - 20 mcg/kg |
|
Relanium 0.5% |
0.15-0.2 mg/kg (ataralgesia 0.3-0.5 mg/kg) |
||
|
Rohypnol 0.2% |
0.015-0.03 mg/kg i.m., i.v. (induction - same doses) |
||
|
Flormidal 0.5% |
0.15-0.2 mg/kg, effective for 30-40 minutes. |
0.15-0.2 mg/kg |
|
|
Droperidol 0.25% |
0.1-0.15 mg/kg. Induction - 0.2 mg/kg, |
||
|
Diphenhydramine 2% |
0.3-0.5 mg/kg (short-acting T 1/2=1.5 hours, prescribed at 16.00) |
||
|
Suprastin 2% |
0.3-0.5 mg/kg (short-acting T 1/2 = 1.5 hours, prescribed at 16.00) |
0.3-0.5 mg/kg |
|
|
0.3-0.5 mg/kg (average effect T 1/2=6 hours) |
0.03-0.05 mg/kg |
||
| Captopril (for controlled hypotension) |
3.0 mg/kg (1.5 hours before surgery) |
||
| Phenobarbital | 2-3 mg/kg | 2-3 mg/kg | |
| Morphine sulfate | 0.05 mg/kg |
0.1-0.2 mg/kg |
Based on materials:
In medicine, a lot of terms are used that are incomprehensible to humans. Sometimes such names sound intimidating. That is why the patient should become familiar with some terminology before treatment. own development and understanding of everything that happens to him. In this article we'll talk about the concept of “premedication”. This is a term used by surgeons, anesthesiologists and operating room nurses. You will also learn how such manipulation is carried out.
Premedication - what is it?
To begin with, it is worth saying that this term means preparation for the prescribed treatment. Depending on what kind of manipulation will be performed, the method of premedication is selected.
This procedure helps the patient to calm down, relax and tune in to a positive outcome. Also, in some cases, premedication is a salvation from frequently manifested allergic reaction for various drugs.
Where is premedication used?
Most often, this preparation is carried out before surgical interventions of various types. In some cases, premedication is used before surgery with or without anesthesia.
Also, similar preparation is carried out before dental treatment. In some cases, premedication in dentistry helps the doctor do his job as correctly as possible. Thus, preparation is always carried out when treating teeth in young children, the elderly or during complex operations.
The effectiveness of premedication in medicine
Currently, many doctors refuse some points of this manipulation. They explain this by the fact that the administered medicine is not always effective, and a reaction to the drug occurs very often. Sometimes there are situations when the administered drug simply does not have time to act on the human body.
The patient's consent must always be obtained for premedication. Also, before the procedure, it is necessary to clarify whether the person has a tendency to any allergies.
What drugs are used for premedication?
It is worth noting that there are a large number of tools used. If you have an intolerance to one of them, you should definitely warn your doctor. In this case, an alternative drug is selected.
Premedication includes drugs from the following groups: antihistamines, as well as solutions that reduce the contractile activity of muscles and various glands.
So, to sedatives can be attributed:
- "Phenobarbital";
- "Sedonal";
- "Luminal" and other drugs.
The following antihistamines can be used:
- "Tavegil";
- "Suprastin";
- "Diphenhydramine" and others.
Contractile function blockers are most often used:
- "Methacin";
- "Atropine";
- "Glycopyrrolate" and so on.
In some cases, premedication before surgery may require the administration of narcotics that allow the dose of anesthetic to be reduced.
Premedication
The manipulation consists of several main points. There is so-called early premedication. which is carried out the night before (before surgery). Also, preparation must be carried out on the day on which it is scheduled surgery. So, let's consider in detail the method of premedication.
First step: early patient preparation
The evening before set day The operation involves cleansing the intestines. This is done with an enema or by taking laxatives. Such preparation is necessary in the case when the surgical intervention will be carried out in the same place. If the operation requires affecting others, then this stage can be avoided.
Also in the evening the patient is offered sleeping pill long-acting. Every person experiences excitement and fear of surgical intervention. That is why this stage is so necessary for the patient.
Second step: premedication on the day of surgery
You will be given additional premedication several hours before surgery begins. "Atropine" and other blockers are used precisely at this stage. They are necessary if the device will be used for artificial ventilation lungs, or when treatment is carried out on a muscular organ. So, often before the study reproductive organ In women, large doses of this substance are used.
You will also be injected. It will help avoid an allergic reaction to the anesthetic and various medicinal substances in blood. In addition, it is proposed to take sedative. Thanks to its action, the patient will be able to relax and cope with mental stress. The main condition for preparing for surgery is the refusal of food and water.
Third step: premedication on the operating table
There is also so-called anesthesia premedication. On at this stage the patient is administered drugs that help to fall into euphoria and enhance the effect of the anesthetic. At possible allergies For painkillers, this point must be taken into account.
This manipulation is carried out at a time when the person is already on the operating table. The most harmless assistant to anesthesia is oxygen. It helps a person quickly switch off and not hear everything that is happening around. Also at this stage can be used the following drugs: “Droperidol”, “Valium”, “Morphine sulfate” and other drugs.
Fourth step: anesthesia
After the premedication is completed, the anesthesiologist can begin his work. The doctor prescribes an individual dose of a particular substance to each patient. This takes into account height, weight, age, area of work and the presence of premedication.
In the future, the doctor performing the operation can begin surgical treatment.
Features of premedication that need to be taken into account
Most drugs that are used during preparation for surgical intervention, administered orally or rectally. This method is explained by the fact that the medicine lasts longer and does not react directly with anesthetics. Also, some drugs can be used by intramuscular administration.
When directly entering the bloodstream, drugs quickly lose their effectiveness and are eliminated from the body. It is worth noting that, depending on gender, age and weight, an individual dosage of premedication agents should be selected. Otherwise, the substance may simply not work, or an overdose may occur.
Summing up and a short conclusion
If you are prescribed surgical treatment, then it is worth knowing what premedication is, what drugs are used to carry it out, and why this manipulation is needed at all. Do not refuse this procedure without permission. If you are confused by any point, consult your doctor. If necessary, the doctor can change some medications at your request.
Premedication will help you get ready for surgery and cope with psychological stress. Treat yourself correctly and always be healthy!
