Premedication
The premedication is the administration of drugs before a medical procedure. These can be drugs to suppress the production of saliva during surgery on the respiratory tract, or drugs for the gastrointestinal tract during surgery there. Before exposure to allergens , antiallergic drugs can be given, and when the thyroid gland is stressed, drugs to block it. The administration of antibiotics to patients at risk for endocarditis is equally important .
Premedication can also take place before anesthesia ( narcosis ) , for example . This is how the London anesthesiologist Michael D. Nosworthy (1902–1980) defined in his 1935 book The theory and practice of anaesthesia : 'The term' premedication 'covers the use of any drug which is prescribed beforehand to smooth the subsequent anesthesia'. For example, scopolamine used to be administered to reduce hypersalivation and to reduce ether pneumonia. Premedication also served to reduce the excitation stage during the earlier usual induction with the mold mask . Due to the decline in the introduction of anesthesia with ether , the anesthetist nowadays sets different goals for premedication. For example, he will prescribe medication for patients with gastroesophageal reflux , or a beta blocker for those at risk of cardiac disease . He will also prescribe a therapy scheme for the treatment of diabetes mellitus .
This premedication is by anesthesiologists in preoperative visit , which is why earlier in the jargon are prescribed was also called Prämedikationsvisite. The equation of the term premedication with the pre-anesthetic visit at that time is historically and semantically a curiosity, since the preoperative visit is neither limited to the arrangement of a premedication nor arose from it.
In selected patients, the anesthetist may also consider preoperative sedation to be necessary after weighing the risks . The aim of this premedication is that the patient comes to the operating theater without fear, relaxed but cooperative. Therefore it can be necessary with known difficult children. For anxious inpatients, this premedication can start on the evening before the operation so that the patient can sleep well the night before the operation. Nowadays, oral premedication before unpleasant procedures with the venous catheter in place can be replaced by venous premedication. This is easier to control, reduces the risks and reduces the logistical and personnel effort. A sedating premedicated patient requires constant close monitoring with a pulse oximeter and is no longer considered to be able to give consent.
For oral sedative premedication before anesthesia, benzodiazepines (e.g. clorazepate , delorazepam , diazepam , lorazepam , midazolam or oxazepam ) are almost exclusively used today. For inpatients, they can be administered the evening before and in the morning of the operation, for outpatients only on the morning of the day of the operation.
Intramuscular premedication, which was very common in the past, especially with children, with a drug mixture is hardly used today. A typical mixture for intramuscular premedication consisted, for example, of the opioid pethidine , the low-potency neuroleptic promethazine and the vagolytic atropine . Nowadays, children who have to be inserted with a cannula are often given a mixture of local anesthetics such as EMLA, an ointment with the active ingredients lidocaine and prilocaine .
Rectal premedication with barbiturates is rarely used . Instead, rectal or nasal application of the benzodiazepine midazolam is now used in children, when oral premedication is not possible .
