Preoperative Medications

Commonly Used Preoperative Medications

  1. Tranquilizers
  2. Sedatives
  3. Analgesics
  4. Anticholinergics
  5. Histamine H2 receptor Antagonist

Pharmakokinetics of Preanesthetic Medication

  • Barbiturates or Tranquilizers/ Sedatives. These medications are commonly used for sedation. However, a visit to the client before the surgery has a more reassuring and calming effect than barbiturates. Hypnotics are usually prescribed the night before the surgery to allay insomnia. Drugs under this classification are:
    1. Pentobarbital (Nembutal)
    2. Secobarbital (Seconal Sodium)
    3. Benzodiazepines as hypnotics such as Flurazepam and Diazepam
  • Opioids. To reduce the amount of general anesthetic required, opioid medications may be prescribed before an operation. Aside from that, these medications can also be given to produce analgesia in patients who have pain prior to surgery. However, it is important to know that doses of analgesic may depress the respiration and cough reflex not to mention the risk of respiratory acidosis and aspiration pneumonitis. Full doses of these medications may result to unpleasant effects such as hypotension, nausea and vomiting, constipation and abdominal distention. Some examples opioid drugs are the following:
    1. Morphine sulfate
    2. Meperidine (Demerol)
  • Anticholinergics. To reduce the respiratory tract secretions and prevent or treat the severe reflex slowing of the heart during anesthesia, anticholinergic drugs should be given. Aside from that, these medications are also administered to counteract secretions that are anticipated with anesthetic induction and intubation. Examples of anticholinergic drugs are:
    1. Atropine
    2. Scopolamine
    3. Glycopyrrolate (Robinul) – often used because Atropine and Scopolamine and other belladonna alkaloids have varying effects on pulse rate. Robinul is a quarternay ammonium compound which is twice as potent as an anti-sialogogue, reducing secretions, and acts three times as long.

Nursing Responsibilities

M – Medications (preanesthetic) should be given from 45 minutes to 75 minutes before anesthesia is begun. Hence, the nurse should administer these medications accurately at the prescribed time. Otherwise, the effects of medications will be worn off or will not have begun to act when anesthesia is started.

E – Encourage the patient to remain in bed with side rails up because the medication will cause lightheadedness and drowsiness.

D – Directly observe the patient for untoward reactions to the medications.

S – Surroundings are kept quiet to promote patient relaxation.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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