1.9 Premedication

What are our goals in premedication:

1. The patient is unconcious and doesn't remember anything.
2. They dont feel any pain
3. The stomach contents dont come out in vomiting during and after anesthesia.
4. The stomach is less acidic itself
5. The stomach contents are cleared by way of the intestines.

So, the first point is the patient is unconcious. Benzodiazapines like Midazolam are used for this purpose.

Next, analgesics like NSAIDS or opoids can be used. If we use a combination of NSAIDS and opoids, lower doses of opoids can be used. We just need to be careful of prescribing COX-2 inhibitors to MI patients.

Now, we dont the patient to aspirate or have vomiting so we can prescribe them Odansetron which is a 5-HT3 receptor blocker.

To make the stomach less acidic, we can use H2 receptor antagonists like ranitidine and famotidine. We can also use PPIs like esomeprazole and omeprazole. Lastly, we can also use antacids ofcourse like Sodium Citrate.

To increase gastric emptying we can give metoclopramide which is a D-2 receptor agonist. This is also known as a prokinetic.

Lastly, if it is a specific procedure, specific premedications may be required like atropine for Awake fiber optic intubation.