Premedication Before Surgery

In the perioperative world, “premedication” refers to pharmacologic therapy administered to relieve anxiety, provide light sedation, and even create some degree of antegrade amnesia prior to an operation. While there are many styles, I’m certainly a proponent of “verbal anxiolysis” by using humor, reassurance, and crystal clear language to paint the picture of what patients can expect not only in the OR but immediately afterwards.

We do these procedures and anesthetics every day… not our patients. Fear and anxiety is often driven by the “unknown.” Are these noises okay? What’s that blue number? Am I supposed to feel this arterial line going in? Why are you doing this to me while I’m awake? By walking patients (and their families/caretakers) through each step and providing them with prompts BEFORE anything remotely uncomfortable, I feel like I’m able to give my patients back some degree of control in their care (and alleviate some anxiety by doing so).

That being said, pharmacologic therapy certainly has a role especially if I’m going to be performing a procedure pre-operatively like a peripheral nerve block, thoracic epidural, arterial line, etc. Midazolam and narcotics like fentanyl or sufentanil are my preferred agents, but if I’m planning on a total intravenous anesthetic (TIVA) for the case, I may incorporate some of my TIVA-cocktail as part of the premedication (ie, dexmedetomidine or ketamine). While I’m performing the procedure, I’ll connect a pulse oximeter to keep an eye on the patient’s oxyhemoglobin saturation and heart rate.

Drop me a comment below with questions! 🙂

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