The Utility of Various Pre-anesthetic Medications Based on Type of General Anesthesia

Page: [171 - 176] Pages: 6

  • * (Excluding Mailing and Handling)

Abstract

Background: Premedication is used prior to surgery to reduce the adverse effects that might result from general anesthesia.

Objective: This study was performed to examine the types and utility of various pre-anesthetic agents in 100 patients aged between 3 and 60 years who were admitted to Baladrooz General Hospital for different surgical operations during February (winter) and April (spring) 2021.

Methods: A total of 62 patients received isoflurane, and 7 patients received sevoflurane, both by inhalational administration. The other 31 subjects were administered Marcaine (bupivacaine) by spinal anesthesia.

Results: In this study, eight types of pre-anesthetic medication were administered prior to anesthesia, as follows: hydrocortisone (35 patients), metoclopramide (25 patients), atropine (13 patients), dexamethasone (12 patients), midazolam (7 patients), morphine (3 patients), ephedrine (3 patients), and fentanyl (2 patients).

The most commonly used pre-anesthetic agent administered with isoflurane was hydrocortisone (37 patients), while the least used were fentanyl and morphine, which were administered to 3 patients each. Hydrocortisone was the premedication most often used (6 patients) with isoflurane, followed by dexamethasone, midazolam, and metoclopramide (5, 2, and 2 patients, respectively). The preanesthetic agent used most often with sevoflurane was hydrocortisone (6 patients), followed by dexamethasone (5 patients) and metoclopramide and midazolam (2 patients each). The premedication most commonly used with bupivacaine was metoclopramide (25 patients), while the least used was midazolam (2 patients).

Conclusion: The study showed that several different pre-anesthetic drugs were used prior to anesthetic agents, which suggests that the selection of a pre-anesthetic drug depends on the risks that might be incurred when using a specific anesthetic drug.

Keywords: Pre-anesthetic drugs, general anesthesia, surgical operations, hydrocortisone, metoclopramide, atropine.

Graphical Abstract

[1]
Sheen MJ, Chang F-L, Ho S-T. Anesthetic premedication: New horizons of an old practice. Acta Anaesthesiol Taiwan 2014; 52(3): 134-42.
[http://dx.doi.org/10.1016/j.aat.2014.08.001] [PMID: 25304317]
[2]
Maurice-Szamburski A, Auquier P, Viarre-Oreal V, et al. Effect of sedative premedication on patient experience after general anesthesia: A randomized clinical trial. JAMA 2015; 313(9): 916-25.
[http://dx.doi.org/10.1001/jama.2015.1108] [PMID: 25734733]
[3]
Dave NM. Premedication and induction of anaesthesia in paediatric patients. Indian J Anaesth 2019; 63(9): 713-20.
[http://dx.doi.org/10.4103/ija.IJA_491_19] [PMID: 31571684]
[4]
Haxholdt BF. Pre-anesthetic medication with new drugs: A comparative study of the clinical effects of N-methylpiperidyl-3-methylphenthiazin, chlorpromazin, morphinescopolamine, resrpine and placebo. Br J Anaesth 1958; 30(5): 226-32.
[http://dx.doi.org/10.1093/bja/30.5.226] [PMID: 13536202]
[5]
Strom S. Preoperative evaluation, premedication, and induction of anesthesia in infants and children. Curr Opin Anaesthesiol 2012; 25(3): 321-5.
[http://dx.doi.org/10.1097/ACO.0b013e3283530e0d] [PMID: 22488124]
[6]
Ghazal EA, Vadi MG, Mason LJ, Coté CJ. 4 - Preoperative Evaluation, Premedication, and Induction of Anesthesia, in.A Practice of Anesthesia for Infants and Children. 6th ed. Philadelphia: Elsevier 2019; pp. 35-68.
[http://dx.doi.org/10.1016/B978-0-323-42974-0.00004-5]
[7]
Fortier MA, Kain ZN. Treating perioperative anxiety and pain in children: A tailored and innovative approach. Paediatr Anaesth 2015; 25(1): 27-35.
[http://dx.doi.org/10.1111/pan.12546] [PMID: 25266082]
[8]
Kulkarni M, Patil A. A cross-sectional pharmacoepidemiological study of the utilization pattern of pre-anesthetic medications in major surgical procedures in a tertiary care hospital. Cureus 2017; 9(6): e1344-54.
[http://dx.doi.org/10.7759/cureus.1344] [PMID: 28713660]
[9]
Ghazal EA, Vadi MG, Mason LJ, Coté CJ. Preoperative evaluation, premedication, and induction of anesthesia. In: Cote CJ, Anderson BJ, Lerman J, Eds. A Practice of Anesthesia for Infants and Children. Amsterdam, Netherlands: Elsevier 2019; pp. 35-68.
[http://dx.doi.org/10.1016/B978-0-323-42974-0.00004-5]
[10]
Heuberger JAAC, Cohen Tervaert JM, Schepers FML, et al. Erythropoietin doping in cycling: Lack of evidence for efficacy and a negative risk-benefit. Br J Clin Pharmacol 2013; 75(6): 1406-21.
[http://dx.doi.org/10.1111/bcp.12034] [PMID: 23216370]
[11]
Miller AL, Theodore D, Widrich J. Inhalational Anesthetic StatPearls. Treasure Island, FL: StatPearls Publishing LLC 2021.
[12]
Sellers WFS. Inhaled and intravenous treatment in acute severe and life-threatening asthma. Br J Anaesth 2013; 110(2): 183-90.
[http://dx.doi.org/10.1093/bja/aes444] [PMID: 23234642]
[13]
Murray DJ, Forbes RB, Dillman JB, Mahoney LT, Dull DL. Haemodynamic effects of atropine during halothane or isoflurane anaesthesia in infants and small children. Can J Anaesth 1989; 36(3 Pt 1): 295-300.
[http://dx.doi.org/10.1007/BF03010768] [PMID: 2720867]
[14]
Pratt O, Ginnutt C. What is the autonomic nervous system? Basic pharmacology, Part II 2006.
[15]
Wallenborn J, Rudolph C, Gelbrich G, et al. Metoclopramide and dexamethasone in prevention of postoperative nausea and vomiting after inhalational anaesthesia. Anasthesiol Intensivmed Notfallmed Schmerzther 2003; 38(11): 695-704.
[PMID: 14600859]
[16]
Carlisle J, Stevenson CA. WITHDRAWN: Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2017; 7(7): CD004125.
[PMID: 28715610]
[17]
Shoroghi M, Arbabi S, Farahbakhsh F, Sheikhvatan M, Abbasi A. Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment. A double-blinded randomized placebo-controlled trial. Acta Cir Bras 2011; 26(4): 303-9.
[http://dx.doi.org/10.1590/S0102-86502011000400010] [PMID: 21808844]
[18]
Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain management in the emergency department: A review article on options and methods. Adv J Emerg Med 2018; 2(4): e45.
[PMID: 31172108]
[19]
Saraswat V. Effects of anaesthesia techniques and drugs on pulmonary function. Indian J Anaesth 2015; 59(9): 557-64.
[http://dx.doi.org/10.4103/0019-5049.165850] [PMID: 26556914]
[20]
Tautz TJ, Urwyler A, Antognini JF, Riou B. Case scenario: Increased end-tidal carbon dioxide: A diagnostic dilemma. Anesthesiology 2010; 112(2): 440-6.
[http://dx.doi.org/10.1097/ALN.0b013e3181ca7c38] [PMID: 20068452]
[21]
Demirhan A, Tekelioglu YU, Akkaya A, et al. Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia. Afr Health Sci 2013; 13(2): 475-82.
[http://dx.doi.org/10.4314/ahs.v13i2.39] [PMID: 24235952]
[22]
Wang J, Sun P, Liang P. Neuropsychopharmacological effects of midazolam on the human brain. Brain Inform 2020; 7(1): 15.
[http://dx.doi.org/10.1186/s40708-020-00116-y] [PMID: 33170396]
[23]
Prommer E. Midazolam: An essential palliative care drug. Palliative care and social practice 2020; 14: 1-12.
[24]
Tullberg S. Metoclopramide, in xPharm: The Comprehensive Pharmacology Reference. New York: Elsevier 2007; pp. 1-6.
[25]
Paganelli MA, Popescu GK. Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses. J Neurosci 2015; 35(2): 831-42.
[http://dx.doi.org/10.1523/JNEUROSCI.3578-14.2015] [PMID: 25589775]
[26]
Jelting Y, Klein C, Harlander T, Eberhart L, Roewer N, Kranke P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: Challenges and solutions. Local Reg Anesth 2017; 10: 83-90.
[http://dx.doi.org/10.2147/LRA.S111459] [PMID: 28860857]
[27]
Becker DE. Basic and clinical pharmacology of glucocorticosteroids. Anesth Prog 2013; 60(1): 25-31.
[http://dx.doi.org/10.2344/0003-3006-60.1.25] [PMID: 23506281]
[28]
Elmawgood AA, Rashwan S, Rashwan D. Efficacy of prophylactic use of hydrocortisone and low dose ketamine for prevention of shivering during spinal anesthesia. Egypt J Anaesth 2012; 28(3): 217-21.
[http://dx.doi.org/10.1016/j.egja.2012.04.002]
[29]
Weinberger MM. Use of ephedrine in bronchodilator therapy. Pediatr Clin North Am 1975; 22(1): 121-7.
[http://dx.doi.org/10.1016/S0031-3955(16)33107-8] [PMID: 1096043]
[30]
Laitinen LA, Empey DW, Bye C, Britton MG, McDonnell K, Hughes DT. A comparison of the bronchodilator action of pseudoephedrine and ephedrine in patients with reversible airway obstruction. Eur J Clin Pharmacol 1982; 23(2): 107-9.
[http://dx.doi.org/10.1007/BF00545963] [PMID: 7140799]
[31]
Braga Ade F, Frias JAF, Braga FSS, Pereira RIC, Titotto SMMC. Spinal anesthesia for elective ceasarean section: Use of different doses of hyperbaric bupivacaine associated with morphine and clonidine. Acta Cir Bras 2013; 28(1): 26-32.
[http://dx.doi.org/10.1590/S0102-86502013000100005] [PMID: 23338110]