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Management of anesthesia begins with

preoperative psychological preparation of the
patient and administration of a drug or drugs
selected to elicit specific pharmacologic
This initial psychological and pharmacologic
component of anesthetic management is
referred to as “Premedication”
Psychological Premedication is provided by
the anesthesiologist’s preoperative visit and
interview with the patient and family

Pharmacological Premedication is
administration of drugs orally or
intramuscularly 1 to 2 hours before the
anticipated induction of anesthesia
Goals for Pharmacologic Premedication
Primary Goals for Pharmacologic
2. Anxiety relief ( anxiolysis)
3. Sedation
4. Analgesia
5. Amnesia
6. Antisalogogoue effect
7. Increase in gastric fluid pH
8. Decreased in gastric fluid volume
9. Attenuation of sympathetic nervous system
reflex responses
10. Decrease in anesthetic requirements
11. Prophylaxis against allergic reactions
• Secondary Goals for Pharmacologic Premedication
2. Decrease in cardiac vagal activity …anticholinergic
(atropine) just before the time of anticipated need
3. Facilitation of induction of anesthesia …. Not
necessary in view of availability of potent intravenous
induction drugs
Postoperative analgesia… better achieved with opioids
or the intravenous injection of an opioids just before
the time of anticipated need ( preemptive analgesia )
3. Prevention of postoperative nausea and vomiting …
intravenous injection of an antiemetic ( droperidol ,
ondansetron) just before the time of anticipated need
Drugs and Doses used for Pharmacologic Premedication
before Inaction of Anesthesia

Classification Drug Typical Adult Route of

(Dose (mg
Barbiturates Secobarbital 50-150 PO,IM
Pentobarbital 50-150 PO,IM
Opioids Morphine 5-15 IM
Meperidine 50-100 IM
Benzodiazepine Midazolam 2.5-5 IM
Diazepam 5-10 PO,IM
Lorazepam 2-4 PO,IM
Temazepam 15-30 PO
Antihistamines Diphenhydramine 25-75 PO,IM
Promethazine 25-75 IM

Alpha-2 agonists Clonidine 0.3-0.4 PO

Dexmedetomidine 0.4-0.5 IV

Anticholinergics Atropine 0.3-0.6 IM

Scopolamine 0.3-0.6 IM
Glycopyrrolate 0.2-0.3 IM
H2 antagonists Cimetidine 300 PO,IM,IV
Ranitidine 150 PO,IM
Famotidine 20-40 PO
Antacids Particulate ml 15-30 PO
Nonparticulate 10-20ml PO

Stimulates of metoclopramide 10-20 PO,IM,IV

gastric motility
Anesthetic Drugs

General anesthesia Supportive drugs Local analgesics

General anesthesia

Inhalational agents IV agents Muscle Relaxants

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