PERIOPERATIVE

CARE
Preoperative
Preoperative medications
Premedication is the administration of
medication before anesthesia

Premedication is used to prepare the patient

for anesthesia and to help provide optimal
conditions for surgery.

The choice of drug(s) used for premedication

depends on the procedure, patient and
anaesthetic
It includes:
1. Reduction of anxiety and pain.
-Benzodiazepines are ideal agents to reduce anxiety (given 1-
2 hours before surgery)
-Relieving anxiety and sedation may also be achieved by
morphine, pethidine and fentanyl citrate

2. Promotion of amnesia.
-reducing risk of awareness during surgery
-most effective agents are lorazepam and midazolam.

3. Reduction of secretions.
-atropine (reduce acid production)
- Hyoscine ( strong sedative amnesic and anti-
salivation properties)
4. Reduction of volume and pH of gastric contents (to
avoid Mendelson's syndrome)
Mendelson's syndrome is chemical pneumonitis caused by
aspiration during anaesthesia
-Antacids ( Ranitidine, zantac, famotidine )- neutralizes
acid in the stomach

5. Reduction of postoperative nausea and vomiting

- Are used either to reduce the emetic effects of
anesthetic agents
ex. antihistamines, butyrophenones, hyoscine ) or to
enhance gastric emptying (metoclopramide).
6. Enhancing the hypnotic effects of general anesthesia.
-Barbiturates (class of sedative and sleep-inducing
drugs)- calm the patient and induce sleep derived
from barbituric acid

7. Reduction of vagal reflexes to intubation

-succinylcholine (Anectine)-neuromuscular blocking
agent
-Rocuronium (Zemuron)
Intraoperative
Anesthetic agents
1. General- the entire body, including the brain are put into a
state of deep sleep

2. Regional anesthesia- injection near a cluster of nerves to

numb the area of the body that requires surgery.
-may remain awake, or may be given a
sedative to help you relax
3. Sedation anesthesia- deeply relaxed
- may be sleeping, but are able to be
awakened easily and can respond to questions
or physical stimulation
 4. Local anesthesia -anesthesiologist injects medicine into the
tissue to numb just the specific location of the body
requiring minor surgery

5. Spinal anesthesia (or spinal anesthesia), also called spinal

block, subarachnoid block (SAB), intradural block and
intrathecal block
is a form of regional anaesthesia involving
injection of a local anaesthetic into the subarachnoid space
ex. Hernia
Hip replacement
Knee replacement
 6. Epidural analgesia
-pain medications are injected through a catheter
inserted into the epidural space within the spinal canal but
outside the spinal fluid.

is often used for: labor and delivery

cesarean section
major abdominal surgery.
 7.Blocks - Nerve blocks are used for pain treatment and
management.
ex.
1. Therapeutic nerve blocks are used to treat
painful conditions
2. Diagnostic nerve blocks are used to determine
sources of pain
3. Prognostic nerve blocks predict the outcomes
of given treatments
4. Preemptive nerve blocks are meant to
prevent subsequent pain from a procedure
that can cause problems.. e. g phantom limb
pain
5. Nerve blocks can be used, in some cases, to
avoid surgery
Post-operative
 1. Opioid analgesics- moderate to severe pain

2. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Traditional NSAIDs such as ibuprofen (Advil,
Motrin IB)

3. Antipyretics -Fever and mild pain

4. antibiotics - antimicrobial drug used in the treatment and

prevention of bacterial infection