Editing Premedication

{{distinguish|Premeditation}}

[[File:Midazolam.JPG | thumb | right | alt=Two bottles of Midazolam, one being 1 mg/ml and one being 5 mg/ml | Midazolam is a premedication used for pre-surgical sedation]]
'''Premedication''' is using [[pharmaceutical drug|medication]] before some other [[therapy]] (usually [[surgery]] or [[chemotherapy]]) to prepare for that forthcoming therapy. Typical examples include premedicating with a [[sedative]] or [[analgesic]] before surgery; using [[preventive healthcare|prophylactic (preventive)]] antibiotics before surgery; and using [[antiemetic]]s or [[antihistamine]]s before chemotherapy.

Premedication before chemotherapy for cancer often consists of drug regimens (usually 2  or more drugs, e.g. [[dexamethasone]], [[diphenhydramine]] and [[omeprazole]]) given to a patient minutes to hours before the chemotherapy to avert side effects or  [[hypersensitivity]] reactions (i.e. allergic reactions).{{cn|date=February 2022}}

[[Melatonin]] has been found to be effective as a premedication in both adults and children due to its pharmacological properties of [[hypnotic]], [[antinociceptive]] and [[anticonvulsant]] which produce effective [[anxiolysis]] and sedation. Unlike midazolam, melatonin does not impair psychomotor skills or adversely affect the quality of recovery. It has a faster recovery time compared to midazolam and has a reduced incidence of post-operative excitement and results in a reduction in dose required of [[propofol]] and [[thiopental]].<ref>{{Cite journal | last1 = Naguib | first1 = M. | last2 = Gottumukkala | first2 = V. | last3 = Goldstein | first3 = PA. | title = Melatonin and anesthesia: a clinical perspective. | journal = J Pineal Res | volume = 42 | issue = 1 | pages = 12–21 |date=Jan 2007 | doi = 10.1111/j.1600-079X.2006.00384.x | pmid = 17198534 | doi-access = free }}</ref>

[[Midazolam]] is effective in children in reducing anxiety associated with separation from parents and induction of [[anesthesia]].<ref>{{Cite journal | last1 = Cox | first1 = RG. | last2 = Nemish | first2 = U. | last3 = Ewen | first3 = A. | last4 = Crowe | first4 = MJ. | title = Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children? | journal = Can J Anaesth | volume = 53 | issue = 12 | pages = 1213–9 |date=Dec 2006 | doi =  10.1007/BF03021583| pmid = 17142656 | doi-access = free }}</ref> [[Sufentanil]] is also sometimes used as a premedication. [[Clonidine]] is becoming increasingly popular as a premedication for children. One drawback of clonidine is that it can take up to 45 minutes to take full effect.<ref name="Rosenbaum-2009">{{Cite journal  | last1 = Rosenbaum | first1 = A. | last2 = Kain | first2 = ZN. | last3 = Larsson | first3 = P. | last4 = Lönnqvist | first4 = PA. | last5 = Wolf | first5 = AR. | title = The place of premedication in pediatric practice. | journal = Paediatr Anaesth | volume = 19 | issue = 9 | pages = 817–28 |date=Sep 2009 | doi = 10.1111/j.1460-9592.2009.03114.x | pmid = 19691689 | s2cid = 7743205 }}</ref> In children, clonidine has been found to be equal to and possibly superior to benzodiazepines as a premedication. It has a more favourable side effect profile. It also reduces the need for an [[General anesthesia#Induction|induction]] agent. It improves post-operative pain relief, is better at inducing sedation at induction, reduces [[agitated emergence]], reduces shivering and [[post-operative nausea and vomiting]] and reduces post-operative delirium associated with [[sevoflurane]] anaesthesia. [[Benzodiazepine]]s such as [[midazolam]] are more commonly used due largely to a lack of a marketing effort by the pharmaceutical companies. As a result, clonidine is becoming increasingly popular with [[anesthesiologists]].<ref>{{Cite journal | last1 = Bergendahl | first1 = H. | last2 = Lönnqvist | first2 = PA. | last3 = Eksborg | first3 = S. | title = Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication. | url = http://www3.interscience.wiley.com/cgi-bin/fulltext/118557949/HTMLSTART | archive-url = https://archive.today/20121216135407/http://www3.interscience.wiley.com/cgi-bin/fulltext/118557949/HTMLSTART | url-status = dead | archive-date = 2012-12-16 | journal = Acta Anaesthesiol Scand | volume = 50 | issue = 2 | pages = 135–43 |date=Feb 2006 | doi = 10.1111/j.1399-6576.2006.00940.x | pmid = 16430532 | s2cid = 25797363 | doi-access = free }}</ref><ref>{{Cite journal | last1 = Dahmani | first1 = S. | last2 = Brasher | first2 = C. | last3 = Stany | first3 = I. | last4 = Golmard | first4 = J. | last5 = Skhiri | first5 = A. | last6 = Bruneau | first6 = B. | last7 = Nivoche | first7 = Y. | last8 = Constant | first8 = I. | last9 = Murat | first9 = I. | title = Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies | journal = Acta Anaesthesiol Scand |date=Jan 2010 | doi = 10.1111/j.1399-6576.2009.02207.x | pmid = 20085541 | volume = 54 | issue = 4 | pages = 397–402  | s2cid = 205430269 | doi-access = free }}</ref> [[Dexmedetomidine]] and [[atypical antipsychotic agents]] are other premedications which are used particularly in very uncooperative children.<ref>{{Cite journal | last1 = Bozkurt | first1 = P. | title = Premedication of the pediatric patient - anesthesia for the uncooperative child | journal = Curr Opin Anesthesiol | volume = 20 | issue = 3 | pages = 211–5 |date=Jun 2007 | doi = 10.1097/ACO.0b013e328105e0dd | pmid = 17479023 | s2cid = 25446995 }}</ref>

Non-drug interventions for children include playing relaxing music, massages, reducing noise and controlling light to maintain the sleep wake cycle.<ref name="Mencía-2007">{{Cite journal | last1 = Mencía | first1 = SB. | last2 = López-Herce | first2 = JC. | last3 = Freddi | first3 = N. | title = Analgesia and sedation in children: practical approach for the most frequent situations | journal = J Pediatr (Rio J) | volume = 83 | issue = 2 Suppl | pages = S71–82 |date=May 2007 | doi = 10.2223/JPED.1625 | pmid = 17530139 | doi-access = free }}</ref> Other non-pharmacological options for children who refuse or cannot tolerate premedication include clown doctors; low sensory stimulation and hand-held video games may also help reduce anxiety during induction of general anesthesia.<ref>{{Cite journal|last1=Manyande|first1=Anne|last2=Cyna|first2=Allan M.|last3=Yip|first3=Peggy|last4=Chooi|first4=Cheryl|last5=Middleton|first5=Philippa|date=2015-07-14|title=Non-pharmacological interventions for assisting the induction of anaesthesia in children|journal=The Cochrane Database of Systematic Reviews|volume=2015 |issue=7|pages=CD006447|doi=10.1002/14651858.CD006447.pub3|issn=1469-493X|pmid=26171895|pmc=8935979 |url=https://repository.uwl.ac.uk/id/eprint/1566/1/ACE%20113%20published%20-%20Non-pharmacological%20interventions%20for%20assisting%20the%20induction%20of%20anaesthesia%20in%20children%202015.pdf}}</ref>

==References==
{{Reflist}}

[[Category:Drugs]]
[[Category:Anesthesia]]