Mixin Classes in Odoo 17 How to Extend Models Using Mixin Classes
Premedication mgmc (1)
1. PREMEDICATION
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu),
Dip. Diab. DCA, Dip. Software statistics
PhD (physio)
Mahatma Gandhi medical college and research institute –
Puducherry – India
2. WHY WE NEED ??
Sedation and anxiolysis
Analgesia and amnesia
Antisialagogue effect
To maintain hemodynamic stability, including
decrease in autonomic response
To prevent and/or minimize the impact of
aspiration
To decrease postoperative nausea and vomiting
Prophylaxis against allergic reaction
VAAAAAS--pneumonic
3. BEFORE WE WRITE !!
Patient age and weight
Physical status
Levels of anxiety and pain
Previous history of drug use or abuse
History of postoperative nausea, vomiting or
motion sickness
Drug allergies
Elective or emergency surgery
Inpatient or outpatient status
Familiarity with drugs
5. WHEN TO ADMINISTER
Drug , route
Choose so that the peak action time is at
their entry into the operating room
6. BENZODIAZEPINES
Sedation
Anxiolysis
No nausea
but
No analgesia
Excess sedation, paradoxical agitation
especially in Old age ??
oral, IV, spray midaz,
oral diazepam .Lorazepam
Sublingual – midaz can be used
10. OPIOIDS ++ AND ---
Where we need analgesia
Ortho
IV and arterial lines
Decrease anaesthetic requirements
But respiratory depression, Sphincter of
Oddi, PONV – problems
12. REDUCTION IN VAGAL RELEXES (CLINICAL SCENARIO)
Traction of ocular muscles
Second dose of scoline
Propofol, fentanyl, halothane
Atropine and glyco pyrollate
But – problems
central anticholinergic syndrome,
tachycardia, blocking sweat glands ??
13. ADRENERGIC AGONISTS
Clonidine
in doses of 2.5 to 5 µg/kg – oral
sedation,
prevent hypertension and tachycardia from
endotracheal intubation and surgical
stimulation
Hypotensive anaesthesia
IM,IV – OK
14. ASPIRATION
pH of 2.5 and a volume of 25 ml
Danger zone
Ranitidine , famotidine, nizatidine are H2
blockers
15. ANTACIDS
Nonparticulate antacid 0.3 M sodium citrate
Colloid antacid suspension
Immediate , no lag time
Increase volume,
with food ??
16. OMEPRAZOLE
Intravenous doses of 40 mg 30 minutes
before induction have been used.
Oral doses of 40 to 80 mg must be given 2 to
4 hours before surgery to be effective
Other PPIs – used
17. GASTROKINETIC AGENTS
Gastrokinetic agents are useful because of
their effectiveness in reducing gastric fluid
volume.
Metoclopramide
Increased gastric emptying – but no
guaranteed emptiness of stomach
Antiemetic
No change in pH
18. AT THE END ?? ANTIEMESIS
Many anesthesiologists prefer not to
administer antiemetics as part of a
preoperative regimen, but believe that
antiemetics should be administered
intravenously just before they are needed at
the conclusion of surgery.
Droperidol, metoclopramide, ondansetron,
and dexamethasone
20. THEY ARE NOT PREMEDICANTS IN STRICT
SENSE BUT WE USE
Steroids
Antibiotics
Insulin
Methadone
21. ANTIBIOTICS
Infective endocarditis prophylaxis
Probable contamination
Immunosupressed
Diabetic
On steroids
Cephalosporin –ok around one hour prior
Vancomycin 2 hours prior
Tourniquet !! Give antibiotics before
inflation
22. STEROIDS
consider treatment in any patient who has
received corticosteroid therapy for at least 1
month in the past 6 to 12 months.
80 mg 6 hourly
Why ??
300 mg / day – maximal daily production to
stress
23. OTHER PREMEDICANTS TO CONTINUE
Beta blockers
Thyroxine
Statins
And the other dugs he /she is taking for
systemic illness
24. DEEP VEIN THROMBOSIS
Heparin
Warfarin
Clopidogrel
When to use and stop – guidelines are there
25. IN A CHILD ??
parental presence on induction of
anesthesia
an increase in heart rate and skin conductance
levels in mothers
Oral midaz better than parent and the combined is
not very superior
IV midaz – wait for 4.8 minutes
Intranasal – 10 minutes
26. BENZODIAZEPINES IN PAEDIATRICS
Lorazepam
slow onset and offset of action, and therefore
is better used for inpatients
Diazepam
immature liver function that would lead to a
prolonged half life
27. PEDIATRIC VS. ADULT PATIENTS
Vagolysis
Anticholinergic
Anxiolysis
Oral/ nasal/SL routes
IM ??
28. PEDIATRICS
Upto 6 months – no problem in parental
separation
6 months to 5 years -- maximal
psychological problem and anxiety
5 years and above – easy to convince
29.
30.
31. DEXMED PREMED
Intranasal dexmedetomidine produces more
sedation than oral midazolam when children
were separated from their parents and at
induction of anesthesia
32. KETAMINE
Nasal transmucosal ketamine at a dose of 6
mg/kg is also effective in sedating children
within 20 to 40 minutes before induction of
anesthesia.
Oral ketamine, IM ketamine , IV ketamine
33. PATCHES FOR VENIPUNCTURE
EMLA cream
(eutectic mixture of local anesthetic),
is a mixture of two local anesthetics (2.5%
lidocaine and 2.5% prilocaine).
ELA-Max (4% lidocaine) ,
Ametop (4% tetracaine )
The S-Caine Patch (eutectic mixture of
lignocaine and tetracaine – 70 mg of each
drug/ patch )
