Page 46 - GALENIKA MEDICAL JOURNAL

delirijuma nije u potpunosti razjašnjen, ali se smatra da Nakon premedikacije midazolamom može doći do pa-
su uključeni različiti neurotransmiteri u mozgu, uključujući radoksalne reakcije, odnosno pogoršanja anksioznosti .
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GABA, glutamat i dopamin. Delirijum izazvan benzodiaze- Paradoksalna reakcija predstavlja neuobičajenu reakciju
pinima može biti posebno izražen kod starijih pacijenata ili organizma na ovaj tip lijekova. Umjesto očekivane sedacije
pacijenata sa neurološkim ili psihijatrijskim poremećajima. i smanjenja anksioznosti, dolazi do suprotnog efekta, uzne-
Zbog toga se preporučuje oprez pri korišćenju benzodiaze- mirenosti, agresivnosti, odnosno povećane anksioznosti .
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pina kod ovih grupa pacijenata, kao i pažljiv nadzor i praće- U slučaju predoziranja ili pretjerane sedacije specifičan an-
nje nakon primjene benzodiazepinske premedikacije. tagonist je flumazelin u dozi od 0,01 mg/kg IV (Intravenous)
tokom 15 sekundi (maksimalna doza 0,05 mg/kg IV).

Zaključak

Oralna premedikacija benzodiazepinima je efikasan način za smanjenje anksioznosti i straha kod
pacijenata koji se pripremaju za invazivne zahvate ili dijagnostičke procedure, a posebno kod
djece. Dovode i do anterogradne amnezije. Relativno su jednostavni za primjenu, mogu se lako

dozirati oralno i imaju relativno brz početak dejstva. Za optimalnu primjenu oralne premedikacije
benzodiazepinima, važno je pažljivo procijeniti svakog pacijenta pojedinačno i prilagoditi način
primjene i doziranje lijekova u skladu sa njihovim individualnim potrebama. Treba imati u vidu rizik
od neželjenih efekata i komplikacija, kao što su depresija disanja, mišićna slabost, sedacija i gubitak
koordinacije, kako bi se minimizirali rizici i osigurala bezbjedna i efikasna primjena. Premedikaciju
treba koristiti s oprezom i pod nadzorom medicinskog osoblja.

Abstract

Preoperative medication or premedication is the administration of medications before surgery, to reduce anxiety, which
is common in these patients, and as prophylaxis of side effects of anesthesia like heart rhythm disorders, blood pressure
variations, hypersalivation, etc. Benzodiazepines are the usual agents used in premedication to provide relief of anxiety,
anterograde amnesia, and light sedation. The most common benzodiazepines used for premedication are midazolam,
diazepam and lorazepam. They are usually given intramuscularly or orally in children. The time of use should be correlated
with the moment of maximum effect depending on the method of administration. Time varies from twenty minutes for
intramuscularly administered midazolam to two hours for peroral administered lorazepam. The choice of a particular
benzodiazepine, used for premedication, depends on its effects, duration of action, active metabolites, and side effects.
The dose should be carefully tailored to provide the expected reduction of anxiety and light sedation and to avoid sleep and
especially respiratory depression.

Keywords: premedication, benzodiazepines, oral administration, children

Literatura 4. Woldegerima YB, Fitwi GL, Yimer HT, Hailekiros AG. Prevalence and
factors associated with preoperative anxiety among elective surgical
patients at University of Gondar Hospital. Gondar, Northwest Ethiopia,
1. Kassie GM, Nguyen TA, Kalisch Ellett LM, Pratt NL, Roughead EE. 2017. A cross-sectional study. Int J Surg Open. 2018; 10:21–9.
Preoperative medication use and postoperative delirium: a systematic 5. Ma J, Li C, Zhang W, Zhou L, Shu S, Wang S, et al. Preoperative
review. BMC Geriatr. 2017 Dec 29;17(1):298. anxiety predicted the incidence of postoperative delirium in patients
2. Tobias JD. Preoperative anesthesia evaluation. Semin Pediatr Surg. 2018 undergoing total hip arthroplasty: a prospective cohort study. BMC
Apr;27(2):67-74. Anesthesiol. 2021 Feb 12;21(1):48.
3. Gorsky K, Black ND, Niazi A, Saripella A, Englesakis M, Leroux T, et al. 6. Practice Guidelines for Preoperative Fasting and the Use of
Psychological interventions to reduce postoperative pain and opioid Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration:
consumption: a narrative review of literature. Reg Anesth Pain Med. Application to Healthy Patients Undergoing Elective Procedures: An
2021 Oct;46(10):893-903. Updated Report by the American Society of Anesthesiologists Task
Force on Preoperative Fasting and the Use of Pharmacologic Agents

44 DOI: 10.5937/Galmed2307041S