TAM (Treatments and Medicines) NHS Highland
Anxiolytic premedication may not be required
Non-pharmacological anxiolysis strategies should always be employed, even when utilising sedative premedication
- The ideal scenario involves identification of potential patients benefiting from these interventions during their pre-operative assessment process, or earlier, and liaison with the named anaesthetist for that list.
- Discussion with the care givers and patient (as appropriate) is vital to success; this will help inform chosen route of administration
- Enquiries about previous experiences may inform chosen strategy; anaesthetic records may provide additional information;
- Midazolam may have idiosyncratic paradoxical excitatory effects in those with ADHD, or on the autistic spectrum.
- Clonidine is a useful alternative, or can be included alongside midazolam to minimise these effects.
- Oral, buccal or intranasal routes are preferred wherever possible.
- Appropriate safety measures should be put in place if choosing to administer IM drugs to minimise risk to patients, staff and other caregivers.
- Oral medications can be combined in a single enteral syringe or mixed with a small volume of water or diluting juice.
- IV preparation of clonidine can easily be administered enterally as it is concentrated and has no appreciable taste or odour.
- Minimum standards of monitoring as per the AAGBI must be adhered to; this includes waveform capnography if moderate/deep sedation is required prior to entering the anaesthetic room.
- Means of providing airway and respiratory support must also be prepared and immediately to hand if deep sedation techniques are employed to facilitate transfer to the theatre suite; a trained airway assistant must also be present.
- Administration of anxiolytics may be required on rare occasions outside the hospital building, for example in the car park.
- These instances should be agreed in advance, with appropriate planning involving all relevant parties.
- The oral, buccal or intranasal routes are still preferred if possible.
- Appropriate preparations should be made to provide respiratory, cardiovascular and ongoing sedation requirements in this setting (i.e. appropriately trained staff, thorough briefing, availability of trolley, oxygen, airway support and monitoring).