The evolution of premedication

Abstract

Morton's demonstration of the anesthetic effects of diethyl ether (ether) made painless surgery possible, but ether irritated the airways, often initiating laryngospasm and stimulating production of secretions. Premedication'the administration of drugs before induction of anesthesia'alleviated such problems. Over the latter half of the nineteenth century, clinicians increasingly injected morphine and scopolamine or atropine before ether anesthesia. The capacity of morphine to depress breathing was of limited concern because ether did not appear to depress breathing. The rationale for using premedication before chloroform, was less compelling. Chloroform depressed breathing and did not irritate the airway or promote secretions. However, morphine plus scopolamine could decrease preoperative apprehension before anesthesia with either ether or chloroform. Introduced in 1934, pentobarbital might be given as premedication in place of or in addition to morphine. It offered two advantages over morphine: greater sedation and much less postoperative nausea and vomiting.