Premedication

• Atropine:
  There is no controversy about atropine except for the route of administration. Atropine can be administered IM, subcutaneously, intravenously or given by aerosol. I do not find the intravenous route satisfactory. When intravenously given, atropine produces sinus tachycardia and has the potential for inducing an arrhythmia.

  Theoretically, atropine administered by aerosol can minimize these systemic reactions. However, this has never been confirmed by a study. There is no overall advantage to administering atropine by aerosol. Additionally, this route of administration failed to inhibit the vasovagal response.

  Nevertheless, it is reasonable to consider this route of administration in those patients with heart disease (e.g., sick sinus syndrome) in whom there is danger of IM atropine producing a serious arrhythmia, and those with a narrow-angle glaucoma in whom IM atropine could cause an acute rise in intraocular pressure.

  References:

  1. Zavala, CZ, et al. The response to atropine sulfate given by aerosol and intramuscular route to patients undergoing fiberoptic bronchoscopy. Chest 79:512-15, 1981.
• Sedatives:
  The commonly used drugs for premedication are as follows:
  • Demerol
  • Codeine
  • Valium
  • Stadol
  • Morphine
  • Barbiturate
  • Phenergan
  • Versed

I don't think one drug is superior to another. It is primarily a matter of individual preference. Stadol has been proposed as less of a respiratory depressant. Morphine and codeine are preferred by some for their cough suppressant effect.