Although sedatives are often administered before surgery, a randomised trial finds that among patients undergoing elective surgery under general anaesthesia, receiving the sedative lorazepam before surgery, compared with placebo or no pre-medication, did not improve the self-reported patient experience the day after surgery, but was associated with longer time till removal of a breathing tube (extubation) and a lower rate of early cognitive recovery, according to a study.
Patients scheduled for surgery may experience considerable stress and anxiety. Benzodiazepine (a class of sedatives) pre-medication is frequently used to reduce anxiety but also causes amnesia, drowsiness, and cognitive impairment. Treating anxiety is not necessarily associated with a better peri-operative (before and after surgery) experience for the patient. More needs to be known about the efficacy of pre-operative anxiety treatment to better counsel patients to make informed decisions, according to background information in the article.
Dr Axel Maurice-Szamburski, of the Hôpital de la Timone Adulte, Marseille, France, and colleagues randomly assigned 1,062 adult patients (younger than 70 years of age) who had been scheduled for various elective surgeries under general anaesthesia at 5 French teaching hospitals to receive either 2.5mg of lorazepam (approximately two hours before being transferred to the operating room), placebo, or no pre-medication. The peri-operative patient experience was assessed 24 hours after surgery with a questionnaire.
The researchers found that pre-medication with lorazepam did not improve a measure of overall patient satisfaction compared with no pre-medication or placebo. Of the most anxious patients, no significant differences were found for overall patient satisfaction between the groups.
The time to extubation was significantly longer in the lorazepam group (17 minutes) than in the no pre-medication (12 minutes) and placebo (13 minutes) groups. Forty minutes after the end of anaesthesia, the rate of patients scoring as recovered regarding cognition was significantly lower in the lorazepam group (51%) than in the no pre-¬medication group (71%) and the placebo group (64%). On post-operative day 1, the number of patients with amnesia during the peri-operative period was higher in the lorazepam group than in the other groups.
"Compared with placebo, lorazepam did reduce patient anxiety upon arrival to the operating room. Because there was no overall benefit from pre-operative anxiety treatment, it is possible that anxiety arising upon arrival to the operating room does not influence overall patient satisfaction," the authors write. "The findings suggest a lack of benefit with routine use of lorazepam as sedative pre-medication in patients undergoing general anaesthesia."
[link url="http://media.jamanetwork.com/news-item/findings-question-benefit-of-administering-sedatives-before-surgery-for-patients-receiving-general-anesthesia/"]JAMA material[/link]
[link url="http://jama.jamanetwork.com/article.aspx?articleid=2174028"]JAMA abstract[/link]