Although sedatives are often administered before surgery, a randomised trial finds that among patients undergoing elective surgery under general anaesthesia, receiving lorazepam before surgery, compared with placebo or no premedication, did not improve the self-reported patient experience the day after surgery, but was associated with longer time till extubation and a lower rate of early cognitive recovery, according to a study published in the JAMA.
Benzodiazepines are frequently used to reduce anxiety before surgery, but the drug also causes amnesia, drowsiness, and cognitive impairment. Treating anxiety is not necessarily associated with a better perioperative experience for the patient and more needs to be known about the efficacy of preoperative anxiety treatment to better counsel patients to make informed decisions.
For the current study, Axel Maurice-Szamburski, MD, Hôpital de la Timone Adulte, Marseille, France, and colleagues randomised 1,062 adult patients who had been scheduled for various elective surgeries under general anaesthesia at 5 French teaching hospitals to receive lorazepam 2.5 mg approximately 2 hours before being transferred to the operating room, placebo, or no pre-medication. The perioperative patient experience was assessed 24 hours after surgery with a questionnaire.
The researchers found that premedication with lorazepam did not improve a measure of overall patient satisfaction compared with no premedication 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 premedication group (71%) and the placebo group (64 percent). On postoperative day 1, the number of patients with amnesia during the perioperative 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,” the authors wrote. “Because there was no overall benefit from preoperative anxiety treatment, it is possible that anxiety arising upon arrival to the operating room does not influence overall patient satisfaction. The findings suggest a lack of benefit with routine use of lorazepam as sedative pre-medication in patients undergoing general anaesthesia.”