JAMA: Although sedatives are often administered before surgery, a
randomized trial finds that among patients undergoing elective surgery
under general anesthesia, receiving the sedative 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 removal off a breathing tube
(extubation) and a lower rate of early cognitive recovery, according to a
study in the March 3 issue of JAMA.
Patients scheduled for surgery may experience considerable stress and
anxiety. Benzodiazepine (a class of sedatives) premedication is
frequently used to reduce anxiety but also causes amnesia, drowsiness,
and cognitive impairment. Treating anxiety is not necessarily associated
with a better perioperative (before and after surgery) experience for
the patient. More needs to be known about the efficacy of preoperative
anxiety treatment to better counsel patients to make informed decisions,
according to background information in the article.
Axel Maurice-Szamburski, M.D., 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 anesthesia at 5 French teaching
hospitals to receive either 2.5 mg of lorazepam (approximately two hours
before being transferred to the operating room), placebo, or no
premedication. 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 premedication (12 minutes) and placebo
(13 minutes) groups. Forty minutes after the end of anesthesia, the
rate of patients scoring as recovered regarding cognition was
significantly lower in the lorazepam group (51 percent) than in the no
premedication group (71 percent) 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. 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 authors write.
“The findings suggest a lack of benefit with routine use of lorazepam
as sedative pre-medication in patients undergoing general anesthesia.”
(doi:10.1001/jama.2015.1108; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor’s Note:
This work was supported by a grant from the French Institutional
Clinical Hospital Research Program, Ministry of Health. The authors have
completed and submitted the ICMJE Form for Disclosure of Potential
Conflicts of Interest and none were reported.