Patients’ desires for anxiolytic premedication – an observational study in adults undergoing elective surgery

Abstract

Background Most patients experiencing preoperative anxiety would welcome support in coping with their anxiety. Anxiolytic medication is a common way to address preoperative anxiety. However, the proportion of patients who welcome anxiolytic medication preoperatively and the preferred time of taking it have not been studied thoroughly. Methods Adult patients (n = 1000) scheduled to undergo elective surgery under general anesthesia were eligible to participate in this single-center observational study. Primary outcomes were the ratio of patients desiring anxiolytic medication (no/yes/on request) and the preferred time of taking it (evening before surgery/morning of day of surgery/on call to the operating room). Secondary outcomes included associations between different measures of anxiety (i.e., anxiety level according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and anxiety status (no/yes)) and desire for anxiolytic medication (no/yes/on request). Primary outcomes were analyzed descriptively, and secondary outcomes were analyzed using multinomial logistic regressions. Results Three hundred fifty-six (35.6%) out of 1000 patients desired anxiolytic medication and 239 (23.9%) patients would welcome anxiolytic medication on request. In patients reporting anxiety (no/yes; n = 493), 228 (46.2%) stated a clear desire for anxiolytic medication (yes) and 142 (28.8%) considered anxiolytic medication (on request). Patients’ preferences concerning the timing of premedication vary widely. In patients reporting a clear desire for anxiolytic medication (n = 356), the “morning of the day of surgery” was most frequently (n = 111, 31.2%) stated as the preferred time to get anxiolytic medication, followed by “on call to the operating room” (n = 51, 14.3%). All anxiety measures were significantly associated with desire for anxiolytic medication (p < 0.05). Conclusions Given the importance of preoperative anxiety to patients, patients’ desire for anxiolytic medication should be considered when discussing the pros and cons of premedication. Individualized instead of standardized prescription and timing of premedication is recommended. Trial registration German Clinical Trials Register (DRKS 00013319, approved 23/11/2017).

Pro-Con Debate: Judicious Benzodiazepine Administration for Preoperative Anxiolysis in Older Patients

“…1,2 Patients have been shown to find anxiety emotionally distressing, desire anesthesiologists aid in coping with the anxiety, and desire anxiolytic medication whether or not they perceived a high level of anxiety. 1,10 One RCT showed a reduction in postoperative, patient-controlled-analgesia dosages but not in postoperative pain scores in women who received oral lorazepam the night prior and intramuscular midazolam the morning of a total hysterectomy. 5 Another RCT in women undergoing total hysterectomy demonstrated that anxious women who did not receive preoperative lorazepam had higher pain scores and opioid consumption than anxious and nonanxious women who received preoperative lorazepam as well as nonanxious women who received placebo.…”

“…1 Another study showed that the majority of patients desired anxiolytic medication whether or not they perceived themselves as anxious. 10 Our subsequent argument details the lack of evidence that a single, preoperative anxiolytic benzodiazepine when given judiciously causes harm. We detail why alternative anxiolytic methods may not be adequate for all patients and that appropriate treatment of high anxiety offers significant benefits.…”

“…[3][4][5][6][7][8][9] Preoperative anxiety is emotionally distressing, and patients desire anxiolytic medications and the support of their anesthesiologist in coping with the anxiety. 1,10 This may be why preoperative benzodiazepine administration to older patients remains commonplace despite many multidisciplinary clinical guidelines recommending avoidance. [11][12][13] In fact, recent studies have shown that 38% to 65% of older patients received benzodiazepines during anesthesia care.…”