Preoperative use of anxiolytic-sedative agents; are we on the right track?

Bucx, M. J. L.; Krijtenburg, Piet; Kox, Matthijs

doi:10.1016/j.jclinane.2016.03.025

Cited by 34 publications

(21 citation statements)

References 15 publications

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“…The indication of premedication for the preoperative setting may be less important for non-day-surgery. 30 Studies showing a positive effect are dated from 1980 to 2000. Healthcare has significantly changed over time.…”

Section: Discussionmentioning

confidence: 99%

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Beek¹,

Kroon²,

Rijs³

et al. 2019

Can J Anesth/J Can Anesth

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Purpose Despite the uncertain effects of anxiolytic premedication with benzodiazepines on the quality of postoperative recovery, perioperative benzodiazepine administration is still a common practice in many hospitals. We evaluated the effect of premedication with midazolam on the quality of recovery in hospitalized patients undergoing a laparotomy. Methods We conducted a single-centre randomized placebo-controlled, double-blinded clinical trial from July 2014 to September 2015. We included 192 patients aged [ 18 yr scheduled for elective laparotomy with a planned postoperative stay of C three days. Participants were randomized into two groups to receive either midazolam 3 mg or sodium chloride 0.9% intravenously as premedication prior to surgery. Patients were followed up for up to one week after surgery. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day (POD) 3. The secondary outcomes included the QoR-40 score on POD 7, and the State-Trait Anxiety Inventory, State-Trait Anger Scale, Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale scores. Results The mean (standard deviation) postoperative QoR-40 scores on POD 3 were not significantly different in the midazolam group compared with controls [166.4 (17.0) vs 163.9 (19.8), respectively; mean difference, 2.3; 95% confidence interval,-2.9 to 8.4; P = 0.35]. There were no between-group differences in any of the secondary outcomes. Conclusions Administration of midazolam as premedication for laparotomy patients did not improve the quality of recovery up to one week after surgery. General prescription of midazolam as premedication can be questioned and might only suit some patients. Trial registration www.clinicaltrials.gov (NCT01993459); registered

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Section: Discussionmentioning

confidence: 99%

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Beek¹,

Kroon²,

Rijs³

et al. 2019

Can J Anesth/J Can Anesth

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“…Twenty years ago, it was already concluded that "much was unclear about the intended effects, choice of optimal agents, patient selection, and effectiveness" [6]. Till the present time the same can be concluded [10].…”

Section: Introductionmentioning

confidence: 86%

Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

Kamel¹,

Shoukry²

2017

OJAnes

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Background: Preoperative anxiety is common among children. It can result in adverse physiological and psychological outcomes. Pharmacological and non-pharmacologic techniques used preoperatively to decrease anxiety and improve cooperation in pediatric patients. The extent of an individual child's risk for stress reflects genetics, personality, parenting, and previous life experience. Children 1 to 5 years of age are at the highest risk for extreme preoperative anxiety. Material and methods: The study is a double blinded clinical trial that conducted in Ain Sham University on 90 children for pulpotomy in the period from august 2015 to may 2017 after approval of the ethical committee and informed written consent from the guardians. The patients were divided randomly into two groups. Fifteen min. before the procedure, In group O, midazolam/paracetamol at a dose of 0.5 and 15 mg/kg respectively was given orally. In group N, midazolam/Ketamine 0.5 mg/kg and 10 mg/kg sprayed nasally. Ramsay sedation scale, child separation, mask acceptance, Aldrete's scoring system, postanesthetic discharge criteria and parent satisfaction scores were recorded. Results: group N showed more smooth parenteral separation [88.9 vs 8.9%] and better tolerance to the face mask "scale 1" [73.3% vs 22.2%] lam/paracetamol is orally comparable to the combination of midazolam/ketamine nasally; however "midazolam/paracetamol" achieves a higher parents satisfaction and earlier postoperative discharge.

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“…Hence, it has been argued that they should be used in a minority of patients, and only when absolutely necessary. [ 17 ]…”

Section: Current Concepts In Anaesthesia For Day-care Surgeriesmentioning

confidence: 99%

Consensus statement on anaesthesia for day care surgeries

et al. 2017

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The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory.

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Preoperative use of anxiolytic-sedative agents; are we on the right track?

Cited by 34 publications

References 15 publications

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

Consensus statement on anaesthesia for day care surgeries

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