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Premedication for anxiety in adult day surgeryWalker KJ, Smith AF, Pittaway A
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SummaryPremedication for anxiety in adult day surgery does not delay discharge of patients.Adult day case surgery is a common clinical practice that is no longer confined to simple procedures; throughput of patients is an important economic consideration for facilities. Premedication for anxiety, prior to general anaesthesia, is not routinely used because of a concern that it may delay discharge of patients. Some patients would like this option. We identified 16 studies; 13 compared benzodiazepines to placebo; two opioids; and one beta-adrenoceptor blocker. Where directly measured, time to ambulation or discharge was unaffected by use of premedication although a number of studies reported short-term impairment of psychomotor function with benzodiazepines
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 24. 2000 AbstractBackgroundSince the early 1980's, it has become more and more common to carry out surgical procedures on a day case basis. Many patients are anxious before surgery yet there is sometimes a reluctance to provide sedative medication because it is believed to delay discharge from hospital. ObjectivesTo assess the effect of anxiolytic premedication on time to discharge in adult patients undergoing day case surgery under general anaesthesia. Search strategyWe identified trials by computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2004); MEDLINE (1980 to October 2005); EMBASE (from 1974 to October 2005).We also checked the reference lists of trials and review articles; handsearched three main anaesthesia journals; and contacted five researchers active in the field, as well as the Product Information Departments of the manufacturers of five commonly used premedicants. Selection criteriaWe included all randomized controlled trials comparing anxiolytic drug(s) with placebo before general anaesthesia in adult day case surgical patients. Data collection and analysisWe collected data on anaesthetic drugs used, results of psychomotor function tests where these were used to assess residual effect of premedication, and on times from end of anaesthesia to ability to walk unaided or readiness for discharge from hospital. Formal statistical synthesis of individual trials was not performed in view of the variety of drugs studied. Main resultsWe identified 35 reports by searching, and included 16 studies. Of these, only three studies specifically addressed the discharge question; none found any delay in premedicated patients. Three other studies used clinical criteria to assess fitness for discharge, though times were not given. Again, there was no difference from placebo. Ten studies used tests of psychomotor function as indicators of recovery from anaesthesia; six of these also included clinical measures of recovery. In none of these studies did the premedication appear to delay discharge, although performance on tests of psychomotor function was sometimes still impaired. Three studies showed no impairment in psychomotor function; five showed some impairment which had resolved by three hours or time of discharge and two showed significant impairment (after midazolam 15mg, triazolam 0.25mg, diazepam 10mg). Authors' conclusionsWe have found no evidence of a difference in time to discharge from hospital, as assessed by clinical criteria, in patients who received anxiolytic premedication. However, in view of the age and variety of anaesthetic techniques used, inferences for current day case practice should be made with caution. |