Preoperative anxiolysis with minimal sedation in elderly patients: bromazepam or clorazepate-dipotassium?
BACKGROUND
In elderly patients undergoing ophthalmic surgery the loss of co-operation due to over-sedation, induced by drugs given preoperatively, may jeopardise the success of microsurgery performed under regional anaesthesia. The aim of this study was to compare the psychotropic effects of bromazepam and clorazepate-dipotassium, two benzodiazepines with predominantly anxiolytic and only weak sedative action.


METHODS
A randomised, placebo-controlled, double-blind study was designed to include 60 patients, ASA physical status II-III, older than 60 years scheduled for ophthalmic surgery under regional anaesthesia. The patients were randomised to receive either bromazepam (3 mg) or clorazepate-dipotassium (20 mg) or placebo. The study drugs were given at 10 p.m. the night before surgery and 90 min before surgery. Using the State-Trait Anxiety Inventory (STAI), the patient's anxiety was assessed at the end of the preoperative visit, on the next morning before the study drug was given and on arrival at the operating theatre.


RESULTS
Bromazepam induced a marked anxiolytic effect as documented by a significant reduction in the STAI State values after both applications (P<0.01). Clorazepate did not differ from placebo at any evaluation time with regard to the STAI and haemodynamic values. Sedative effects and oxygen saturation (SpO2) were comparable in all groups.


CONCLUSIONS
Bromazepam is superior to clorazepate in its anxiolytic action and suitable as preoperative medication in the elderly patient because of lack of overt sedative effects.
Erb
T
T
Department of Anaesthesia, University of Basel, Kantonsspital, Switzerland.
Sluga
M
M
Hampl
K F
KF
Ummenhofer
W
W
Schneider
M C
MC
D000368:Aged; D000704:Analysis of Variance; D000765:Anesthesia, Conduction; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control*; D001794:Blood Pressure / Q000187:drug effects; D001960:Bromazepam / Q000627:therapeutic use*; D002387:Cataract Extraction; D003009:Clorazepate Dipotassium / Q000627:therapeutic use*; D016292:Procedural Sedation; D003299:Cooperative Behavior; D004311:Double-Blind Method; D005901:Glaucoma / Q000601:surgery; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008568:Memory / Q000187:drug effects; D008866:Microsurgery; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010919:Placebos; D011229:Preanesthetic Medication; D012890:Sleep / Q000187:drug effects; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D010919:Placebos; D003009:Clorazepate Dipotassium; D010100:Oxygen; D001960:Bromazepam