Benzodiazepine premedication may attenuate the stress response in daycase anesthesia: a pilot study.
OBJECTIVE
Patients undergoing daycase surgery suffer from varying degrees of fear and anxiety. There is conflicting evidence in the literature regarding the benefit of benzodiazepine premedication in daycase surgery. We carried out a prospective, double-blind, randomized pilot study investigating the effect of benzodiazepine premedication on the stress response in patients undergoing daycase anesthesia and surgery.


METHODS
Group I (n = 16) received diazepam 0.1 mg*kg(-1) orally 60 min preoperatively; Group II (n = 15) received diazepam 0.1 mg*kg(-1) orally 90 min preoperatively; Group III (n = 30) received a placebo. The stress response was measured by analyzing urinary catecholamine and cortisol levels and by scoring anxiety levels using state-trait anxiety inventory (STAI) scores and visual analogue scores (VAS).


RESULTS
Anxiety scores (VAS and STAI scores) were not different between groups. We found a statistically significant reduction in urinary cortisol and noradrenaline levels in the groups receiving diazepam vs placebo.


CONCLUSIONS
The reduction in stress hormones following diazepam premedication, in patients undergoing daycase surgery may support the role for benzodiazepine premedication in this setting. However, further studies are warranted to determine the clinical significance of these findings.
Duggan
Michelle
M
Department of Anaesthesia, and Chemical Pathology, Beaumont Hospital, Dublin, Ireland. mduggan@sickkids.on.ca
Dowd
Noreen
N
O'Mara
Denise
D
Harmon
Dominic
D
Tormey
William
W
Cunningham
Anthony J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000758:Anesthesia; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D001569:Benzodiazepines; D002395:Catecholamines / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011229:Preanesthetic Medication; D011446:Prospective Studies; D013315:Stress, Psychological / Q000517:prevention & control* / Q000523:psychology / Q000652:urine
D014151:Anti-Anxiety Agents; D002395:Catecholamines; D001569:Benzodiazepines; D006854:Hydrocortisone