Premedication for anxiety in adult day surgery.
BACKGROUND
Since 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.


OBJECTIVE
To assess the effect of anxiolytic premedication on time to discharge in adult patients undergoing day case surgery under general anaesthesia.


METHODS
Trials were identified by computerized searches of the Cochrane Controlled Trials Register, MEDLINE (1980 to April 2002), EMBASE (from 1974 onwards), by checking the reference lists of trials and review articles, by hand-searching three main anaesthesia journals and by contacting five researchers active in the field and the Product Information Departments of the manufacturers of five commonly used premedicants.


METHODS
All randomized controlled trials comparing an anxiolytic drug(s) with placebo before general anaesthesia in adult day case surgical patients.


METHODS
We collected data on anaesthetic drugs used, results of tests of psychomotor function 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.


RESULTS
Searching identified thirty-one reports; fifteen studies, with data from 1313 patients, were considered eligible for analysis. Only three studies specifically addressed the discharge question; both found no 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. Four studies used both clinical measures and tests of psychomotor function as tests of recovery from anaesthesia. In none of these studies did the premedication appear to delay discharge, although performance on tests of psychomotor function was sometimes still impaired. Of the four studies which used tests of psychomotor function to assess recovery, three showed impaired recovery (after midazolam 7.5mg, midazolam 15mg or diazepam 15mg) which might possibly interfere with discharge from hospital. Seven studies used either clinical criteria alone or in combination with psychomotor tests; none showed discharge delay.


CONCLUSIONS
We 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 currant day case practice should be made with caution.
Smith
A F
AF
Department of Anaesthetics, Royal Lancaster Infirmary, Ashton Road, Lancaster, UK, LA1 4RP. Andrew.Smith@l.bay-tr.nwest.nhs.uk
Pittaway
A J
AJ
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000523:psychology*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control*; D006801:Humans; D010351:Patient Discharge; D011292:Premedication; D016032:Randomized Controlled Trials as Topic
D014151:Anti-Anxiety Agents