title: Preoperative use of anxiolytic-sedative agents; are we on the right track?
abstract: OBJECTIVE
  Although anxiolytic-sedative agents are used preoperatively since the advent of anesthesia, many aspects of this treatment, including the intended effects among which anxiolysis, effectiveness, and optimal agents, remain unclear. The objective of this study was to provide insight into the preoperative use of anxiolytic-sedative agents in the Netherlands and to relate the administration of these agents to the anxiolytic-sedative state of patients.
  
  
  METHODS
  Questionnaire study.
  
  
  METHODS
  University, general, and specialized hospitals in the Netherlands.
  
  
  METHODS
  One anesthesiologist in each hospital was asked for details about premedication in all elective procedures, except cardiothoracic surgery, in normal weighted adults in good to fair clinical condition.
  
  
  METHODS
  None.
  
  
  METHODS
  Estimated percentage of patients receiving anxiolytic-sedative premedication, type, dose, route of administration and timing of these agents, and anxiolytic state of patients when arriving at the holding area.
  
  
  RESULTS
  All 8 university hospitals, 69 of 82 general hospitals and 2 of 3 specialized hospitals participated in this study (response rate, 84.9%). The estimated percentage of patients that received anxiolytic-sedative agents was 46.8% for in-patients and 30.4% for day care patients (P<.0001), with large between-hospital variation. Midazolam (62.7%), oxazepam (20.2%), and temazepam (7.8%) were most frequently used and were virtually always orally administered 1 hour preoperatively. There was no relationship between use of anxiolytic-sedative agents and reduction of perceived anxiety (r=-0.09, P=.46 and r=-0.01, P=.91 for clinical and day care patients, respectively).
  
  
  CONCLUSIONS
  Anxiolytic-sedative agents are used preoperatively in a substantial number of patients in the Netherlands, and the pharmacokinetic characteristics of many agents are not optimal of their intended use. In addition, we found no relationship with reduced anxiety. This study stresses the need for clear guidelines on preoperative use of anxiolytic-sedative agents.
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands. Electronic address: martin.bucx@radboudumc.nl.
authors.forename: Martin J L
authors.initials: MJ
authors.lastname: Bucx
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Krijtenburg
authors.affiliation: Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: Kox
mesh_terms: D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001007:Anxiety / Q000517:prevention & control / Q000523:psychology; D004363:Drug Utilization; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D009426:Netherlands; D011229:Preanesthetic Medication; D011300:Preoperative Care / Q000379:methods*; D011795:Surveys and Questionnaires
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives
keywords: Anti-anxiety agents; Drug therapy; Patient care; Preanesthetic medication; Premedication; Preoperative care