Receiving a sedative prior to undergoing surgery in which anesthesia is administered may not benefit a patient but instead could help lengthen recovery times, a new study found.
But one leading anesthesiologist already is raising questions about the findings.
Researchers in France conducted a randomized trial involving more than 1,000 adults under the age of 70 who underwent surgeries at five teaching hospitals between January 2013 and June 2014. Those who received the drug lorazepam before elective surgery were found to have had no improvement in overall satisfaction 24 hours after their operation when compared with those who took a placebo or had no premedication, according to a study published online Tuesday in the Journal of the American Medical Association.
Patients who received sedatives also were found to take longer in the removal of breathing tubes, or extubation, compared with non-medicated patients, and had lower rates of early cognitive recovery. After the first postoperative day, a higher number of patients who had taken lorazem experienced amnesia compared to either the placebo or non-medicated group.
“Compared with placebo, lorazepam did reduce patient anxiety upon arrival to the operating room,” the study concluded. “Because there was no overall benefit from preoperative anxiety treatment, it is possible that anxiety arising upon arrival to the operating room does not influence overall patient satisfaction.”
Dr. J.P. Abenstein, president of the American Society of Anesthesiologists, took issue with the study's findings, saying it offered nothing that was not already known about the effects of lorazepem on cognitive ability for at least the past few decades.
“Lorazepem lasts about 12 hours and most surgeries are about two, maybe four hours,” Abenstein said. “So the fact that they took longer to wake up and took longer to clear their heads wasn't surprising at all given the pharmacology of the medication.”
Sedatives are usually administered to patients who are experiencing anxiety prior to a surgery, but treating anxiety is not necessarily associated with a better patient experience before or after surgery. Researchers say the findings suggest more needs to be known about how efficacy of preoperative treatment for anxiety.
Abenstein noted that the study failed to take into consideration the potential effects of pre-operative anxiety on elderly patients, which increasing evidence he said has suggested that in large surgeries such as cardiac procedures there was increased incidence of post-operative psychosis while in the intensive-care unit.
“What's most important is for patients to discuss their concerns and their medical history with their physicians and their anesthesiologist prior to surgery,” Abenstein said. “Talking through a procedure with my patients is oftentimes a more powerful relief of anxiety than any drug I have.”
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