This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by De Witte, J. L. Articles by Cammu, G. Search for Related Content PubMed PubMed Citation Articles by De Witte, J. L. Articles by Cammu, G. Related Collections Ambulatory Pharmacology

---

AMBULATORY ANESTHESIA

Preoperative Alprazolam Reduces Anxiety in Ambulatory Surgery Patients: A Comparison with Oral Midazolam

Jan L. De Witte, MD^*, Carmen Alegret, MD, Daniel I. Sessler, MD, and Guy Cammu, MD^*

*Department of Anesthesiology and Intensive Care, OLV-Hospital, Aalst, Belgium; Department of Anesthesiology, AZ Groeninge, Kortrijk, Belgium; and Outcomes Research^TM Institute, Department of Anesthesiology, University of Louisville, Louisville, Kentucky, and the Ludwig Boltzmann Institute, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Jan De Witte, MD, Department of Anesthesiology and Intensive Care, OLV-Hospital, Aalst, Belgium. Address e-mail to jan.de.witte{at}olvz-aalst.be

Because an oral formulation of midazolam is not approved in certain countries, we evaluated oral alprazolam as an alternative. Forty-five outpatients scheduled for gynecological laparoscopic surgery participated in a double-blinded study to compare the effectiveness and side effects of oral alprazolam 0.5 mg with midazolam 7.5 mg, as a reference drug, and placebo. We evaluated psychomotor function by means of the Trieger Dot Test (TDT) and the Digit-Symbol Substitution Test. Simple memory tests were performed. Data were analyzed with ² or paired Student’s t-tests, or with one-way analysis of variance with the Student-Newman-Keuls or Kruskal-Wallis test, as appropriate; P < 0.05 was considered statistically significant. Alprazolam and midazolam both decreased anxiety scores more than placebo (P < 0.05). One hour after premedication, the Digit- Symbol Substitution Test score was similar in all groups, whereas the TDT score was greater (indicating impairment of performance) in the alprazolam group than in the placebo group (P < 0.05). Sedation scores, extubation time, and discharge times in the active drug groups did not differ from placebo. At discharge from the postanesthesia care unit, the TDT score was greater in both active drug groups compared with placebo (P < 0.05). Five patients, exclusively in the midazolam group, had amnesia (P < 0.05). We conclude that alprazolam may be an effective alternative to midazolam for anxiety reduction without causing amnesia. However, it may cause greater impairment of psychomotor function in the early postoperative period.

IMPLICATIONS: Oral alprazolam 0.5 mg and midazolam 7.5 mg comparably reduce anxiety in ambulatory surgery patients. Despite early psychomotor impairment, neither drug delays postanesthetic extubation nor prolongs discharge from the postanesthesia care unit.

This article has been cited by other articles:

				A. Movafegh, R. Alizadeh, F. Hajimohamadi, F. Esfehani, and M. Nejatfar Preoperative Oral Passiflora Incarnata Reduces Anxiety in Ambulatory Surgery Patients: A Double-Blind, Placebo-Controlled Study Anesth. Analg., June 1, 2008; 106(6): 1728 - 1732. [Abstract] [Full Text] [PDF]

				J. B. Schnur, D. H. Bovbjerg, D. David, K. Tatrow, A. B. Goldfarb, J. H. Silverstein, C. R. Weltz, and G. H. Montgomery Hypnosis Decreases Presurgical Distress in Excisional Breast Biopsy Patients Anesth. Analg., February 1, 2008; 106(2): 440 - 444. [Abstract] [Full Text] [PDF]