Sedative premedication before surgery may not improve patient experience, outcomes

Patients who receive sedative premedication with lorazepam before elective surgery involving general anesthesia may not benefit, according to a new study.


Patients who receive sedative premedication with lorazepam before elective surgery involving general anesthesia may not benefit, according to a new study.

Researchers performed a randomized clinical trial to determine the efficacy of sedative premedication before elective surgery with general anesthesia. Patients who were younger than age 70 and who were undergoing general surgery at 5 French teaching hospitals between January 2013 and June 2014 were randomly assigned to receive 2.5 mg of lorazepam, no premedication, or placebo. Patients who were undergoing neurosurgery or obstetric, cardiac, or outpatient surgery were excluded. The study's primary outcome was perioperative patient experience 24 hours after surgery, as assessed via a validated questionnaire, while secondary outcomes included time to extubation and early cognitive recovery. The study results were published in the March 3 Journal of the American Medical Association.

A total of 1,062 patients were included in the study, and 354 were randomly assigned to each study group. Three hundred thirty patients in the lorazepam group, 319 in the no premedication group, and 322 in the placebo group were included in the primary analysis. The researchers found that premedication with lorazepam did not improve the mean global index of overall patient satisfaction versus no medication or placebo (P=0.38). In addition, no significant difference was seen with lorazepam versus the other groups among the 24% of patients who had high preoperative anxiety (P=0.18). The lorazepam group had a time to extubation of 17 minutes, compared with 12 minutes in the no premedication group and 13 minutes in the placebo group (P<0.001). The rate of early cognitive recovery in the 3 groups, respectively, was 51%, 71%, and 64% (P<0.001).

The authors noted that their study examined only 1 premedication drug, that a class effect of the drug was probably present, and that the patients who received no medication were aware of that fact, among other limitations. They concluded that premedication with lorazepam before elective surgery involving general anesthesia did not improve the postoperative patient experience; however, they did find an association with modestly increased time to extubation and lower rates of early cognitive recovery. “The findings suggest a lack of benefit with routine use of lorazepam as sedative premedication in patients undergoing general anesthesia,” the authors wrote. They noted that since high preoperative anxiety is not seen in the majority of patients, “there is little justification for routine administration of preoperative anxiolytic medication for all surgical patients.”