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Benzodiazepine premedication may attenuate the stress response in daycase anesthesia: a pilot study

[La prémédication avec de la benzodiazépine peut diminuer la réaction de stress en chirurgie d’un jour : une étude pilote]

Michelle Duggan, FFARCSI^*, Noreen Dowd, FFARCSI^*, Denise O’Mara, RN MBA^*, Dominic Harmon, FFARCSI^*, William Tormey, FRCPI and Anthony J. Cunningham, MD FRCPC^*

^* From the Department of Anaesthesia, and
Chemical Pathology, Beaumont Hospital, Dublin, Ireland.

Address correspondence to: Dr. Michelle Duggan, Department of Anaesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Phone: 416-813-7445; Fax: 416-813-7543; E-mail: mduggan{at}sickkids.on.ca

Purpose: Patients undergoing daycase surgery suffer from varying degrees of fear and anxiety. There is conflicting evidence in the literature regarding the benefit of benzodiazepine premedication in daycase surgery. We carried out a prospective, double-blind, randomized pilot study investigating the effect of benzodiazepine premedication on the stress response in patients undergoing daycase anesthesia and surgery.

Methods: Group I (n = 16) received diazepam 0.1 mg•kg^–1 orally 60 min preoperatively; Group II (n = 15) received diazepam 0.1 mg•kg^–1 orally 90 min preoperatively; Group III (n = 30) received a placebo. The stress response was measured by analyzing urinary catecholamine and cortisol levels and by scoring anxiety levels using state-trait anxiety inventory (STAI) scores and visual analogue scores (VAS).

Results: Anxiety scores (VAS and STAI scores) were not different between groups. We found a statistically significant reduction in urinary cortisol and noradrenaline levels in the groups receiving diazepam vs placebo.

Discussion: The reduction in stress hormones following diazepam premedication, in patients undergoing daycase surgery may support the role for benzodiazepine premedication in this setting. However, further studies are warranted to determine the clinical significance of these findings.

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