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Lorazepam given the night before surgery reduces preoperative anxiety in children undergoing reconstructive burn
J E McCall1, C G Fischer, G Warden
1Department of Anesthesiology, Shriners Hospital for Children-Cincinnati, Ohio 45229, USA.
Insights
Giving children lorazepam the night before reconstructive burn surgery significantly reduced their preoperative anxiety. Patient self-ratings were more sensitive to anxiety reduction than investigator observations.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Psychology
Background:
- Preoperative anxiety is common in children undergoing reconstructive burn surgery.
- Current anxiety reduction strategies are often initiated too close to surgery.
- Children report significant anxiety the night before procedures.
Purpose of the Study:
- To evaluate the efficacy of preoperative oral lorazepam administered the night before surgery in reducing anxiety in pediatric patients.
- To compare patient self-reported anxiety with investigator observations.
Main Methods:
- A prospective, randomized, double-blind study involving 45 pediatric patients undergoing reconstructive burn surgery.
- Patients received either oral lorazepam (0.025 mg/kg) or placebo the night before surgery.
- Anxiety was assessed using a visual analog scale (VAS) preoperatively and postoperatively, alongside investigator ratings.
Main Results:
- Patients receiving lorazepam the night before surgery reported significantly lower preoperative anxiety levels compared to the placebo group.
- Investigator observations did not reveal a significant difference in anxiety between the groups.
- Patient self-ratings on the VAS were a more sensitive indicator of anxiety reduction.
Conclusions:
- Administering lorazepam the night before surgery is an effective strategy for reducing preoperative anxiety in children.
- Patient self-assessment of anxiety is a valuable tool in evaluating the effectiveness of interventions.
- This approach may improve the psychological well-being of pediatric surgical patients.
Abstract:
A high level of preoperative anxiety frequently occurs in children undergoing reconstructive burn surgery. Reduction of this anxiety may have a number of physiological and psychological benefits. Various pharmaceutical and nonpharmaceutical regimens to reduce preoperative anxiety have been devised; however, most regimens are not initiated until the period immediately before surgery. Many of the children in our institution report high levels of anxiety beginning the night before surgery. Therefore we hypothesized that sedation the night before surgery would be beneficial. Oral lorazepam 0.025 mg/kg or placebo was given the night before surgery to 45 patients in a prospective, randomized, double-blind fashion; in addition, all patients received preoperative sedation per protocol on the day of surgery. Immediately before induction of anesthesia, all patients (mean age 12.5 +/- 0.9 years, range 6 to 18 years) performed an anxiety self-rating with the use of a validated visual analog scale (VAS). Patient anxiety and quality of anesthesia induction was also rated by one of the investigators. Postoperatively, patients rated their recall of anxiety with the use of the VAS. When queried preoperatively, patients who received lorazepam the night before surgery self-reported significantly less anxiety than those receiving placebo. Investigator observations did not detect this difference; this reinforces the assertion that patient self-rating of anxiety may be the best tool for rating anxiety.