Patient-administered anxiolysis--a pilot study

The feasibility of self-premedication with intravenous diazepam was examined in an open study of 50 preoperative patients. Using a Bard 'Harvard PCA' patient-controlled analgesia system, patients were instructed to deliver the drug in a dose sufficient to remove their anxiety for the scheduled surgical procedure. Aliquots of diazepam 2 mg were delivered on demand up to a total dose of 20 mg over a 30 minute premedication period. The mean dose administered was 8.1 mg (range 0-16 mg) producing a highly significant reduction in both patient- and anaesthetist-assessed anxiety rating. Neither the patient's sex nor the nature of the surgical procedure influenced the dose administered. Although poor, the best predictor of self-premedicating dose was patient's own preoperative anxiety rating with the anaesthetist's assessment of patient anxiety not correlating with the dose administered. No patient was considered excessively sedated by the premedication. Patient-administered anxiolysis is suggested as a useful research tool in the examination of anxiety and of value in premedicating patients with high preoperative anxiety levels.