Premedication with oral and rectal diazepam

Area of Science:

• Anesthesiology
• Clinical Pharmacology

Background:

• Esophageal retention of oral diazepam tablets has been suggested as a clinical issue.
• Rectal administration of diazepam is proposed as a potentially superior alternative.

Purpose of the Study:

• To compare the efficacy and safety of oral versus rectal diazepam for patient premedication.
• To investigate the clinical significance of esophageal diazepam tablet retention.

Main Methods:

• A randomized, double-dummy study involving 100 patients.
• Patients received either 15 mg oral diazepam or 10 mg rectal diazepam solution.
• Sedative effects and pre-induction anxiety levels were assessed.

Main Results:

• Oral diazepam (50%) resulted in a significantly higher sedative effect compared to rectal administration (20%) (P<0.05).
• Anxiety levels before induction were not significantly different between groups (9% oral vs. 18% rectal).
• Plasma concentrations were higher with oral tablets, but no clear correlation with sedative effect was found.

Conclusions:

• Oral diazepam demonstrated a more potent sedative effect than rectal administration in this study.
• No evidence of persistent esophageal retention of diazepam tablets was observed.
• Rectal diazepam was not found to be a clinically advantageous alternative for premedication in this patient cohort.