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Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled
Danny Guo1, David M Zloty2, Irèn Kossintseva2
1Division of Dermatology, University of Calgary, Calgary, Alberta, Canada.
Background:
Patient anxiety can complicate surgical outcomes by elevating blood pressure, increasing the need for postoperative pain management, and reducing overall patient satisfaction. Despite the use of anxiolytic medications in outpatient procedures, there is limited comparative evidence on the efficacy and safety of these agents in Mohs micrographic surgery.
Objective:
To compare the effectiveness and safety of different preprocedural anxiolytic agents in Mohs surgery on perioperative patient anxiety and patient satisfaction.
Materials And Methods:
A double-blinded, randomized, placebo-controlled trial was conducted of 6 different preprocedural anxiolytic agents (lorazepam, diazepam, alprazolam, gabapentin, pregabalin, and melatonin) in 350 patients undergoing Mohs surgery. Anxiety and vital signs were recorded.
Results:
Diazepam demonstrated a statistically significant, sustained reduction in anxiety levels compared with placebo ( p = .03). Gabapentin significantly reduced early anxiety ( p = .02). Alprazolam showed a trend to early anxiety reduction ( p = .08). Lorazepam ( p = .73), pregabalin ( p = .53), and melatonin ( p = .24) failed to reduce patient anxiety compared with placebo at any time point. No anxiolytic significantly impacted any patient vital sign or cognition.
Conclusion:
Although short-acting benzodiazepines and gamma-aminobutyric acid medications may have transient anxiolytic effects, a single oral dose of 5 mg of diazepam can provide a sustained anxiolytic effect in Mohs surgery, with excellent patient safety.
Insights
Diazepam effectively reduced anxiety during Mohs surgery, unlike other tested agents. This study highlights diazepam as a safe and effective option for managing patient anxiety in this outpatient procedure.
Area of Science:
- Dermatology
- Pharmacology
- Surgical Anesthesia
Background:
- Patient anxiety negatively impacts surgical outcomes, including blood pressure, pain management, and satisfaction.
- Limited comparative data exists on anxiolytic efficacy and safety in Mohs micrographic surgery.
- Preprocedural anxiolytics are used, but their comparative effectiveness is not well-established.
Purpose of the Study:
- To compare the effectiveness and safety of various preprocedural anxiolytic agents in Mohs surgery.
- To evaluate the impact of these agents on perioperative patient anxiety.
- To assess the influence on patient satisfaction.
Main Methods:
- A double-blinded, randomized, placebo-controlled trial involving 350 patients undergoing Mohs surgery.
- Six anxiolytic agents were tested: lorazepam, diazepam, alprazolam, gabapentin, pregabalin, and melatonin.
- Anxiety levels and vital signs were systematically recorded.
Main Results:
- Diazepam showed a statistically significant, sustained reduction in anxiety compared to placebo (p = .03).
- Gabapentin significantly reduced early anxiety (p = .02), and alprazolam showed a trend (p = .08).
- Lorazepam, pregabalin, and melatonin did not significantly reduce anxiety; no agent affected vital signs or cognition.
Conclusions:
- A single oral dose of 5 mg diazepam provides sustained anxiolytic effects in Mohs surgery with excellent safety.
- Short-acting benzodiazepines and GABA medications may offer transient relief.
- Diazepam emerges as a preferred agent for managing anxiety in Mohs surgery patients.
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