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[Stress reduction by i.m. premedication with 6 different single substances]
Anasthesie, Intensivtherapie, Notfallmedizin
|February 1, 1984
Summary
Flunitrazepam, diazepam, and triflupromazine effectively reduced preoperative anxiety and stress. Patients preferred these, along with placebo, over other tested premedications like droperidol and pethidine.
Area of Science:
- Anesthesiology and Pharmacology
- Preoperative Medicine
- Psychopharmacology
Background:
- Preoperative anxiety and stress significantly impact patient outcomes.
- Effective premedication is crucial for managing surgical stress and improving patient experience.
- Several pharmacological agents are used for intramuscular premedication, each with varying efficacy and side effect profiles.
Purpose of the Study:
- To compare the efficacy of six intramuscular premedication substances against placebo in reducing preoperative stress.
- To evaluate the effects on anxiety, depression, asthenia, and physiological stress markers.
- To assess sedation levels, side effects, and patient preference post-surgery.
Main Methods:
- Three prospective randomized studies involving intramuscular administration of diazepam, flunitrazepam, droperidol, triflupromazine, pethidine, and buprenorphine compared to placebo (NaCl 0.9%).
- Psychometrical methods (ESB), heart rate, blood pressure, and plasma-cortisol levels were used to evaluate stress.
- Sedation and side effects were systematically recorded, and patient preferences were assessed the day after surgery.
Main Results:
- Flunitrazepam, diazepam, and triflupromazine showed good anxiolytic effects. Pethidine and droperidol had the least anxiolytic effect.
- Diazepam and flunitrazepam positively influenced physiological stress parameters, unlike placebo and droperidol.
- Patient preference ranked placebo, flunitrazepam, diazepam, and triflupromazine highest, with droperidol being the least preferred due to side effects like nausea, vomiting, and neurological issues.
Conclusions:
- Flunitrazepam, diazepam, and triflupromazine are effective premedications for reducing preoperative anxiety and stress.
- Droperidol and pethidine demonstrated poorer anxiolytic effects and were associated with more adverse events.
- Patient-reported outcomes and preference highlight the superiority of certain agents over others for preoperative management.