Conclusions
This article highlights our ignorance of the aetiology and natural history of preoperative anxiety, especially when considering particular patient subgroups. There is some evidence that we should give information and drug therapy much earlier than is currently practised; this will involve hospital personnel other than anaesthetists and perhaps even family physicians.
New tests are available to measure the efficacy of premedication but the validity of some of these has yet to be established. A protocol incorporating objective, subject rated and observer assessments of anxiety, which is acceptable, and gives reproducible results in different centres has yet to be devised.
There is little justification for the continued use of opiate premedication except for the treatment of pain or in preparation for painful procedures. A combination of opiate and benzodiazepine premedication does not adequately protect the cardiac patient for the insertion of invasive monitoring, in the absence of beta blockade. Anticholinergics should only be used for premedication when adequate blockage of salivation cannot be achieved predictably with intravenous administration at induction.
Benzodiazepines come nearest to the ideal of anxiolysis with minimal side effects. However, the role of the newer shorter acting drugs has yet to be established. The number of benzodiazepines currently available cannot be justified in terms of diversity of action, duration or side effects. Certainly an anaesthetist’s requirements could be satisfied with two or three compounds of varying duration which could be administered by both parenteral and oral routes.
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Madej, T.H., Paasuke, R.T. Review Article. Can J Anaesth 34, 259–273 (1987). https://doi.org/10.1007/BF03015163
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DOI: https://doi.org/10.1007/BF03015163