[Study of presurgical anxiety in urologic, gynecologic, and ophthalmologic surgery as a function of the administration or non-administration of anxiolytic premedication]

Abstract

Objective: Anxiety commonly appears before surgery, triggering a set of events that can be described as a general stress response. We measured changes in preoperative stress in relation to premedication or not with diazepam in patients undergoing urologic, gynecologic and ophthalmologic surgery.

Patients and method: We enrolled 87 patients undergoing elective surgery in urology (n = 30), gynecology (n = 30) and ophthalmology (n = 27). Randomly, the patients were premedicated with diazepam, placebo or nothing. During the preoperative visit the patient was administered a test to determine the level of anxiety and blood pressure, heart rate and potassium plasma concentration (K+) the night before surgery and moments before entering the operating theater.

Results: No significant differences in anxiety between patients undergoing different types of surgery were detected in the operating theater; however, at that time, anxiety was found to be significantly less among patients premedicated with diazepam than among those given placebo. Preoperative anxiety was significantly less in ophthalmology patients and in those premedicated with diazepam. Both systolic and diastolic blood pressure increased significantly among urologic and ophthalmologic surgery patients and in those who were not premedicated with diazepam regardless of type of surgery. Heart rate did not change significantly. Potassemia decreased significantly in all patients.

Conclusion: The discrepancy between the psychological and somatic response to the stress conditions studied may be the result of the calming effect of the preoperative visit by the anesthesiologist and to premedication with a tranquilizer. However, neither the preoperative visit nor premedication seem to completely block the stress response.