Attenuation of the preoperative stress response with midazolam: effects on postoperative outcomes.

BACKGROUND: Previously, effects of preoperative sedatives were assessed mainly with respect to preoperative outcomes such as anxiety and compliance. The purpose of this investigation was to evaluate the effects of preoperative sedatives on postoperative psychological and clinical recovery. METHODS: Patients undergoing general anesthesia and outpatient surgery were enrolled in a double-blind, randomized, placebo-controlled trial. Subjects (n = 55) were randomly assigned to receive either 5 mg intramuscular midazolam (n = 26) or a placebo injection (n = 29) at least 30 min before surgery. The anesthetic technique was controlled. Postoperative anxiety, pain, analgesic consumption, clinical recovery parameters, and global health (SF-36) were evaluated up to 1 month after surgery. RESULTS: Surgery length did not differ significantly between the treatment and placebo groups (118 +/- 45 min vs 129 +/- 53 min; P = NS). Throughout the first postoperative week, subjects in the treatment group reported a greater reduction in postoperative pain compared with subjects in the placebo group (F1,50= 3.5; P = 0.035). Moreover, at 1 week, ibuprofen use was reported by less subjects in the treatment group than in the placebo group (0% vs 17.2%; P = 0.026). Subjects in the treatment group also reported a greater reduction in postoperative anxiety throughout the follow-up period (F1,53 = 9.2; P = 0.04). However, global health indexes (SF-36) did not detect any significant differences between the two experimental groups (multivariate F1,45 = 0.44; P = 0.51). CONCLUSION: Subjects treated with midazolam preoperatively self-report improved postoperative psychological and pain recovery. However, the clinical significance of these findings is unclear at the present time.

Desire for perioperative information in adult patients: a cross-sectional study.

STUDY OBJECTIVE: To identify which perioperative information outpatients want from their anesthesiologist. DESIGN: Cross-sectional study. SETTING: Outpatient center. PATIENTS: 197 ASA physical status I and II patients undergoing outpatient surgery. INTERVENTIONS: A questionnaire examining for "desire for information". MEASUREMENTS AND MAIN RESULTS: Demographic data including age, ethnicity, gender, socioeconomic status, and history of previous surgery were obtained. Trait, situational anxiety, and coping strategy were assessed using a validated behavioral instrument and a questionnaire adopted from previous studies conducted in Australia, Scotland, and Canada. Each questionnaire contained 14 statements regarding specific perioperative details. An index of the overall patient desire for information (PDI) was calculated for each subject. More than 85% of subjects gave a high priority to being informed for all the 14 items. Scores on the overall index were found to be higher for females than for males (32 +/- 6 vs. 30 +/- 6; p = 0.03), and this finding persisted in a multivariable model that also included coping strategies and anxiety (DF = 1,175, F = 4.6, p = 0.01). Subjects also had higher PDI scores if a first degree relative had a history of previous surgery (33 +/- 5 vs. 31 +/- 6; p = 0.007). On analysis of individual questionnaire items, Latino Americans were significantly less likely than European Americans or African Americans to desire perioperative information (p < 0.05). Similarly, females had a significantly higher desire for information than males. Subjects who were divorced demonstrated a higher desire for information than did single or married subjects. CONCLUSIONS: Ethnicity, gender, coping mechanism, marital status, and a history of previous surgery in a relative have been identified as predictors for the desire for information.

Time required for oral ranitidine to decrease gastric fluid acidity.

This study documented gastric fluid acidity in ambulatory surgical patients 30-120 min after they had taken a 300-mg tablet of ranitidine, as changes specific to this relatively brief dose-to-sampling interval previously had not been delineated. At 20-120 min before outpatient surgery, ranitidine was given with 15 mL of water to 112 ASA physical status I-III adults without increased risk factors for aspiration of acidic gastric contents. After induction of general endotracheal anesthesia, the gastric fluid was aspirated. Volume and pH were compared with a reference group (pH = 1.6 +/- 1; n = 161) that did not receive an H2-antagonist or water. Of 40 patients sampled at 30-60 min after dosing, 26 had pH greater than or equal to 2.5; mean pH was 3.9 +/- 2 (P less than 0.05 vs reference by Wilcoxon signed rank and chi 2 tests). Beyond 90 min, 28 of 28 patients had a pH greater than or equal to 2.5, with a mean of 6.3 +/- 1. No significant differences were noted with respect to mean gastric volume. We conclude that in patients without additional risk factors, oral ranitidine consistently prevents acid production when it is administered more than 90 min before induction of anesthesia.