PREMEDICATION IN THE UNITED-STATES - A STATUS-REPORT

We undertook a mailing survey study to assess the current practice of sedative premedication in anesthesia. A total of 5396 questionnaires w ere mailed to randomly selected physician members of the American Soci ety of Anesthesiologists. Forty-six percent (n = 2421) of those sample d returned the questionnaire after two mailings. The reported rate of sedative premedication in the United States varied widely among age gr oups and geographical locations. Premedicant sedative drugs were least often used with children younger than age 3 years and most often used with adults less than 65 years of age (25% vs 75%, P = 0.001). Midazo lam was the most frequently used premedicant both in adults and childr en (>75%). When analyzed based on geographical locations, use of sedat ive premedicants among adults was least frequent in the Northeast regi on and most frequent in the Southeast region (50% vs 90%, P = 0.001). When the frequency of premedication was examined against health mainte nance organization (HMO) penetration (i.e., HMO enrollment by total po pulation) in the various geographical regions, correlation coefficient s (r) ranged from -0.96 to -0.54. Multivariable analysis revealed that HMO penetration is an independent predictor for the use of premedicat ion in adults and children. The marked variation among geographical ar eas in premedicant usage patterns underscores the lack of consensus am ong anesthesiologists about the need for premedication. The data sugge st that HMO participation may affect delivery of this component of ane sthetic care.