Lorazepam given the night before surgery reduces preoperative anxiety in children undergoing reconstructive burn surgery

A high level of preoperative anxiety frequently occurs in children undergoi ng reconstructive burn surgery. Reduction of this anxiety may have a number of physiological and psychological benefits. Various pharmaceutical and no npharmaceutical regimens to reduce preoperative anxiety have been devised; however, most regimens are not initiated until the period immediately befor e surgery. Many of the children in our institution report high levels of an xiety beginning the night before surgery. Therefore we hypothesized that se dation the night before surgery would be beneficial. Oral lorazepam 0.025 m g/kg or placebo was given the night before surgery to 45 patients in a pros pective, randomized, double-blind fashion; in addition, all patients receiv ed preoperative sedation per protocol on the day of surgery. Immediately be fore induction of anesthesia, all patients (mean age 12.5 +/- 0.9 years, ra nge 6 to 18 years) performed an anxiety self-rating with the use of a valid ated visual analog scale (VAS). Patient anxiety and quality of anesthesia i nduction was also rated by one of the investigators. Postoperatively, patie nts rated their recall of anxiety with the use of the VAS. When queried pre operatively, patients who received lorazepam the night before surgery self- reported significantly less anxiety than those receiving placebo. Investiga tor observations did not detect this difference; this reinforces the assert ion that patient self-rating of anxiety may be the best tool for rating anx iety.