THE BENZODIAZEPINE-DEPENDENT PATIENT - PE RIOPERATIVE CONSIDERATIONS

Benzodiazepines which are known to have beneficial effects with regard to their anxiolytic action in premedication and their potentiating ef fect in conjunction with a volatile or an intravenous type of anaesthe sia, Due to the extensive investigation in regard to their mode and si te of action, it is known that they bind to specific receptor sites in selective brain areas, Also, it is known that different ligands have different potencies which is derived from their difference in affinity to their binding site, Their wide margin of safety and the existence of a highly specific antagonist make this group of compounds relativel y safe in cases of a potential overdose, However, as a regular prescri ption medication, especially in women over the age of 50, potentiation of anaesthesia has to be anticipated in patients with a history of tr anquilizer intake, Especially a so called low-dose dependency, often n ot considered important in premedical evaluation, may result in unexpe cted cardiovascular reactions and more so in an overhang of anaestheti cs with an ensueing respiratory depression, But more important is a po tential withdrawal syndrome in the postoperative period which may resu lt in typical symptoms culminating in life-threatening epileptic seizu res, Such an increased activity of the central nervous system is to be treated immediately by the injection of a benzodiazepine or a barbitu rate. The management of addictive disorders and especially that of a l ow-dose benzodiazepine dependency, is by tapering down the dose over s everal weeks, In elderly patients, the potential benefits of withdrawa l from benzodiazepine dependency are outweighted by the negative side- effects.