Attentuation of the peroperative stress response with midazolam - Effects on postoperative outcomes

Background. Previously, effects of preoperative sedatives were assessed mai nly with respect to preoperative outcomes such as anxiety and compliance. T he purpose of this investigation was to evaluate the effects of preoperativ e 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 midaz olam (n = 26) or a placebo injection (n = 29) at least 30 min before surger y. The anesthetic technique was controlled. Postoperative anxiety, pain, an algesic: consumption, clinical recovery parameters, and global health (SF-S G) 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 t he first postoperative week, subjects in the treatment group reported a gre ater reduction in postoperative pain compared with subjects in the placebo group (F-1,F-50 = 3.5; P = 0.035). Moreover, at 1 week, ibuprofen use was r eported 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 gr eater reduction in postoperative anxiety throughout the follow-up period(F- 1,F-53 = 9.2; P = 0.04). However, global health indexes (SF-36) did not det ect any significant differences between the two experimental groups (multiv ariate F-1,F-45 = 0.44; P = 0.51). Conclusion: Subjects treated with midazolam preoperatively self-report impr oved postoperative psychological and pain recovery. However, the clinical s ignificance of these findings is unclear at the present time.