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A comparison of propranolol and diazepam for preoperative anxiolysis

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The effectiveness of propranolol, a nonsedating anxiolytic premedication, was studied by monitoring preoperative anxiety and postoperative recovery of cognitive function in 92 healthy ASA physical status 1 females aged 15–42 yr undergoing outpatient dilatation and curretage (D&C)for therapeutic abortion. In a randomized double-blind design, patients received one of the following oral medications 1–1.5 hr preoperatively: (1) diazepam 10 mg (n = 31); (2) propranolol 80 mg (n = 31); (3) placebo (n = 30). Anxiety throughout the hospital stay was monitored using the State-Trait Anxiety Inventory (STAI). Postoperative cognitive recovery was assessed using the digit span and Trieger tests. STAI anxiety levels were recorded on admission to hospital, immediately before entering the operating room, and two hours postoperatively. There was no difference among the anxiolytic properties of the three medications and all three patient groups showed a significant decrease in anxiety levels after administration of the medication. Tests of cognitive function after anaesthesia showed the fastest return to baseline status in patients receiving propranolol, possibly because beta adrenergic blockade blunted the autonomic signs of light anaesthesia and less anaesthetic was administered. None of the study premedications was demonstrated to have an anxiolytic advantage, but propranolol did offer a faster return of cognitive function in the postoperative period.


Nous avons voulu évaluer l’efficacité du propranolol à litre de prémédication anxiolytique non-sédative en mesurant le degré d’anxiété préopératoire et la rapidité de la récupération postopératoire des fonctions cognitives. Quatre-vingt douze femmes de 15 à 42 ans de classe ASA I, candidates à une dilatation cervicale et curetage pour avortement en externe, se sont prêtées à notre étude. Après randomisation à double-insu, elles prenaient par la bouche soit 10 mg de diazépam (n = 31), soit 80 mg de propranolol (n = 31), soit un placebo (n = 30) et ce, de 60 à 90 minutes avant l’intervention. Nous mesurions le niveau d’anxiété à l’admission, juste avant d’entrer en salle d’opération et deux heures après l’intervention en utilisant le «State-Trait Anxiety Inventory (STAI)». Le «digit span», test mnémonique numérique et le test de Trieger nous servaient à mesurer les fonctions cognitives avant et après l’opération. Les trois médications utilisés n’ont pas démontré de propriétés anxiolytiques différentes, les niveaux d’anxiété allant décroissant dans les trois groupes à partir de l’admission à l’hôpital. Par contre, après l’opération, les fonctions cognitives retournaient plus vite à la normale chez les patientes du groupe propranolol, peut-être parce que le blocage β-adrénergique avait permis de surestimer la profondeur de l’anesthésie pendant l’intervention entraînant l’utilisation de moindres doses d’anesthésique.


  1. 1

    James IM, Pearson RM, Griffith DNW, Newbury P. Effect of oxprenolol on stage-fright in musicians. Lancet 1977; 2: 952–4.

  2. 2

    Granville-Grossman KL, Turner P. The effect of propranolol on anxiety. Lancet 1966; 1: 788–90.

  3. 3

    Betts TA, Knight R, Crowe A, Blake A, Harvey A, Mortiboy D. Effect of beta blockers on psychomotor performance in normal volunteers. Eur J Clin Pharmacol 1985; 28: 39–49.

  4. 4

    Brantigan CO, Brantigan TA, Joseph N. Effect of beta blockade and stimulation of stage fright. Am J Med 1982; 72: 88–94.

  5. 5

    Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory Form Y (“Self Evaluation Questionnaire”). Palo Alto, Consulting Psychologists Press, 1983.

  6. 6

    Spielberger CD, Auerbach SM, Wadsworth AP, Dunn TM, Taulbee ES. Emotional reactions to surgery. J Consult Clin Psychol 1973; 40: 33–8.

  7. 7

    Lezak MD. Neuropsychological Assessment. Oxford University Press. 1983; 266–70.

  8. 8

    Newman MG, Trieger N, Miller JC. Measuring recovery from anesthesia — a simple test. Anesth Analg 1969; 48: 136–40.

  9. 9

    Tyrer PJ, Lader MH. Response to propranolol and diazepam in somatic and psychic anxiety. BMJ 1974; 2: 14–6.

  10. 10

    Burrows GD, Davies B, Fail L, Poynton C, Stevenson H. A placebo controlled trial of diazepam and oxprenolol for anxiety. Psychopharmacology 1976; 50: 177–9.

  11. 11

    Wheatley D. Comparative effects of propranolol and chlordiazepoxide in anxiety slates. Br J Psychiatry 1969; 115: 1411–2.

  12. 12

    Hartley LR, Ungapen S, Davie I, Spencer DJ. The effect of beta adrenergic blocking drugs on speakers’ performance and memory. Br J Psychiatry 1983; 142: 512–7.

  13. 13

    Siitonen L, Sonck T, Jänne J. Effect of beta-blockade on performance: use of beta-blockade in bowling and in shooting competitions. J Int Med Res 1977; 5: 359–66.

  14. 14

    Chung F, Houston PL, Cheng DCH et al. Calcium channel blockade does not offer adequate protection from perioperative myocardial ischemia. Anesthesiology 1988; 69: 343–7.

  15. 15

    Antrobus JHL. Anxiety and informed consent. Anaesthesia 1988; 43: 267–9.

  16. 16

    Arellano R, Cruise C, Chung F. Timing of the anesthetist’s preoperative outpatient interview. Anesth Analg 1989; 68: 645–8.

  17. 17

    Male CG, Lim YT, Male M, Stewart JM, Gibbs JM. Comparison of three benzodiazepines for oral premedication in minor gynaecological surgery. Br J Anaesth 1980; 52: 429–35.

  18. 18

    Jakobsen H, Hertz JB, Johansen JR, Hansen A, Kolliker K. Premedication before day surgery. Br J Anaesth 1985; 57: 300–5.

  19. 19

    Raeder JC, Breivik H. Premedication with midazolam in out-patient general anaesthesia. A comparison with morphine-scopolamine and placebo. Acta Anaesthesiol Scand 1987; 31: 509–14.

  20. 20

    Shafer A, White PF, Urquhart ML, Doze VA. Outpatient premedication: use of midazolam and opioid analgesics. Anesthesiology 1989; 71: 495–501.

  21. 21

    Assaf RAE, Dundee JW, Bali IM. Studies of drugs given before anaesthesia XXV: medazepam, a new benzodiazepine. Br J Anaesth 1975; 47: 464–7.

  22. 22

    Forrest WH, Brown CR, Brown BW. Subjective responses to six common preoperative medications. Anesthesiology 1977; 47: 241–7.

  23. 23

    Simpson KH, Dearden MJ, Ellis FR, Jack TM. Premedication with slow release morphine (MST) and adjuvants. Br J Anaesth 1988; 60: 825–30.

  24. 24

    O’Boyle CA, Barry H, Fox E, McCreary C, Brewley A. Controlled comparison of a new sublingual lormetazepam formulation and IV diazepam in outpatient minor oral surgery. Br J Anaesth 1988; 60: 419–25.

  25. 25

    O’Boyle CA, Harris D, Barry H, McCreary C, Brewley A, Fox E. Comparison of midazolam by mouth and diazepam IV in outpatient oral surgery. Br J Anaesth 1987; 59: 746–54.

  26. 26

    Artru AA, Dhamee MS, Seifen AB, Wright B. A reevaluation of the anxiolytic properties of intramuscular midazolam. Anaesth Intensive Care 1986; 14: 152–7.

  27. 27

    Forrest P, Galletly DC, Yee P. Placebo controlled comparison of midazolam, triazolam and diazepam as oral premedicants for outpatient anaesthesia. Anaesth Intensive Care 1987; 15:296–304.

  28. 28

    Pinnock CA, Fell D, Hunt PCW, Miller R, Smith G. A comparison of triazolam and diazepam as premedication agents for minor gynaecological surgery. Anaesthesia 1985; 40: 324–8.

  29. 29

    Raybould D, Bradshaw EG. Premedication for day case surgery. Anaesthesia 1987; 42: 591–5.

  30. 30

    Baughman VL, Becker GL, Ryan CM, Glaser M, Abenstein JP. Effectiveness of triazolam, diazepam, and placebo as preanesthetic medications. Anesthesiology 1989; 71: 196–200.

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Correspondence to F. Chung.

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Dyck, J.B., Chung, F. A comparison of propranolol and diazepam for preoperative anxiolysis. Can J Anaesth 38, 704–709 (1991). https://doi.org/10.1007/BF03008446

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Key Words

  • premedication: diazepam, propranolol
  • surgery: ambulatory