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A comparison of propranolol and diazepam for preoperative anxiolysis

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Abstract

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.

Résumé

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.

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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