A CROSS-SECTIONAL COMPARATIVE OBSERVATIONAL STUDY ON ORAL PREMEDICATION EFFECT OF ALPRAZOLAM AND DIAZEPAM ON SELECT PSYCHOLOGICAL FUNCTIONS

Abstract

Background: Anxiety is an emotional state characterized by apprehension and
fear resulting from the anticipation of a threatening event.Preoperative anxiety
may lead to various problems and a wide range of physiological and
psychological responses. Various factors influencing anxiety in a patient
planned for surgery include age, gender, the extent and type of surgery,
previous hospital experiences, susceptibility to and ability to cope with stressful
experiences, and preoperative information. So the benefits of effective
premedication include a reduction in patient’s anxiety, facilitation of smooth
anaesthetic induction, reduction in reported undesirable postoperative
behavioural changes, and reduction in recoverytime.
Aim: To evaluate and compare the effects of oral Diazepam and oral
Alprazolam on preoperative anxiety, sedation, alertness, psychomotor and
cognitive functions on the morning of surgery.
Primary objective:
To compare oral premedicants Alprazolam and Diazepam in terms of sleep
quality and alertness on the morning of surgery.
Secondary objectives:
To compare oral Alprazolam and Diazepam in terms of
1. Level of anxiety andsedation
2. Psychomotor and cognitivefunction
3. Vitalparameters
4. Adverse effects, ifany
Methods: After obtaining institutional ethics committee clearance and
informed consent from the patients scheduled for surgery, 94 patients were
divided into two groups, A (Alprazolam) and D (Diazepam) by the consultant
anaesthesiologist.
Patients were given tablet Alprazolam or tablet Diazepam at 9 p.m. in the
preoperative night and 7 a.m. in the morning. Each patient's Non-Invasive
Blood Pressure (NIBP), Heart Rate (HR), and Respiration Rate (RR) were
monitored before premedication at 9 p.m. and after morning premedication at 7
a.m. The APAIS was used to assess the patient's level of anxiety and state of
mind just before the evening premedication was administered. The Digit
Symbol Substitution Test (DSST) and the Trail Making Test (TMT) were used
to provide a comprehensive assessment of the participant's cognitive and motor
skills before premedication at night and after morning premedication. After
giving morning premedication at 7.00 a.m., the patient‟s sedation level was
assessed at 8.00 a.m. using Richmond Agitation and Sedation Score (RAAS),
the patient's alertness and the previous night's sleep was studied using
Karolinska Sleep Diary (KSD) scoring. The patient‟sorientation was assessed
using Galveston Orientation Amnesia Test (GOAT) in the morning. Categorical
values were calculated using the Chi-square test and Fisher’s exact test.
Continuous variables were calculated using Unpaired t-tests, and MannWhitney U-test. Any value of P less than 0.05 was regarded to be statistically
significant.
Results: Both groups were comparable demographically. Baseline
haemodynamic parameters were also similar across the groups. After
premedication, the patients in the Diazepam group have taken a longer time to
complete Trail Making Test (TMT B) when compared to patients in the
Alprazolam group. This indicates executive functioning was preserved in the
Alprazolamgroup.
In the (KSD) assessment, patients in the Alprazolam group felt refreshed after
waking up and ease of waking up also was more in patients with the
Alprazolam group as premedication when compared to the Diazepam group.
Conclusion: We conclude that Alprazolam is a better premedication when
compared to Diazepam as morning alertness was better and it retained
executive functions. Thus Alprazolam is a better premedication when compared
to Diazepam in terms of preserving select psychological functions.