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A year in review in Minerva Anestesiologica 2016

2017; Edizioni Minerva Medica; Volume: 83; Issue: 2 Linguagem: Inglês

10.23736/s0375-9393.17.11971-1

1827-1596

Franco Cavaliere, Marco Rossi, Massimo Allegri, Alparslan Apan, Edoardo Calderini, Massimiliano Carassiti, Flaminia Coluzzi, Pierangelo Di Marco, Olivier Langeron, Marco Piastra,

Cardiac, Anesthesia and Surgical Outcomes

MiNerVa aNestesiologica 225 ed out that in most cases, the need for anxiolytic medication may be cancelled by means of a good preoperative interview. 3ntravenous premedication with short-acting drugs provides an alternative to traditional BDZ administration. 4White et al. compared the effects of sub-hypnotic intravenous doses of propofol 20 mg, and midazolam 2 mg, given in the preoperative holding area just before being transferred to the operating theatre.Both drugs caused significant anxiolytic, sedative, and amnestic effects, without cardiorespiratory depression. 5the only difference was a stronger amnestic effect of midazolam.the authors recommended to respect proper dose/ body weight relationships (0.2-0.4 mg/kg for propofol, 25 µg/kg for midazolam) in order to avoid undesirable effects, particularly in elderly and high-risk patients.elderly people are particularly prone to develop postoperative delirium (PoD), which often delay the discharge from the hospital, prevents full return to normal life, and increases social costs of healthcare. 6 stukenberg et al. carried out a secondary analysis on data General anesthesiaaccording to the principles of enhanced recovery after surgery (eras), a recommendation of grade strong has been issued to avoid anxiolytics for premedication because they could delay postoperative recovery. 1the april issue of Minerva Anestesiologica contained a systematic review by Mijderwijk et al. on premedication with benzodiazepines (BZDs) in one-day surgery. 2 the associated meta-analysis showed that BDZs increased time to recovery, but not time to discharge to wards, and reduced the incidence of postoperative nausea and headache, but did not improve anxiety and, in general, psychological outcome.the authors concluded that withholding benzodiazepine premedication to avoid delayed discharge to wards is not evidence-based.However, the main quality of the nineteen studies reviewed was not high, because most of them investigated only oral administration, some were very old, and some pulled different BDZs and routes of administration together.