Einfluss einer Prämedikation mit Dikaliumclorazepat auf den affektiven Zustand des Patienten vor einer Anästhesie

Summary Background: Current standardized operating procedures in preoperative anesthetic care comprise an interview (history taking, physical examination, analysis of preoperative findings, identification of special/individual risk factors, education and informed consent) as well as prescription of a psychotropic drug with anxiolytic action. Pharmacotherapy aims at avoiding distress and establishment of patient´s content and therapeutic success. Thus, all patients who undergo anesthesia in our hospital receive 20 or 50 mg dipotassium clorazeptate (Tranxilium®) at least 60 minutes before anesthesia is induced. The objective of the presented investigation was to critically scrutinize the efficacy of this common practice on a scientific basis. For this reason the anesthesiologist who established primary contact with the patient was completely free to choose the method of history taking as well as the amount of dipotassium clorazeptate administered. Methods: A total of 461 patients (255 females, 206 males) were included in this investigation with an average age of 49.8±16.0 years (range 18-86 years, median 48 years). Affective condition and preoperative fears were evaluated at three set points (i.e. before first contact with anesthesiologist, after history taking and talk down as well as 60 minutes after administration of dipotassium clorazeptate). Values were assessed with the aid of a questionnaire on preoperative fear, short questionnaire on present impairment as well as self-assessment of preoperative fears with a visual analogue scale (range 0-10; 0=no fear; 10=greatest imaginable fear). Results: 1. Preoperative administration of a psychotropic drug does not result in an additional improvement of emotional condition after initial contact with the anesthesiologist. 2. Patients with poor or negative information or experience concerning anesthesia carry an increased emotional load before initial contact with the anesthesiologist. This burden can be reduced to a greater extent in patients with negative information or experience by the primary anesthesiologist (visual analogue scale and questionnaire on present impairment). 3. Patients who are able to set confidence into the anesthesiologist and whose fears could be relieved by the initial contact with the anesthesiologist show a more intense change in the values for present emotional impairment. 4. Female patients suffer from vague fears about anesthesia. On top of that the incidence of being afraid of not awakening after anesthesia as well as unwanted awareness during anesthesia is much higher in females as compared to male patients. 5. After initial contact with the anesthesiologist emotional as well as mental pressure rises until anesthesia is induced. If this anxiety could be reduced during premedication, increase of stress was not as clear. Conclusion: This investigation clearly demonstrates the benefit of a personal encounter with the anesthesiologist on relieving emotional as well as mental stress before the anesthesia even if the conversation does not strictly follow pre-set parameters. Comparable degree of emotional load reduction was not observed at the third set point of this investigation (after administering dipotassium clorazepate). Precise statements on the effect of the psychotropic drug cannot be given, though results of this investigation hint towards the fact that the effect of anxiolytic pharmacologic premedication before anesthesia may be overestimated. Patients with poor or negative information or experience require special attention as their load can be dramatically reduced by the personal contact with the anesthesiologist. Emotional load can be alleviated and satisfaction can be increased if the same anesthesiologist who first establishes contact and conducts the preoperative conversation also performs the anesthesia. Closing Remarks: The first contact and the preanesthetic conversation has tremendous impact on the entire course of surgical treatment regarding preoperative fear, emotional load and patient satisfaction. Preoperative administration of anxiolytic psychotropic drugs needs to be reevaluated scientifically.