The use of oral benzodiazepines as premedications: the usefulness of temazepam

Pharmacological premedication for anaesthesia

The psychological component of preoperative preparation should be completed with a selective use of drugs. The days of poly-pharmacy are over. Heavily sedated patients coming to the operation room with minimal oral secretions are not the purpose of modern premedication. Anxiolysis and slight sedation (painless patients) and analgesia (patients suffering from pain) are the main goals. Anticholinergics should be used only when needed, as is the case with premedication generally. The use of antiemetics and that of agents given for prophylaxis against allergic reactions or aspiration pneumonitis depend on specific needs of the patient. More accurate and generally accepted but simple methods are needed in studying the effects of different premedicants. The present results produced with a huge number of different more or less validated assessments can seldom be compared with each other.

The relationship between clinical effect and concentrations of temazepam in plasma and cerebrospinal fluid

The clinical pharmacodynamics of temazepam were investigated in patients who received spinal anaesthesia. Total plasma and cerebrospinal fluid temazepam concentrations were measured and correlated with the clinical effects. Sedation was measured by three separate methods. None, including an aggregated score of all three measures, was correlated closely with either the plasma or the cerebrospinal fluid levels (p = 0.86 and 0.12 respectively). Anxiety was measured before and after premedication. The two scores were correlated but the change in anxiety after premedication did not correlate with either the plasma or the cerebrospinal fluid concentrations (p = 0.11 and 0.45 respectively). Short-term memory was measured before and after premedication. The decline in short-term memory ability was moderately well correlated with both the plasma and the cerebrospinal fluid levels (p = 0.0005 and 0.013 respectively). With temazepam, the variation in sedative and anxiolytic effects between subjects is explained not by differences in pharmacokinetics but rather by differences in the pharmacodynamic response. Because sedative and anxiolytic effects are poorly correlated, but the amnesic effect is well correlated with temazepam concentrations, different sites of action for these effects are suggested.

Attenuation of anxiety in ambulatory oral surgery patients with oral triazolam

The purpose of this investigation was to determine if the preoperative administration of an oral anxiolytic agent (triazolam) is beneficial in reducing the cardiovascular response to stress and anxiety. Twelve consecutive patients, six who received the drug and six who received a placebo, were monitored from the night before surgery at home until the morning with a Holter monitor. On presentation for surgery, levels of anxiety as well as heart rate and presence of cardiac arrhythmias were determined for the two groups. Patients who received the study medication had an anxiety level on the day of surgery similar to that recorded at an earlier consultation visit, whereas the placebo group showed a tendency toward an increase in anxiety on the day of surgery. There was a significant difference for resting heart rate between the two groups at various intervals associated with the preparation for the surgery. There were no complications related to the medication and, therefore, on the basis of this study, it appears that the administration of an oral anxiolytic agent prior to the patient presenting for surgery is beneficial in reducing the stress and anxiety associated with the operation as well as in reducing some of the cardiac manifestations of this stress.

Temazepam or midazolam for night sedation. A double-blind study

The effects of oral temazepam (20 mg), oral midazolam (15 mg) and a placebo were compared for night sedation on the evening prior to surgery in a double-blind study. Patients in the placebo group had significantly worse sleep than those in the temazepam (p = 0.004) or midazolam groups (p = 0.04). There was no significant difference between the two drug groups, nor between the residual effects of the three treatments. Temazepam appears to be somewhat more effective than the ultrashort-acting midazolam in pre-operative transient insomnia.