Key result
Lorazepam premedication resulted in 67% and 60% of patients not remembering i.v. insertion or recovery room stay, respectively (P<0.01 vs other groups), though satisfaction depended on expectations.
Why the study?
Does the match between patients' expectations and the actual amnesic effect of preanaesthetic medication affect their postoperative satisfaction?
RCT (n=130)
Random fashion
Does the match between patients' expectations and the actual amnesic effect of preanaesthetic medication affect their postoperative satisfaction?
p-value: p=<0.01
Patients' preferences for light versus amnesic premedication should be considered, as receiving an unexpected amnesic premedication leads to lower satisfaction.
Match patient expectations to premedication amnesia effects to maximize satisfaction; extends evidence for individualized preoperative care.
Patients (130) scheduled for elective general surgery under balanced general anaesthesia were interviewed on the day before operation and asked whether they wanted a light premedication allowing them to remember all events before and after surgery or whether they wanted a potent premedication rendering them amnesic for the events before and after operation. Regardless of their preferences, the patients were given 1 mg/kgofpethidine; 12.5 to 50 mg of promethazine, plus 0.14 mg/kg oxycodone; or 0.05 mg/kg of lorazepam; and 0.01 mg/kg of atropine intramuscularly in random fashion as preanaesthetic medication before operation. On the first postoperative day, patients were questioned again about their opinions of the premedication. Most patients wanted light (53%) or moderate (22%) premedication, and only 5% wanted to receive amnesic premedication. Assessments of degree of fatigue and apprehension were similar after each premedication when assessed before operation. Sixty‐seven and 60% of the patients receiving lorazepam did not remember insertion of the i.v. needle before induction of anaesthesia or the stay in the recovery room, respectively (P<0.01 vs. other groups), whereas most of the patients given pethidine or oxycodone recalled the events before and after operation. Almost all the patients who both expected and received a light (91% acceptance) or an amnesic (100% acceptance) premedication accepted it. However, only 58% of patients who expected to be given a light but received an amnesic premedication were satisfied with it, whereas 89% of patients who expected an amnesic but received a light premedication accepted it. It is concluded that patients' opinions on the potency and capacity of preanaesthetic medication to produce amnesic action should be taken into account in routine clinical work. Administration of a potent, amnesic premedication is indicated only if patients prefer it to light premedication.
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Korttila et al. (1981) conducted an RCT in Elective general surgery (n=130). Lorazepam vs. Pethidine (1 mg/kg) or Promethazine (12.5-50 mg) plus Oxycodone (0.14 mg/kg) was evaluated on Amnesia for insertion of the i.v. needle before induction of anaesthesia (p=<0.01). Lorazepam premedication resulted in 67% and 60% of patients not remembering i.v. insertion or recovery room stay, respectively (P<0.01 vs other groups), though satisfaction depended on expectations.
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