Benzodiazepines are the most commonly used
anxiolytic agents. Among the
benzodiazepines,
midazolam has the advantage of a short elimination half-life, which is especially useful in
outpatient surgery. However, in contrast to other commonly prescribed
benzodiazepines, such as
chlorazepate dipotassium, oral
premedication with
midazolam has not been thoroughly investigated. Therefore, the present study was performed to compare anxiolysis, sedation and stress reduction with
midazolam and
clorazepate dipotassium in adults. METHODS. After IRB approval and informed consent had been obtained, 85 patients scheduled for breast biopsy were studied. The patients were chosen at random to receive either 7.5 mg
midazolam (n = 29), 20 mg
clorazepate dipotassium (n = 28) or placebo (n = 28) preoperatively. Before
premedication, immediately prior to surgery and postoperatively in the recovery room, the following parameters were determined with visual analogue scales (VAS): "
asthenia," "depression," oral salivation, muscle tension, motoric
restlessness and sweating of the palms. In addition, anxiety (STAI-G-X-1, Spielberger), heart rate and arterial blood pressure were measured. Before patients underwent surgery, the degree of sedation was evaluated by the anaesthesiologist. RESULTS.
Clorazepate dipotassium and
midazolam both caused a reduction in anxiety as compared with the placebo (P < 0.05). Only
clorazepate dipotassium reduced anxiety postoperatively (P < 0.05). Neither
midazolam nor
clorazepate dipotassium caused a reduction in "
asthenia" and "depression."
Midazolam was more effective in preventing increased blood pressure than
clorazepate dipotassium and the placebo (P < 0.05). Furthermore, after
premedication with
midazolam, salivation, muscle tension, motoric
restlessness and sweating of the palms remained stable, in contrast to the results after
premedication using
clorazepate dipotassium or placebo (P < 0.05). CONCLUSIONS. The
anxiolytic effects of 7.5 mg
midazolam and 20 mg
clorazepate dipotassium were similar after oral application. However, the
anxiolytic effect of
midazolam is shorter-lived than that of
clorazepate dipotassium. In contrast to
clorazepate dipotassium,
midazolam produced no increase in arterial blood pressure and stabilized oral salivation, production in the palms, muscle tension and motoric
restlessness.