Low-dose oral midazolam not linked to improved patient satisfaction after surgery

Premedication with low-dose oral midazolam in older patients undergoing a surgical procedure falls short of improving perioperative patient satisfaction, according to a study.

The study included 616 patients between 65 and 80 years of age who were scheduled for elective inpatient surgery for at least 30 minutes under general anaesthesia with planned extubation. These patients were randomly assigned to receive oral midazolam 3.75 mg (n=309) or placebo (n=307) 30–45 minutes before anaesthesia induction.

Global patient satisfaction, the primary outcome, was assessed using the self-reported Evaluation du Vécu de l’Anesthésie Generale (EVAN-G) questionnaire on the first postoperative day. Other outcomes examined were perioperative patient vital data, adverse events, serious complications, and cognitive and functional recovery up to 30 days postoperatively.

A total of 607 patients (mean age 71.9 years, 62.1 percent men) were included in the primary analysis. The mean global index of patient satisfaction did not significantly differ between the midazolam and placebo groups (69.5 vs 69.6, respectively; mean difference, −0.2, 95 percent confidence interval, −1.9 to 1.6; p=0.85).

Results of sensitivity (per-protocol population, multiple imputation) and subgroup analyses (presence of anxiety, frailty status, sex, and previous surgical experience) mirrored the primary results. Secondary outcomes were similar between the two treatment groups, except for a higher proportion of patients with hypertension (systolic blood pressure ≥160 mm Hg) at anaesthesia induction in the placebo group.