Archives of Critical Care Medicine

Background: Anxiety before surgery is a frequent occurrence in patients. There are several strategies such as visiting the patient before surgery, reinforcing the patient’s confidence through an intimate communication with a psychologist or giving sedation to minimize the surgery-related anxiety. Benzodiazepines and beta blockers are the most commonly used drugs to alleviate preoperative anxiety.

Objectives: The current study aimed to compare the effect of orally administered propranolol, lorazepam, and propranolol plus lorazepam on reducing patients’ anxiety before surgery and also on hemodynamic changes before and during operation.

Patients and Methods: This double-blind clinical trial was carried out on 75 patients of both genders aged 18 - 45 years considered as being American Society of Anesthesiologists (ASA) Physical Class (PS) 1 and ASA PS 2 categories according to the American Society for anesthesiologists physical status classification system. Patients were randomly divided into three equal groups marked as group A (lorazepam 2 mg), group B (propranolol 20 mg), and group C (lorazepam 2 mg plus propranolol 20 mg) who received the designated drug a night before the surgery. The degree of anxiety was assessed using the Amsterdam preoperative anxiety and information scale (APAIS). The level of anxiety, blood pressure, and heart rate were measured for all patients the night before surgery, on the day of surgery, and every five minutes from intubation time for a total of 15 minutes. Data analysis was performed by statistical tests including Anova and Chi-square test using SPSS version 15.

Results: The findings of the current study showed that all three drug groups could reduce the degree of anxiety however, lorazepam alone decreased anxiety more than the other two groups (P = 0.001). Furthermore, propranolol alone or in combination with lorazepam showed similar effect on reducing systolic blood pressure and heart rate when entering the operating room and during surgery (P > 0.05) whereas lorazepam alone had no significant effect on these hemodynamic parameters, statistically.

Conclusions: Considering the results obtained in the study, it was concluded that the combination of propranolol and lorazepam was a better premedication in patients with high stress who needed hemodynamic maintenance during surgery