Premedication to Reduce Anxiety in Patients Undergoing Coronary Angiography and Percutaneous Coronary Intervention

Overview

Journal Open Heart

Publisher BMJ Publishing Group

Specialty Cardiology & Vascular Diseases

Date 2018 Oct 3

PMID 30275956

Citations 2

Authors

Wieneke Vlastra

Ronak Delewi

Wim J Rohling

Tineke C Wagenaar

Alexander Hirsch

Martin G Meesterman

Marije M Vis

Joanna J Wykrzykowska

Karel T Koch

Robbert J de Winter

Jan Baan Jr

Jan J Piek

Mirjam A G Sprangers

Jose P S Henriques

Affiliations

Soon will be listed here.

Abstract

Aims: In this study, we examined the effects of the routinely administration of benzodiazepines on reducing periprocedural anxiety versus no premedication.

Methods: In this open label study, we enrolled 1683 patients undergoing diagnostic coronary angiograms (CAG) or percutaneous coronary interventions (PCI). Randomisation was simulated by systematically allocating patients in monthly rotational periods to lorazepam 1 mg/sl, oxazepam 10 mg/po, diazepam 5 mg/po, midazolam 7.5 mg/po or . Anxiety was measured at four different time points using the one-item Visual Analogue Scale for Anxiety (VAS score) ranging from 0 to 10. The primary outcome was the difference in anxiety reduction (ΔVAS, preprocedure to postprocedure), between the different premedication strategies versus .

Results: Anxiety reduction was larger in patients premedicated with lorazepam (ΔVAS=-2.0, SE=1.6, P=0.007) or diazepam (ΔVAS=-2.0, SE=1.5, p=0.003) compared with patients without any premedication (ΔVAS=-1.4, SE=1.2). The use of midazolam or oxazepam did not lead to a significant reduction in anxiety compared with patients who did not receive premedication. Additionally, a high number of patients treated with midazolam (N=39, 19.8%) developed side effects.

Conclusions: In this study, the use of lorazepam or diazepam was associated with a significant, but modest anxiety reduction in patients undergoing CAG or PCI. This study does not support the standard use of oxazepam or midazolam as premedication to reduce anxiety.

Citing Articles

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial.

Breunissen E, Groenveld T, Garms L, Bonnes J, Goor H, Damman P Open Heart. 2024; 11(1).

PMID: 38569670 PMC: 10989163. DOI: 10.1136/openhrt-2024-002628.

Clinical Practice Guidelines for Assessment and Management of Anxiety and Panic Disorders in Emergency Setting.

Raju N, Naga Pavan Kumar K, Nihal G Indian J Psychiatry. 2023; 65(2):181-185.

PMID: 37063628 PMC: 10096212. DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_489_22.

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