Effectiveness of benzodiazepine premedication on recovery in day-case surgery: a systematic review with meta-analysis

INTRODUCTION: Benzodiazepines are frequently used as a premedication. In day-case surgery, anesthetists are reluctant to administer benzodiazepines preoperatively for reasons of delayed recovery. However, premedication with benzodiazepines might be beneficial regarding postoperative somatic symptoms/complaints (i.e. time to recovery and postoperative side effects) and psychological phenomena. EVIDENCE ACQUISITION: A systematic review with meta-analysis was performed using all important search engines. Study methodological quality was assessed using risk of bias tables. Mean differences (MD) and odds ratios (OR) were used for continuous data (time to recovery and psychological phenomena) and categorical data (postoperative somatic symptoms) respectively. Random effects modelling was applied. Nineteen studies were included. Overall time to recovery was significantly delayed in patients receiving benzodiazepines (MD 1.75; 95% CI 0.82 to 2.69) although time to discharge was not significantly affected. Postoperative side effects were significantly reduced in patients receiving benzodiazepines (OR 0.47; 95% CI 0.36 to 0.63). Regarding psychological outcome, only anxiety could be statistically analyzed showing no statistical difference (MD 1.47; 95% CI -1.01 to 3.96). EVIDENCE SYNTHESIS: Although overall time to recovery was significantly prolonged by benzodiazepine premedication, withholding premedication in day-case surgery patients is not justified for such reason, as time to discharge was not negatively affected. Furthermore, benzodiazepines show to have beneficial effects on postoperative side effects. CONCLUSIONS: For a firm conclusion regarding psychological phenomena, more research is needed. Anaesthetists should take into account this new evidence when they apply their premedication regime in day-case surgery.