Safety and Efficacy of Oral Benzodiazepines for Periprocedural Anxiolysis: A Systematic Review

Boettler, Michelle A.; Shahwan, Kathryn T.; Cusick, Austin; Avila, Christina; Carr, David

doi:10.1097/dss.0000000000003407

Cited by 4 publications

(10 citation statements)

References 20 publications

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“…Although BZDs are commonly used for periprocedural anxiolysis, there is a risk for dependence with overuse as cautioned with an FDA black-box warning. 11 These risks would be negligible in the MMS setting because dosage is single use, and dependence has been shown to correlate with the duration of use. 11,31 Furthermore, anxiolytics may reduce the need for pain medications, including opioids, post surgery.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] A systematic review of oral BZD use in outpatient procedures (including 445 MMS procedures), performed under local anesthesia, showed that BZDs provided anxiolytic effects, with superior or equivalent scores in patient satisfaction and pain, in most studies. 11 A Medicare survey from 2013 to 2017 showed that 4% of Mohs surgeons have prescribed BZD. 12 For MMS, oral midazolam has good evidence showing significant reduction in short-term anxiety, an excellent safety profile, and good patient satisfaction.…”

mentioning

confidence: 99%

“…12 For MMS, oral midazolam has good evidence showing significant reduction in short-term anxiety, an excellent safety profile, and good patient satisfaction. 11,[13][14][15] Although oral midazolam is often used as a preoperative anxiolytic in the United States, 13,14 it is not available in an oral form in other countries including Canada and parts of Europe.…”

mentioning

confidence: 99%

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Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Guo,

Zloty,

Kossintseva

2023

Dermatol Surg

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BACKGROUND Patient anxiety can complicate surgical outcomes by elevating blood pressure, increasing the need for postoperative pain management, and reducing overall patient satisfaction. Despite the use of anxiolytic medications in outpatient procedures, there is limited comparative evidence on the efficacy and safety of these agents in Mohs micrographic surgery. OBJECTIVE To compare the effectiveness and safety of different preprocedural anxiolytic agents in Mohs surgery on perioperative patient anxiety and patient satisfaction. MATERIALS AND METHODS A double-blinded, randomized, placebo-controlled trial was conducted of 6 different preprocedural anxiolytic agents (lorazepam, diazepam, alprazolam, gabapentin, pregabalin, and melatonin) in 350 patients undergoing Mohs surgery. Anxiety and vital signs were recorded. RESULTS Diazepam demonstrated a statistically significant, sustained reduction in anxiety levels compared with placebo (p = .03). Gabapentin significantly reduced early anxiety (p = .02). Alprazolam showed a trend to early anxiety reduction (p = .08). Lorazepam (p = .73), pregabalin (p = .53), and melatonin (p = .24) failed to reduce patient anxiety compared with placebo at any time point. No anxiolytic significantly impacted any patient vital sign or cognition. CONCLUSION Although short-acting benzodiazepines and gamma-aminobutyric acid medications may have transient anxiolytic effects, a single oral dose of 5 mg of diazepam can provide a sustained anxiolytic effect in Mohs surgery, with excellent patient safety.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Guo,

Zloty,

Kossintseva

2023

Dermatol Surg

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“…Oral benzodiazepines form the backbone of traditional perioperative anxiolysis 18 . Benzodiazepines are γ‐aminobutyric acid agonists that reduce anxiety in smaller doses and cause temporary sedation, muscle relaxation, and anterograde amnesia in larger quantities.…”

Section: Noninvasive Anxiolysis Sedation and Analgesiamentioning

confidence: 99%

“…Benzodiazepines are γ‐aminobutyric acid agonists that reduce anxiety in smaller doses and cause temporary sedation, muscle relaxation, and anterograde amnesia in larger quantities. A systematic review of benzodiazepine usage for in‐office procedures shows a generally favorable safety profile with mild adverse reactions in transient hypoxic episodes, lightheadedness, and headaches 18 . When there is a concern for a benzodiazepine overdose, Flumazenil, a competitive benzodiazepine receptor antagonist, can be administered in the office.…”

Section: Noninvasive Anxiolysis Sedation and Analgesiamentioning

confidence: 99%

Anesthesia for office‐based facial plastic surgery procedures

Bharadwaj,

Dougherty

2023

World j. otorhinolaryngol.-head neck surg.

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ObjectiveThe objective of this study is to provide a state‐of‐the‐art review on the use of anesthetics for in‐office facial plastic procedures.MethodsA search was performed on PubMed, Embase, Web of Science, and Cochrane Review using the keywords “anesthesia,” “office‐based procedures,” “local anesthesia,” “facial plastics,” “oral sedation,” “moderate sedation,” and “deep sedation.”Results and ConclusionsOver the past few decades, the shift toward in‐office invasive procedures has increased patient convenience and decreased hospital resource utilization. Many tools exist to reduce patient anxiety and discomfort in an office‐based setting. With proper patient selection and technique, facial plastic surgeons can adequately anesthetize patients to perform Mohs reconstruction, cutaneous excisions, blepharoplasty, face‐lifts, and other in‐office procedures.

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Protein phosphatase 2A inhibitors: a possible pharmacotherapy for benzodiazepine dependence

Kobayashi,

Kitanaka,

Nakai

et al. 2024

Journal of Pharmacy and Pharmacology

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Objectives Benzodiazepines (BZDs) activate the γ-aminobutyric acid (GABA) subtype A (GABAA) receptors, and thus are widely used medicines for the treatment of anxiety and insomnia. For chronic use, tolerance to BZDs is a major problem. Patients with chronic insomnia that develop tolerance to BZDs lose therapeutic effects but also potentially suffer from BZD dependence resulting in BZD withdrawal. The development of such treatments is important for the appropriate use of BZDs. Methods Research articles regarding investigation of BZD dependence were searched on PubMed, Embase, and Scopus databases using keywords “benzodiazepine”, “dependence”, “treatment”. Key findings When BZDs are taken chronically, continuous GABAA binding results in up-regulation of α-amino-3-hydroxy-5-methyl-4-lisoxazolepropionic acid (AMPA) glutamate receptor function and release of brain-derived neurotrophic factor (BDNF). Released BDNF binds to its specific receptor tropomyosin-related kinase receptor B (TrkB). Enhanced BDNF-TrkB signaling activates protein phosphatase 2A (PP2A). Activated PP2A dephosphorylates GABAA receptors, resulting in the downregulation of the GABAA receptor function. Reduced GABAA receptor function augments long-term potentiation (LTP), AMPA-mediated glutamatergic neuroplasticity, by reducing LTP inhibition by GABAA receptor function. Augmented LTP enhances extreme anxiety, which leads to BZD dependence. Conclusion Therefore, iInhibiting dephosphorylation of the GABAA receptor by PP2A, PP2A inhibitors could reduce LTP and anxiety, restoring BZD effectiveness and resulting in possible therapeutic effects for BZD dependence.

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Safety and Efficacy of Oral Benzodiazepines for Periprocedural Anxiolysis: A Systematic Review

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 4 publications

References 20 publications

Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Anesthesia for office‐based facial plastic surgery procedures

Protein phosphatase 2A inhibitors: a possible pharmacotherapy for benzodiazepine dependence

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