A randomized clinical trial to compare the amnestic effect following oral premedication with midazolam and alprazolam in patients undergoing surgery under general anaesthesia – comparative clinical trial at KLES Dr. Prabhakar Kore hospital and medical research centre

Abstract

Background and Objectives ABSTRACT Anaesthetic memory and awareness continues to occur both in adults and at a higher rate in children. Anaesthetic awareness and memory is a potent precipitant for anxiety, depression and post-traumatic stress disorder (PSTD). Various benzodiazepines are used with varying efficacy to prevent memory formation, to produce anxiolysis and sedation. In this study we compare the efficacy of oral midazolam and alprazolam on amnesia, anxiolysis and sedation. Methods This one year comparative clinical trial was done on 120 patients scheduled for surgeries under general anaesthesia at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Patients were allocated into two groups. Anaesthetic technique was standardized for all patients. Patients were given oral midazolam 7.5 mg (Group-B) or oral alprazolam 0.5 mg (Group- A) 60 minutes before surgery. Amnesia, memory test, anxiety and sedation were assessed using abbreviated Westmead post-traumatic amnesia (PTA) scale, questionnaire, 0 to 100 mm VAS and five-point objective scale respectively. Results Amnesia was better with midazolam with a mean of 0.25 when compared to alprazolam of 2.5 using a modified W-PTA scale. It was also better with a mean of 0.58 when compared to alprazolam with a mean of 2.56 in the memory questionnaire. At 60 min,at arrival and discharge from PACU, the mean VAS VIII scores for alprazolam were lower than midazolam. At 60 minutes, at arrival and discharge from PACU, sedation scores were higher in the midazolam group. Conclusion and interpretation The results of present study showed midazolam provides better amnesia and sedation than alprazolam, while latter is a better anxiolytic.