Antianxiety/sedative drugs. The benzodiazepines.

Oral presurgical medication with benzodiazepines carries several distinct advantages; it often reduces the patient's anxiety and allows for a "smoother" surgical procedure, provides analgesia, facilitates venipuncture, aids in the patient's tolerance of an ankle tourniquet, limits postoperative nausea and vomiting, and provides varying degrees of retrograde amnesia. Many podiatric surgeons prefer using oral anxiolytics/sedatives along with local anesthesia for their surgical patients because they are simple to use with in-office surgery. Patients may prefer this method because it allows them a sense of control and eliminates the fear of being "put to sleep." This method, however, is not without its potential drawbacks, as noted. The surgeon must be keenly aware of all the patient's medical problems and potential allergies, and how they may impact on the use of these agents. He or she also must be prepared to act in an emergency should an adverse reaction occur. The recovery time from local anesthesia with oral sedation can often be longer than from general anesthesia, and discharge may be delayed. The patient may have an unsteady gait for the period prior to complete drug elimination and may require assistance. If an oral agent is chosen, it must be administered early enough to provide the desired effect at the desired time. The clinician must be aware of the time to onset and the duration of action of the drug chosen. Dosage adjustments must be considered in the elderly, individuals with medical disorders, and patients taking multiple medications. If IV premedication is selected, the clinician must be even more aware of its potential effects and well trained in emergency procedures. IV administration allows the patient to present to the surgical suite without being sedated. The medication should be given shortly after venipuncture; the patient then becomes relaxed and ready for the local anesthesia. Intravenous sedation can be maintained throughout the procedure by carefully titrating small incremental doses; however, this requires close observation and monitoring of vital signs. This route often results in a faster drug elimination, patient recovery, and discharge. It has been said that the best preoperative anxiolytic is a complete, thorough, and reassuring preoperative explanation of the events that are to follow.(ABSTRACT TRUNCATED AT 400 WORDS)