Day case surgery, where patients are sent home on the same day as the operation, is a common clinical practice which is no longer confined to simple procedures. Premedication with drugs to reduce anxiety prior to general anaesthesia may be withheld from patients due to concerns that they may delay recovery after surgery. This may reduce the efficiency of day surgery units and has important economic considerations. It may also lead to unanticipated hospital admission which can be unacceptable for patients. However, some patients would still like the option of anxiety reducing medication.
We identified 17 studies which compared premedication with a placebo prior to day case surgery. Twelve studies involved benzodiazepines (sedatives), two involved opioids (painkillers), two involved beta-blockers, one compared a benzodiazepine with a beta-blocker and one involved a herbal medication. In general, the studies were of poor quality and many used anaesthetic techniques which are no longer common. Only seven studies directly measured time to ambulation or discharge and found that this was not affected by the use of premedication. Some studies used specific tests to assess for residual effects of the premedication. Although these were often impaired after surgery, this did not appear to delay discharge.