From the FDA Drug Label
Buspirone hydrochloride tablets are indicated for the management of anxiety disorder or the short-term relief of the symptoms of anxiety. The efficacy of buspirone hydrochloride tablets has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD). The patient's symptoms of anxiety and agitation may be managed with buspirone, as it is indicated for the management of anxiety disorder. However, it is essential to note that the effectiveness of buspirone in long-term use has not been demonstrated in controlled trials 1.
- Key considerations:
- Buspirone is indicated for anxiety disorder
- Efficacy demonstrated in controlled clinical trials for GAD
- Long-term use effectiveness not demonstrated in controlled trials Given the patient's postoperative anxiety and agitation, buspirone may be considered for short-term relief of anxiety symptoms, but the physician should periodically reassess the usefulness of the drug for the individual patient 1.
From the Research
I recommend administering a short-acting benzodiazepine like lorazepam (Ativan) 0.5-1mg orally or IV for this post-operative ACDF patient experiencing anxiety without pain, as it is a common and effective treatment for anxiety in the post-operative setting 2. Alternatively, hydroxyzine 25-50mg orally could be used if benzodiazepines are contraindicated.
Considerations for Treatment
For non-pharmacological approaches, encourage relaxation techniques, ensure a quiet environment, and consider having a family member present if possible. It's essential to address the patient's anxiety promptly as agitation can increase blood pressure and heart rate, potentially complicating recovery from cervical spine surgery.
Monitoring and Follow-up
Monitor the patient closely after medication administration for respiratory depression, especially if they're receiving other CNS depressants. If anxiety persists beyond the immediate post-operative period, consider consulting psychiatry for further management. Reassure the patient that post-operative anxiety is common and typically resolves as recovery progresses.
Relevant Evidence
A study published in 2022 found that patients with preoperative sleep difficulties, which can be related to anxiety, showed significant improvements in neck pain, arm pain, and physical function after ACDF surgery 2. Another study from 2020 identified risk factors for reintubation after ACDF, including older age, male sex, and high comorbidity burden, but did not specifically address anxiety management 3. However, the most recent and relevant evidence supports the use of short-acting benzodiazepines for anxiety management in the post-operative setting.
Key Points
- Administer a short-acting benzodiazepine like lorazepam (Ativan) 0.5-1mg orally or IV for anxiety
- Consider hydroxyzine 25-50mg orally if benzodiazepines are contraindicated
- Encourage relaxation techniques and ensure a quiet environment
- Monitor for respiratory depression and consider consulting psychiatry if anxiety persists