Non-Pharmacologic Premedication Before Surgery
Preoperative education and communication strategies are the cornerstone of non-pharmacologic premedication and can reduce patient anxiety to acceptable levels without requiring anxiolytic medication. 1
Primary Non-Pharmacologic Interventions
Preoperative Education Programs
- Attending a preoperative educational session (often called "Surgery School") with information about Enhanced Recovery After Surgery (ERAS) pathways successfully reduces patient anxiety and improves the perioperative experience 1
- Effective communication strategies should be employed days prior to hospital admission, as high anxiety levels occur well before surgery day in most patients 1
- Frank preoperative discussion is sufficient to effectively allay anxiety in many patients without any medication 2
Alternative Therapies for Anxiety and PONV Reduction
The following non-pharmacologic interventions have evidence supporting their use 1:
- Music therapy/musicotherapy 3
- Aromatherapy 1
- Acupuncture 1
- Hypnosis and guided imagery 3
- Relaxation techniques and training [1, 3
- Massage therapy 3
Additional Supportive Measures
- Avoiding prolonged starvation times and adhering to carbohydrate loading protocols reduces preoperative anxiety, hunger, and thirst [1, 1
- Allowing clear fluids up to 2 hours before surgery (rather than traditional overnight fasting) improves patient comfort and reduces anxiety 1
- Maternal or family presence during anesthesia induction (particularly for adolescents and younger patients) 3
- Distraction techniques and therapeutic play (especially in younger populations) 3
Clinical Implementation Strategy
Assessment Phase
- Identify patients with high preoperative anxiety levels through preoperative assessment 1
- Evaluate for catastrophizing and psychological distress, as these increase perioperative analgesic requirements and postoperative complication rates [1, 1
Intervention Selection
- For most patients: Implement preoperative education sessions combined with appropriate fasting guidelines (clear fluids until 2 hours, solids until 6 hours before surgery) [1, [1, 1
- For patients with moderate anxiety: Add music therapy, relaxation techniques, or aromatherapy [1, 3
- For patients with severe anxiety or specific phobias: Consider hypnosis, guided imagery, or acupuncture in addition to education [1, 3
Important Caveats
When Non-Pharmacologic Approaches May Be Insufficient
While non-pharmacologic interventions are highly effective, certain patient populations may still require pharmacologic anxiolysis despite optimal non-pharmacologic measures 1. However, the goal should always be to maximize non-pharmacologic strategies first before resorting to sedative medications, particularly in elderly patients where benzodiazepines carry significant risks of cognitive impairment, delirium, and falls [1, [1, 1
Timing Considerations
- Non-pharmacologic interventions should begin well before the day of surgery, as anxiety peaks days prior to hospital admission in most patients [1, 1
- Education programs are most effective when implemented 4-6 weeks before surgery as part of prehabilitation protocols 1