Alprazolam and Anesthesia: Perioperative Management
You should generally continue your regular alprazolam on the day of surgery, but this decision must be discussed with your anesthesia team due to important safety considerations regarding respiratory depression and sedation when combined with anesthetic agents.
Key Safety Considerations
Additive Central Nervous System Depression
- Benzodiazepines like alprazolam can cause respiratory depression when combined with opioids, general anesthetics, and other central nervous system depressants, potentially leading to hypotension, profound sedation, and death 1.
- The anesthesia team needs to adjust dosing of anesthetic agents to account for the presence of alprazolam in your system 2.
Standard Perioperative Approach for Benzodiazepines
While the provided guidelines do not specifically address alprazolam continuation on the day of surgery, the evidence shows:
- Benzodiazepines are commonly used as premedication on the day of surgery to reduce anxiety and provide sedation before anesthesia 3, 4, 5.
- Short-acting benzodiazepines like midazolam are standard preoperative medications administered on the day of operation 3.
- Longer-acting benzodiazepines are typically given the evening before surgery 3, 4.
Special Population Warning
One guideline specifically lists alprazolam as "not recommended" for patients with renal failure on dialysis 1, though this applies to a specific population and may not be relevant to you.
Clinical Algorithm for Decision-Making
Inform your surgical and anesthesia team that you take alprazolam:
- They need to know the exact dose and timing of your last dose 1.
- The anesthesiologist will adjust anesthetic drug dosages accordingly to prevent excessive sedation 2.
- Monitor for prolonged sedation and respiratory depression in the recovery period 1.
Withdrawal risk versus sedation risk:
- Abrupt discontinuation of chronic benzodiazepines can cause withdrawal symptoms including anxiety, seizures, and autonomic instability.
- However, taking alprazolam on the day of surgery increases the risk of additive sedation with anesthetic agents 1.
Common Pitfalls to Avoid
- Never take alprazolam without informing your anesthesia team, as they must account for its effects when dosing anesthetic medications 1, 2.
- Do not take extra doses for anxiety on the day of surgery without explicit approval from your anesthesiologist 3.
- Be aware that the combination requires careful monitoring for respiratory depression throughout the perioperative period 1.
Bottom Line
Contact your anesthesiologist or surgeon's office before surgery to discuss your alprazolam use. They will provide specific instructions based on your dose, surgical procedure, and individual risk factors. The decision balances withdrawal risks against enhanced anesthetic effects, and must be individualized with your anesthesia provider's input 1, 3.