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VOLUME 5 , ISSUE 1 ( January-March, 2019 ) > List of Articles


Awareness during Anesthesia—Role of Benzodiazepines as a Premedicant

Ananda Bhat, Balajibabu Perumala Ramanna, Ashwini Thimmarayappa

Keywords : Anesthesia, Awareness, Benzodiazepines, Premedication

DOI: 10.5005/jp-journals-10045-00102

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Awareness during anesthesia is a frightening experience. Benzodiazepines like lorazepam have been used to decrease awareness and also to cause amnesia. However, there is insufficient evidence established regarding their efficacy and effectiveness. This study was carried out to evaluate the efficacy of benzodiazepines in minimizing the awareness during general anesthesia. Methods: This randomized controlled trial was undertaken on 100 patients who underwent various elective surgical procedures. Each group consisted of 50 participants who were randomly allocated based on the computer-generated random numbers. The experimental group received midazolam as a premedicant in addition to atropine, while the control group received only atropine. Results: In this study, the overall incidence of awareness was 16%. The incidence was higher in the control group (24%) compared to that in the experimental group (8%). In the control group, awareness was characterized by hearing conversation/music in 58.3% of the participants, followed by remembrance of intraoperative events in 41.6% of the participants. In the experimental group, awareness was pertained to dreaming in all the four participants (100%). Conclusion: There was a significant higher incidence of awareness under anesthesia in the patients who had received only atropine as premedication. Hence, it is recommended to include benzodiazepine like midazolam, a water-soluble agent, routinely as a premedicant to decrease the incidence of awareness.

  1. Agarwal G, Sikh SS. Awareness during anaesthesia. Br J Anaesth 1977;49:835–883
  2. Marshall Barr A, Moxon ANN, et al. The effect of diazepam and lorazepam on awareness during anaesthesia for caesarean section. Anaesthesia 1977;32:873–878.
  3. Parker CJR, Oates JDL, et al. Memory for auditory material presented during anaesthesia. Br J Anaesth 1994;72:181–184.
  4. De Roode A, Jelicic M, et al. The effect of midazolam premedication onimplicit memory activation during alfentanil-nitrous oxide anaesthesia. Anaesthesia 1995;50:191–194.
  5. Dunnett IA. Awareness during endotracheal intubation, a comparison of ketamine and thiopentone. Br J Anaesth 1977;49:491–493.
  6. McKenna T, Wilton TNP. Awareness during endotracheal intubation. Anaesthesia 1973;28:599–602.
  7. Westmoreland CL, Sebel PS, et al. Indirect memory during anaesthesia. The effect of midazolam. Anaesthesiology 1993;78:237–241.
  8. Myles PS, Williams DL, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective surgery of 10811 patients. Br J Anaesthe 2001;84:6–10.
  9. Russell IF. Midazolam-Alfentanil: An anaesthetic? An investigation using the isolated forearm technique. Br J Anaesth 1993;70:42–46.
  10. Cormack RS. Awareness during surgery—a new approach. Br J Anaesth 1979;51:1051–1053.
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