Medications,Pharmacology: What do they give you to calm you down before surgery?

October 11, 2025 •

4 min read

According to one study, approximately half of all surgery patients would welcome anti-anxiety medication on the day of their procedure. To address this common concern, anesthesiologists use a class of medications called premedication, which is specifically designed to reduce anxiety and create a calming effect in patients just before their operation. These drugs, tailored to the individual, are an essential part of preparing for surgery.

Quick Summary

Before surgery, patients commonly receive premedication, primarily benzodiazepines like midazolam, to alleviate anxiety and induce relaxation. These drugs, administered orally or intravenously, are selected based on the procedure and patient health. Other medications may also be used to prevent nausea or manage pain, all monitored by the anesthesia team.

Key Points

Benzodiazepines are primary anxiolytics: Medications like midazolam, lorazepam, and diazepam are most commonly used to reduce anxiety and produce sedation before surgery.
Premedication is personalized care: The choice of drugs is tailored to the individual patient, their health status, the surgical procedure, and their anxiety level.
Memory loss is a common effect: Benzodiazepines often cause amnesia, meaning patients may not remember the time leading up to their surgery.
Other medications serve different purposes: In addition to calming agents, patients may receive drugs to prevent nausea (antiemetics), reduce secretions (anticholinergics), and manage pain (opioids).
Administration methods vary: Medications are typically given orally or intravenously, with IV administration providing faster and more controllable effects.
Constant monitoring is crucial: All sedating medications require continuous monitoring of a patient's vital signs by the anesthesia team to ensure safety.

The Role of Premedication in Surgical Preparation

Experiencing anxiety before an operation is completely normal, and managing it is a priority for the surgical team. Premedication, given before the induction of anesthesia, is a series of pharmacological interventions aimed at creating a smooth, safe, and comfortable experience for the patient. This practice serves several critical purposes, including reducing preoperative anxiety, producing sedation and amnesia, and controlling pain. The specific medications chosen depend on the patient's medical history, the type of surgery, and the anticipated level of anxiety.

Primary Medications for Pre-Surgical Calm

Benzodiazepines (Anxiolytics)

Benzodiazepines are the most common class of anti-anxiety drugs used for premedication, prized for their rapid onset and effectiveness at reducing anxiety and producing a calming effect. They work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA), which slows down activity in the central nervous system. A key feature of benzodiazepines is their ability to induce anterograde amnesia, meaning patients often have little to no memory of the procedure.

Common examples include:

Midazolam (Versed): A fast-acting, short-duration benzodiazepine that is the most commonly used preoperative sedative. It can be administered intravenously or as an oral syrup, particularly for children.
Lorazepam (Ativan): A longer-acting option, effective for both sedation and amnesia.
Diazepam (Valium): Another longer-acting benzodiazepine, although less frequently used intravenously due to potential vein irritation.

Opioid Analgesics

Opioids are potent pain-relieving medications that can also provide sedation and are often used as part of a balanced anesthesia plan. While primarily for pain management, their sedative effects contribute to the overall calming of the patient. Anesthesiologists carefully monitor dosage to balance pain relief with the risk of respiratory depression.

Examples include:

Fentanyl: A powerful, short-acting synthetic opioid commonly used during all phases of surgery, including pre-induction.
Sufentanil: An even more potent opioid, often used for major surgeries.

Alpha-2 Agonists

Alpha-2 agonists represent an alternative to traditional benzodiazepines, particularly in cases where benzodiazepines are contraindicated or less effective. These drugs offer sedation and some pain relief without causing amnesia. Their longer duration of action is a consideration for some procedures.

Examples include:

Dexmedetomidine: Provides a sedation state that resembles natural sleep and is a preferred agent for conscious intubation procedures.
Clonidine: A central alpha-2 agonist that is available orally and can provide a longer-lasting window of sedation.

Additional Pre-Surgical Medications and Preparations

In addition to calming agents, other medications may be administered to prepare the body for surgery and anesthesia.

Antiemetics: Used to prevent or treat postoperative nausea and vomiting (PONV), a common side effect of anesthesia and opioids. Medications like ondansetron are frequently given prophylactically.
Anticholinergics: Drugs such as glycopyrrolate are used to reduce oral and respiratory secretions, ensuring a clear airway during procedures.
Antacids: To reduce the risk of aspiration pneumonia, agents like ranitidine or sodium citrate may be given to lower stomach acid.
Antibiotics: Prophylactic antibiotics, like cefazolin, are often given about an hour before incision to prevent surgical site infections.

Comparison of Common Pre-Surgical Medication Classes


Drug Class	Primary Purpose	Common Examples	Onset of Action	Key Considerations
Benzodiazepines	Reduces anxiety, causes sedation and amnesia.	Midazolam (Versed), Lorazepam (Ativan), Diazepam (Valium)	Rapid (Oral/IV)	Can cause respiratory depression, drowsiness; contraindicated in narrow-angle glaucoma.
Opioid Analgesics	Provides pain relief and sedation.	Fentanyl, Morphine, Hydromorphone	Rapid (IV)	Primarily for pain; can cause respiratory depression, nausea, and vomiting.
Alpha-2 Agonists	Sedation, pain relief, and hemodynamic stability.	Dexmedetomidine, Clonidine	Slower onset than benzodiazepines	No amnesic effects; can cause hypotension and bradycardia.
Antiemetics	Prevents postoperative nausea and vomiting.	Ondansetron (Zofran), Metoclopramide	Varies	Chosen based on patient risk factors for PONV.

Administration and Patient Monitoring

Premedication is always given in a clinical setting by trained healthcare professionals, most often an anesthesiologist or a nurse anesthetist. The method of administration can vary:

Oral: Pills or syrups (e.g., midazolam for children) are given to patients in the pre-op area.
Intravenous (IV): Medication is delivered through an IV line, allowing for faster and more precise dosing, especially for deeper sedation.
Intramuscular (IM): Injections are an option but are less common due to potential pain.

Throughout the entire process, the patient's vital signs, including heart rate, blood pressure, and breathing, are closely and continuously monitored to ensure their safety.

Conclusion

The goal of giving medication to calm patients before surgery is to ensure a safer and more comfortable experience. While the most common drugs are benzodiazepines like midazolam for their potent anxiolytic and amnesic properties, the choice of medication is always individualized. Your anesthesiologist selects the ideal combination of drugs—which may also include opioids for pain control and antiemetics for nausea—after a thorough evaluation of your medical history and specific surgical needs. This personalized approach is a cornerstone of modern anesthesia, guaranteeing that you receive the best care to calm your nerves and prepare your body for a successful procedure.

One Authoritative Outbound Link

For more detailed information on anesthetic medications and their effects, the Anesthesia Patient Safety Foundation provides an excellent resource: What Drugs Are Used in Anesthesia?

Frequently Asked Questions

Yes, it is very common and completely normal to feel anxious before surgery. The surgical team is well-prepared to address these feelings, and medication is often offered to help you relax.

Midazolam (Versed), a type of benzodiazepine, is the most frequently used medication for preoperative sedation. It effectively reduces anxiety and causes drowsiness and amnesia.

Medications can be given orally as a pill or syrup, or intravenously (IV) through a thin tube in your arm. The method depends on the medication, the procedure, and patient preference.

Common side effects include drowsiness, grogginess, forgetfulness, and dizziness. The specific effects vary depending on the drugs used.

No, it is unsafe to drive or operate machinery for at least 24 hours after receiving most premedication, as the effects can impair your coordination and judgment.

Your anesthesiologist may administer other drugs, such as antiemetics to prevent nausea or anticholinergics to reduce secretions, as part of a comprehensive premedication plan.

No, taking premedication is not mandatory. You will have a discussion with your anesthesiologist beforehand to determine the best plan for you. If you prefer, non-pharmacological techniques can also be used.