What anti-anxiety do they give you before surgery?: A guide to pre-operative sedatives

October 7, 2025 •

4 min read

Research indicates that nearly half of all surgical patients experience preoperative anxiety, and many welcome anxiolytic medication to help them relax before the procedure. To address this common concern, anesthesiologists will often prescribe a specific type of anti-anxiety medication before surgery to ensure a smoother, calmer experience.

Quick Summary

The choice of pre-operative anti-anxiety medication, often a benzodiazepine like Midazolam or Lorazepam, depends on the patient's health and procedure. It promotes relaxation, sedation, and amnesia to improve the surgical experience and is selected by the anesthesiologist.

Key Points

Midazolam is the most common choice: Often given intravenously (IV) for rapid calming and its amnesic effect, which helps patients forget the immediate pre-operative period.
Benzodiazepines are the primary class: This group of drugs works on the central nervous system to reduce anxiety, induce sedation, and cause amnesia.
Other options and alternatives exist: Melatonin and non-drug methods like music therapy or relaxation techniques can also be effective in reducing pre-operative anxiety.
Anesthesiologists create a customized plan: They assess your medical history, the procedure, and personal needs to select the appropriate medication and dosage.
Risks and side effects are a key consideration: Potential side effects include respiratory depression and confusion, especially in older adults, so administration is carefully monitored.
Timing and route of administration vary: The medication may be given orally, intramuscularly, or intravenously, with timing depending on the specific drug and patient needs.
Communication with your care team is crucial: Be sure to discuss all your current medications, medical conditions, and anxieties with your anesthesiologist beforehand.

Anxiety before surgery is a very common and normal phenomenon. Patients may worry about the unknown, the anesthesia, or the outcome of the operation. While a certain amount of anxiety is normal, excessive distress can negatively impact the surgical process and recovery. Anesthesiologists and other healthcare professionals use a multi-pronged approach to manage this, including reassurance, communication, and, when necessary, medication. The selection of the right medication is a personalized process based on the patient's medical history, the procedure type, and the desired effect.

The Primary Medication Choice: Benzodiazepines

Benzodiazepines are the most frequently used class of medication for managing pre-operative anxiety due to their rapid onset and effectiveness. They work by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that has an inhibitory, calming effect on the central nervous system. These medications reduce anxiety, induce sedation, and can cause anterograde amnesia, meaning the patient may not remember events that occur immediately after the medication is administered.

Common Benzodiazepines Used

Midazolam (Versed): This is arguably the most common choice for pre-operative sedation, particularly for procedural sedation in both adults and children. Its key features are a rapid onset of action and a short duration. It can be administered intravenously (IV) for a quick effect or as an oral syrup for children. The amnesic effect is highly desirable as it can help prevent unpleasant memories of the procedure.
Lorazepam (Ativan): With a slightly slower onset and longer duration compared to midazolam, lorazepam is another common benzodiazepine used for pre-surgical anxiety. It is often administered via IV or intramuscularly (IM) and is particularly useful for patients requiring a longer period of sedation.
Diazepam (Valium): Historically a common pre-operative medication, diazepam's use has declined for routine pre-op care due to its longer half-life, which can lead to prolonged drowsiness after surgery. It may still be used in specific cases, such as to help manage anxiety that contributes to high blood pressure before certain procedures.

Non-Pharmacological Alternatives and Other Medications

Not every patient requires or receives a benzodiazepine before surgery. Anesthesiologists consider alternatives based on patient health and preference. These can include:

Melatonin: A natural sleep-regulating hormone, melatonin has been studied as a potential alternative to benzodiazepines for reducing pre-operative anxiety. It has been shown to reduce anxiety effectively, especially in certain patient populations like those undergoing cataract surgery, with potentially fewer side effects than midazolam.
Beta-Blockers: These medications can help reduce anxiety related to physical symptoms like a rapid heart rate and high blood pressure. They are sometimes used in specific cases, but they do not provide the same sedative and amnesic effects as benzodiazepines.
Non-Drug Methods: Effective non-pharmacological interventions are increasingly used, particularly in pediatrics, but also for adults. These include music therapy, deep breathing exercises, visualization techniques, and simple reassurance and communication from the care team.

The Anesthesiologist's Role in Medicated Pre-Op Care

The anesthesiologist plays a crucial role in deciding which medication is right for you. Before your surgery, they will conduct a pre-operative assessment to review your medical history, current medications, and address any concerns you may have. They will select the medication and dosage that will most effectively manage your anxiety with the lowest risk of complications. Open and honest communication with your anesthesiologist is vital for a safe and comfortable experience.

Potential Risks and Precautions

While pre-operative medication is generally safe, it's important to be aware of the potential risks and side effects. All sedatives carry a risk of complications, and your anesthesiologist will carefully weigh the benefits against these risks.

Respiratory Depression: This is the most serious risk, where breathing becomes dangerously slow or shallow, especially when combined with other central nervous system depressants like opioids. This is why these medications are only administered in monitored hospital settings.
Drowsiness and Confusion: Patients can feel very drowsy or confused after receiving medication, and these effects can persist for some time after the procedure. Patients should not drive or operate heavy machinery for at least 24 hours post-procedure.
Delirium: In older patients, some benzodiazepines like midazolam carry an increased risk of causing delirium, a state of acute confusion. The anesthesiologist will consider this risk and may choose an alternative medication or a non-pharmacological approach.
Nausea and Dizziness: These are common side effects that usually resolve quickly.

Comparison of Common Pre-Operative Anxiolytics


Medication	Typical Onset	Duration	Common Route(s)	Key Feature	Major Consideration
Midazolam (Versed)	Fast (2-3 min IV)	Short (1.5-2.5 hours)	IV, Oral Syrup	Rapid acting, strong amnesic effect	Risk of respiratory depression, especially with other sedatives
Lorazepam (Ativan)	Intermediate (15-20 min IV)	Long (6+ hours)	IV, IM, Oral	Longer-lasting calming effect	Can cause prolonged drowsiness compared to midazolam
Diazepam (Valium)	Fast (2-3 min IV)	Very Long (20-100 hours half-life)	IV, Oral, Rectal	Historically significant, muscle relaxant	Less common for routine pre-op due to very long duration of action

Conclusion

Pre-operative anxiety is a valid concern for many patients, and modern medicine offers effective ways to manage it. The choice of what anti-anxiety medication they give you before surgery is a carefully considered decision made by your anesthesiologist, weighing your individual needs and potential risks. Whether it's a rapidly-acting benzodiazepine like midazolam, a longer-acting alternative, or a non-pharmacological approach, the goal is always to provide a safe and calm experience. The most important step you can take is to have an open conversation with your healthcare team about your fears and concerns to determine the best course of action for you.

For more in-depth medical information on medication use, consult reliable resources such as the U.S. National Library of Medicine.

Frequently Asked Questions

The most common anti-anxiety medications given before surgery are benzodiazepines, such as midazolam (Versed), lorazepam (Ativan), and diazepam (Valium).

Doctors use anti-anxiety medication to help patients relax, reduce their distress, make the induction of anesthesia smoother, and sometimes to create anterograde amnesia so they won't remember the procedure.

The medication can be administered in several ways, including intravenously (IV) for a rapid effect, orally (as a tablet or syrup), or intramuscularly (IM).

Yes, alternatives include non-pharmacological methods like relaxation techniques, music therapy, and focused breathing. The hormone melatonin can also be used as an effective and potentially safer alternative to traditional sedatives.

You must inform your anesthesiologist and care team about all medications you take, including regular anxiety medication. They will provide specific instructions on which medications to take or hold before the procedure to prevent any harmful interactions.

Common side effects include drowsiness, confusion, dizziness, and nausea. Serious but rare risks include respiratory depression, which is why administration is always monitored.

The choice depends on the patient's age, medical history (e.g., liver or kidney function), the type of surgery, and the desired effect, such as the duration of sedation or level of amnesia.

No, not all patients require or receive pre-operative medication. The decision is made on a case-by-case basis by the anesthesiologist after assessing the patient's anxiety level and overall health.