What do they give you for anxiety before surgery?

October 7, 2025 •

4 min read

Research indicates that approximately 75% of people experience anxiety before surgery, a condition also known as tomophobia. To help manage this stress and ensure a smoother experience, healthcare providers often administer premedication, including a variety of anti-anxiety drugs.

Quick Summary

Healthcare providers commonly use premedication, particularly benzodiazepines like midazolam and diazepam, to reduce patient anxiety before surgical procedures. Other options, including melatonin and non-pharmacological methods, may also be used depending on the patient's specific needs.

Key Points

Benzodiazepines are primary premedication: A class of drugs, including midazolam and diazepam, is commonly used for their fast-acting sedative and anxiolytic effects before surgery.
Anterograde amnesia is a common effect: Some anti-anxiety medications, notably midazolam, can cause memory loss for the time immediately around the procedure, which can be a beneficial side effect for patients.
Alternatives to benzodiazepines exist: For various reasons, including patient age or specific health conditions, anesthesiologists may use other options like melatonin or alpha-2 agonists such as dexmedetomidine.
Non-pharmacological strategies are also effective: Many non-drug methods like patient education, music therapy, and relaxation techniques can significantly help manage preoperative anxiety.
Choice depends on individualized care: The best medication and approach are determined by the anesthesiologist based on the patient's health, age, anxiety level, and the specific surgical procedure.
Open communication with the care team is vital: Patients should discuss their fears, medical history, and any existing medications with their providers to ensure the safest and most effective premedication plan.

Experiencing anxiety before surgery is a very common and normal reaction to a stressful situation. This preoperative anxiety, also known as tomophobia, is not only distressing for the patient but can also increase postoperative pain, delay recovery, and contribute to other complications. To mitigate these effects, anesthesiologists and other healthcare providers use pharmacological and non-pharmacological interventions as part of the premedication process.

Primary Medications: The Role of Benzodiazepines

Benzodiazepines are a cornerstone of pharmacological management for preoperative anxiety. These medications work by acting on gamma-aminobutyric acid (GABA) receptors in the brain, which are responsible for inhibiting neural activity. By enhancing GABA's inhibitory function, benzodiazepines slow down the nervous system, producing a calming and sedative effect. They are valued for their fast action and relatively short duration, making them ideal for the short-term use required before a procedure.

Midazolam (Versed)

Midazolam is one of the most frequently used benzodiazepines for premedication. It is highly effective at reducing anxiety and causing drowsiness. An additional benefit of midazolam is its ability to cause anterograde amnesia, meaning the patient may not remember the potentially stressful period immediately preceding the surgery. It is often administered intravenously (IV) for a rapid onset, but oral or nasal forms are also used, particularly for children.

Diazepam (Valium)

Another well-established benzodiazepine, diazepam, is also used to relieve anxiety before surgery. It can be given orally or intravenously and, like other benzodiazepines, provides a sedative and relaxing effect. Its anxiolytic properties make it a reliable choice, and it can also help to relax muscles. Studies have shown its efficacy in reducing preoperative apprehension.

Lorazepam (Ativan)

Lorazepam is a potent benzodiazepine that provides effective anxiolysis and sedation. While it has proven effective, some studies suggest it may be linked to slightly longer recovery times, so the choice between different benzodiazepines is often based on the specific surgical context and individual patient factors.

Alternative Pharmacological Options

While benzodiazepines are common, other classes of drugs are also used, sometimes as alternatives or in combination, depending on patient needs.

Alpha-2 Adrenoceptor Agonists

This class includes drugs like dexmedetomidine, which provides sedation and anxiolysis that is often described as resembling natural sleep. It has a different mechanism of action than benzodiazepines and offers the advantage of preserving respiratory drive, which can be important for patients with specific health conditions. Dexmedetomidine can be administered intranasally, making it a viable option for pediatric patients.

Melatonin

Melatonin, the body's natural sleep hormone, is an emerging alternative for managing preoperative anxiety. Studies suggest that melatonin can significantly reduce anxiety, with some research indicating it may be as effective as midazolam while potentially having a better safety profile and less impact on cognitive function. Its use may be more prevalent in specific patient populations.

Antihistamines

Certain antihistamines, such as hydroxyzine, have sedative properties that can be used to help calm a patient before surgery. Hydroxyzine can relieve anxiety and tension and is sometimes used as a sedative before or after general anesthesia.

Non-Pharmacological Strategies

Beyond medication, various non-drug interventions can be highly effective in managing preoperative anxiety. These strategies are often used alongside or in place of medication, depending on the patient's level of anxiety and preference.

Patient Education: Providing clear, comprehensive information about the procedure, anesthesia, and recovery can significantly reduce fear of the unknown.
Relaxation Techniques: Breathing exercises, meditation, and guided imagery can calm the mind and body.
Music Therapy: Listening to preferred music before surgery is a simple yet effective distraction technique that can reduce anxiety levels.
Parental Presence: For children, allowing a parent or guardian to be present during the induction of anesthesia can help reduce separation anxiety.

Comparison of Common Premedication Options


Feature	Benzodiazepines (e.g., Midazolam)	Alpha-2 Agonists (e.g., Dexmedetomidine)	Antihistamines (e.g., Hydroxyzine)
Mechanism	Enhances GABA's inhibitory effect	Acts on alpha-2 adrenergic receptors	Blocks histamine receptors
Primary Effect	Anxiolysis, sedation, anterograde amnesia	Sedation, anxiolysis (resembling natural sleep)	Sedation, anxiolysis
Onset Time	Rapid (especially IV)	Slower than IV benzodiazepines	Variable
Best For	Fast, reliable anxiety relief; amnesia	Pediatric or high-risk patients needing minimal respiratory depression	Mild anxiety, patients where other options are contraindicated
Potential Side Effects	Respiratory depression, paradoxical agitation	Bradycardia, hypotension	Drowsiness, dry mouth

The Holistic Approach to Preoperative Care

The choice of premedication is a collaborative decision made by the patient and their care team, led by the anesthesiologist. The selection is based on numerous factors, including the patient's medical history, age, type of surgery, and individual anxiety levels. Patients should always be transparent with their medical team about any anxieties, medications, or supplements they are taking. In some cases, especially for elderly patients or those with certain cardiovascular issues, the risks of some medications may outweigh the benefits, making non-pharmacological methods or alternative drugs more suitable. Ultimately, a tailored, holistic approach that combines clear communication with appropriate pharmacological or non-pharmacological interventions is key to effectively managing anxiety and ensuring a positive surgical experience.

Conclusion

Preoperative anxiety is a natural and common response to impending surgery, but it can be effectively managed through premedication. The medications most commonly used are benzodiazepines, such as midazolam and diazepam, for their rapid anxiolytic and sedative effects. However, alternatives like melatonin, alpha-2 agonists, and sedating antihistamines, in addition to non-pharmacological techniques, offer a range of options for personalized patient care. By communicating openly with the medical team, patients can receive the optimal treatment plan to alleviate their fears and proceed with their surgery calmly and confidently.

For more detailed information on specific medications, such as Midazolam, patients can consult the detailed resources available from trusted medical institutions like the Cleveland Clinic.

Frequently Asked Questions

The most commonly used medications for preoperative anxiety are benzodiazepines. A specific example is Midazolam (Versed), which is frequently given for its fast onset and ability to provide sedation, anxiety relief, and amnesia.

Yes, children often receive premedication for anxiety before surgery. Oral or nasal midazolam is a common choice, as are newer options like intranasal dexmedetomidine, which provides sedation without significantly affecting breathing.

The medication can be given in several ways. For a rapid effect, it is often administered intravenously (IV). Some drugs, like midazolam and diazepam, can also be taken orally as pills or syrup.

Yes, it is important to communicate any anxiety you have to your care team. Many patients express a desire for anti-anxiety medication, and your anesthesiologist can discuss the best options for your specific needs.

Yes, non-pharmacological techniques can be very effective. These include relaxation exercises, listening to calming music, educational videos, and in some cases, parental presence for pediatric patients.

Yes, melatonin is sometimes used as a premedication, especially in adults. Studies have shown it can reduce preoperative anxiety and may have a better side effect profile than benzodiazepines.

Treating preoperative anxiety can lead to a better surgical experience and recovery. High levels of anxiety can increase postoperative pain, delay wound healing, and cause other complications. Relieving this stress promotes a smoother process.

It is crucial to inform your care team of all medications and supplements you take. This allows them to make informed decisions and prevent any potentially harmful interactions with the drugs used during surgery.