15.1.4.1 Anxiolytics and neuroleptics

Pre–operative sedation
First Choice:
diazepam
ortemazepam
Second Choice:
lorazepam
Intravenous sedation (specialist training required)
First Choice:
midazolam
Formulations/Dose
  • diazepam tablets 5mg; oral solution 2mg/5mL: 5−10mg 1−2 hours before procedure.
  • temazepam tablets 10mg, 20mg; oral solution 10mg/5mL: pre–medication, 10–20mg (elderly, 10mg) 1 hour before operation.
  • lorazepam tablets 1mg: 2–3mg the night before operation, or 2–4mg 1–2 hours before operation.
  • midazolam injection 2mg/mL: by intravenous injection, 1mg (max 10mg) titrated slowly to response.
Prescribing Notes
  • Temazepam is short–acting and first choice for day case surgery; timing of the dose is important.
  • Lorazepam may be preferred for pre–operative sedation because of its amnesic effects.
  • Flumazenil can be used to reverse the effect of benzodiazepines.
  • Midazolam is drug of choice for intravenous sedation but has no analgesic effect.
  • For propofol or Entonox® (or Equanox®) sedation see sections 15.1.1 and 15.1.2.