Melatonin and midazolam are commonly used for preoperative anxiolysis and sedation. This comparative study investigated their effects on anxiety, sedation, psychomotor, and cognitive function in patients undergoing elective surgery. Understanding the distinct effects of each medication allows for informed decisions regarding preoperative management. This comparative analysis highlights the advantages of melatonin as a pre-anesthetic medication.
A Comparative Study: Melatonin vs. Midazolam in Preoperative Care
This study evaluated 120 patients aged 16-55, categorized as American Society of Anesthesiologists Grade 1 or 2, scheduled for elective surgery. Patients were randomly assigned to one of three groups: melatonin (0.4 mg/kg), midazolam (0.2 mg/kg), or placebo. All medications were administered orally 60-90 minutes before anesthesia induction.
Preoperative anxiety levels were assessed using the visual analog scale (VAS) anxiety score, orientation score, and sedation score before and after medication administration. The digit symbol substitution test (DSST) and trail making test (TMT) measured psychomotor and cognitive functions. Statistical significance was determined using the Chi-square test or Kruskal-Wallis analysis of variance, with a p-value less than 0.05 considered significant.
Results of the Comparative Analysis
Both melatonin and midazolam significantly reduced VAS anxiety scores compared to the placebo (P = 0.0124 for melatonin and P = 0.0003 for midazolam). However, no significant difference in anxiety reduction was found between the melatonin and midazolam groups (P = 0.49). Both medications also significantly increased sedation scores compared to the placebo (P = 0.0258 for melatonin and P = 0.0000 for midazolam). Importantly, only midazolam negatively impacted psychomotor and cognitive function, as evidenced by significant changes in DSST and TMT scores. Orientation remained unaffected in both the melatonin and placebo groups.
Conclusion: Melatonin’s Advantage in Preoperative Anesthesia
This comparative study demonstrates that oral melatonin (0.4 mg/kg) provides effective preoperative anxiolysis comparable to midazolam (0.2 mg/kg). Critically, melatonin does not impair cognitive or psychomotor function, unlike midazolam, which negatively affects working memory, memory retrieval, sustained attention, and cognitive flexibility. These findings suggest that melatonin may be a preferable option for preoperative anxiolysis, offering similar anxiety reduction without the cognitive and psychomotor side effects associated with midazolam. Future research could explore the efficacy of melatonin in larger patient populations and different surgical settings to further validate these findings.
