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Comparison Of Oral Alprazolam 0.25 Mg With
Alprazolam 0.5 Mg As Preoperative Anti-Anxiety In
Patients Undergo Elective Surgery At Haji Adam Malik
General Hospital Medan
Doni Herianto*, Achsanuddin Hanafie**, Muhammad Ihsan**
*Resident of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
**Departement of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
DOI: 10.29322/IJSRP.10.09.2020.p10506
http://dx.doi.org/10.29322/IJSRP.10.09.2020.p10506
Abstract- Background: Anxiety will affect the body's response to
release catecholamines so that it can result in an increase in heart
rate, contraction of the heart muscle, arterial vasoconstriction,
increase in blood sugar levels and others; these conditions can
aggravate the condition before entering the operating room.
Objective: This study aims to determine the comparison of
the administration of 0.25 mg alprazolam tablets with 0.5 mg
alprazolam as a preoperative anti anxiety in patients undergoing
elective surgery using the Hamilton Anxiety Rating Scale (HARS)
in Haji Adam Malik General Hospital Medan.
Method: This research is a double-blind experimental
research. The study was conducted in the Haji Adam Malik
General Hospital Medan from February-April 2020. The total
sample obtained was 60, of which 30 samples were given
Alprazolam 0.25 mg, while the other 30 samples were given
Alprazolam 0.5 mg. Previously, the level of anxiety was measured
based on the Hamilton Anxiety Rating Scale (HARS) of patients
who were included in the sample were patients with moderate and
severe anxiety level and re-assessed the level of anxiety after 10
hours of alprazolam administration using Hamilton Anxiety
Rating Scale (HARS). Data collection was carried out using
questionnaires.
Results: The level of anxiety after administration of
alprazolam which was assessed based on the Hamilton Anxiety
Rating Scale (HARS) in the group given Alprazolam 0.25 mg and
0.5 mg statistically, no significant difference was found in
reducing the level of anxiety.
Conclusion: Comparison between Alprazolam 0.25 mg with 0.5
mg gives the result that the value of anxiety is equally decreased
in the administration of alprazolam 0.25 mg and 0.5 mg but there
is no statistically significant difference either in the administration
of alprazolam 0.25 mg or 0.5 mg.
Index Terms- Hamilton Anxiety Rating Scale, Alprazolam ,
Anxietas
I. INTRODUCTION
nxiety is a feeling of uncertain, helplessness, isolated, and
insecurity. This emotional state has no specific object.1
Surgery is a treatment procedure that uses an invasive method. The
surgical phases consist of the preoperative, intraoperative and
postoperative phase. The preoperative phase in surgery is the
initial phase of surgical process. This initial phase begins when the
decision is made for surgical intervention and ends when the
patient arrive at the operating table.2
The situation before entering the operating room can
provide discomfort and anxiety which affects the patient's mental
state. This will affect body's response to release catecholamine so
that it can lead to an increase in heart rate, contraction of the heart
muscle, vasoconstriction of the arteries, increased blood sugar
levels and others; this condition can aggravate the condition before
entering the operating room.2
Most of the patients who waiting for elective surgery have
anxiety. The incidence of preoperative anxiety has been estimated
to vary from 11% to 80% in adults. Research in 2007 on the
preoperative anxiety level showed that out of 40 respondents there
were 16 people or 40% who had an anxiety level in the moderate
category, 15 people or 37.5% in the mild category, respondents
with a severe anxiety level were 7 people or 17, 5% and
respondents who did not feel anxious were 2 people or 5%.3
Anxiety can cause elevated in catecholamine level leading
to tachycardia, hypertension and hemodynamic instability,
arrhythmias and high pain thresholds and persist into the
postoperative period. A reliable biological indicator for an anxiety
reaction is a valuable marker in psycho-physiological research and
clinical practice.4
Patients are often given several anxiolytic drugs before
surgery to prevent anxiety. Prevention of preoperative anxiety
with anxiolytic premedication improves surgical outcomes and
decreases hospitalizations in surgical patients. To reduce the level
of anxiety is done by administering drugs from the benzodiazepine
group. Benzodiazepines produce pharmacological effects by
facilitating the action of gamma amino butyric acid (GABA), an
inhibitory neurotransmitter in the central nervous system. The
properties of benzodiazepines can be in the form of sedation,
A
International Journal of Scientific and Research Publications, Volume 10, Issue 9, September 2020 32
ISSN 2250-3153
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anxiolytics, antidepressants, and hypnotics. Benzodiazepines
include diazepam, alprazolam, lorazepam, midazolam,
clonazepam, diazepam, and oxazepam.5
Anxiety can be measured by measuring the anxiety level
according to an anxiety measurement tool called the HARS
(Hamilton Anxiety Rating Scale). The HARS scale is a measure
of anxiety based on the appearance of symptoms in individuals
experiencing anxiety. According to the HARS scale, there are 14
symptoms that appear in individuals who experience anxiety. Each
item that is observed is given 5 levels of score (Likert scale)
between 0 (Zero Present) to 4 (severe). The HARS scale was first
used in 1959, which was introduced by Max Hamilton and has
now become the standard in measuring anxiety, especially in
clinical trial studies. The HARS scale has been proven to have
high enough validity and reliability to measure Anxieties in
clinical trial studies, namely 0.93 and 0.97. This condition
indicates that measurement.6
Based on the literature study and related research results and also
considering the level of anxiety, side effects and drug availability,
so that in this study the administration of alprazolam 0.25 mg and
alprazolam 0.5 mg orally as a premedication drug was to assess
the level of anxiety during premedication in patients who were
going to underwent elective surgery before entering the operating
room using the HARS scale.
II. METHODS
This study is an analytic study with experimental design
carried out at Haji Adam Malik General Hospital Medan.
Consecutive sampling is a sample selection technique by which all
subjects who come and meet the selection criteria are included in
the study until the number of subjects is met. After obtaining
approval from the Ethics Committee, Faculty of Medicine,
University of North Sumatra, based on inclusion and exclusion
criteria 60 research samples were collected. The population
sampled was divided randomly into 2 groups, namely group A
received Alprazolam 0.25 mg and group B received Alprazolam
0.5 mg by using the double blind method. One day before, surgery
schedule was seen for the next day and all possible patients to be
sampled were checked whether they met the inclusion criteria or
not, after being assigned the patients were randomly randomized
and determined whether they were group A or group B. The drug
that had been prepared by one volunteer was given to volunteer 2
to be given to patients at night according to their group. After 10
hours of drug administration, patients will be assessed for anxiety
levels by pre-trained participants according to the HARS scale.
III. RESULTS
This study was attended by 60 subjects who met the
inclusion criteria. The characteristics of this study were displayed
based on gender, age, religion, ethnic, education, and PS ASA.
4.1 Demographic Data Table
Characteristic
Group A
Group B
Total
P
value
Alprazolam
0,25 mg
Alprazolam
0,5 mg
n
n
Gender, n (%)
Man
13 (43,3)
14 (46,7)
27 (45)
0,797
Woman
17 (56,7)
16 (53,3)
33 (55)
Age, Mean (SD)
40,0 ± 7,9
34,4 ± 13,1
37,2 ±
10,9
0,436
Religion, n (%)
Muslim
13 (43,3)
19 (63,3)
32 (53)
0,124
Christian
17 (56,7)
11 (36,7)
28 (47)
Ethnic, n (%)
Batak
17 (56,7)
17 (56,7)
34 (57)
0,946
Malay
11 (36,7)
10 (33,3)
21 (35)
Minang
1 (3,3)
2 (6,7)
3 (5)
Javanese
1 (3,3)
1 (3,3)
2 (3)
Education, n (%)
Bachelor
6 (20,0)
9 (30,0)
15 (25,0)
0,529
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SMA
18 (60,0)
18 (60,0)
36 (60,0)
SMP
3 (10,0)
3 (10,0)
6 (10,0)
SD
3 (10,0)
0 (0)
3 (5,0)
PS ASA
I
11 (36,7)
14 (46,7)
25 (42)
0.436
II
19 (63,3)
16 (53,3)
35 (58)
*Mann-Whitney test
Table 4.1 shows the distribution of social and clinical
characteristics in this study, with a mean patient age of 37.2 ± 10.9
years. Most of the patients were female with a percentage of
55.0%. Most patients were Muslim with a percentage of 53.0%,
with the highest ethnic group being Batak, namely 57.0%. Most
patients were with high school education, namely 60.0% and with
the highest PS ASA II status at 58.0%. The samples in this study
were entirely planned for elective surgery regardless of the
anesthesia technique whether general anesthesia or regional
anesthesia. From the results of the table after being entered into
SPSS, the results obtained for the P value for gender P = 0.797,
for age P = 436, religion P = 0.124, ethnicity P = 0.946, education
P = 0.529, and PS ASA obtained P value = 0.436. It can be
concluded that the patients in this study were relatively
homogeneous (p> 0.05).
4.2 Comparison of anxiety levels in patients before treatment
HARS before treatment
Group
Total
P value
Alprazolam 0,25 mg
Alprazolam 0,5 mg
N
(%)
N
(%)
n
(%)
Mild anxiety
0
0
0
0
0
0
0,795
Moderate anxiety
18
60
17
56,7
35
58,3
Severe anxiety
12
40
13
43,3
25
41,7
*Mann-Whitney test
Based on the table 4.2, subjects with mild anxiety levels
were not included in this study, the group receiving alprazolam
0.25 mg was 18 people (60%), the group receiving Alprazolam 0.5
mg with The level of severe anxiety was 17 people (56.7%). While
subjects with severe anxiety levels in the group receiving
alprazolam 0.25 mg were 12 people (40%), the group receiving
alprazolam 0.5 mg with severe anxiety levels was 13 people
(43.3%). The total number of patients with moderate anxiety
levels in this study was 35 people (58.3%) and the total number of
patients with moderate anxiety levels in this study was 25 people
(41.7%). From the results of the table after being entered into the
SPSS, the p value was 0.795 which can be concluded that the
patients in this study were relatively homogeneous (p> 0.05).
4.3 Comparison of anxiety levels in patients after treatment
HARS after treatment
Group
Total
P value
Alprazolam 0,25 mg
Alprazolam 0,5 mg
n
(%)
N
(%)
n
(%)
Mild anxiety
18
60
18
60
36
60
0,757
Moderate anxiety
9
30
12
40
21
35
Severe anxiety
3
10
0
0
3
5
*Mann-Whitney test
Based on the table 4.3, there were 18 people (60%) with
mild anxiety levels in patients after 10 hours administration of
alprazolam 0.25 mg and the group that received Alprazolam 0.5
mg with mild anxietas levels were 18 people ( 60%). Subjects with
moderate anxiety levels in the group receiving alprazolam 0.25 mg
were 9 people (30%), while the group receiving Alprazolam 0.5
mg with moderate anxietas was 12 people (40%). While the
subjects with severe anxiety levels in the group receiving
alprazolam 0.25 mg were 3 people (10%) and the group receiving
alprazolam 0.5 mg with severe anxiety levels was not found (0%).
The total number of patients with mild anxiety levels was 36
(60%), 21 patients (35%) had moderate anxiety levels, and the
total patients with severe anxiety levels in this study were as many
as 0.25 mg of alprazolam. 3 people (5%). From the results of the
table after being entered into the SPSS, the p value was 0.757
which can be concluded that the patients in this study were
relatively insignificant (p> 0.05).
International Journal of Scientific and Research Publications, Volume 10, Issue 9, September 2020 34
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IV. CONCLUSIONS
There was no significant difference in the administration of
alprazolam 0.25 mg or 0.5 mg in reducing the level of anxiety in
patients undergoing elective surgery.
There was a decrease in anxiety levels in patients receiving
alprazolam 0.25 mg using HARS scoring in patients undergoing
elective surgery.
There was a decrease in anxiety levels in patients receiving
alprazolam 0.5 mg using HARS scoring in patients undergoing
elective surgery.
REFERENCES
[1] Yorbik O, Mutlu C, Ozturk O, Altinay DK, Tanju IA. Salivary alpha amylase
levels in youths with anxiety disorders. Psychiatry Research. 2016;235:148–
53.
[2] Batista MM, Martins JC, Oliveira LM. Anxiety, depression and stress in the
preoperative surgical patient. Research Paper. 2014;3:7–15.
[3] Breines JG, Mcinnis CM, Kuras YI, Thoma MV, Gianferante D, Hanlin
L,dkk. Selfcompassionate young adult show lower salivary alpha amylase
responses to repeated psychosocial stress. Routledge. 2015;14:390– 402.
[4] Paryanto. Perbedaan Tingkat Anxietas Pasien Preoperatif Selama Menunggu
Jam Operasi Antara Ruang Rawat Inap dengan Ruang Persiapan Operasi
Rumah Sakit Ortopedi Surakarta. Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Surakarta; 2009.
[5] Iida R, Kajiwara K, Kashiwai A, Kato J, Ogawa S. Comprehensive evaluation
of the effect of triazolam on amnesia during the preoperative period. Masui
2011; 60: 67-74
[6] Kim WS, Byeon GJ, Song BJ, Lee HJ. Availability of preoperative anxiety
scale as a predictive factor for hemodynamic changes during induction of
anesthesia. Korean J Anesthesiol 2010;58:328 33.
AUTHORS
First Author – Doni Herianto, Post graduate of Anaesthesiology
and Intensive Therapy, Faculty of Medicine, Universitas
Sumatera Utara, Medan, Indonesia, bangdonialoha@gmail.com
Second Author – Achsanuddin Hanafie, Anaesthesiology and
Intensive Therapy, Faculty of Medicine, Universitas Sumatera
Utara, Medan, Indonesia, achsanuddinhanafie@gmail.com
Third Author – Muhammad Ihsan, Anaesthesiology and
Intensive Therapy, Faculty of Medicine, Universitas Sumatera
Utara,Medan, Indonesia, muhammadihsan@gmail.com
Correspondence Author – Doni Herianto, bangdonialoha, +62
853-5640-2917