Comparative evaluation of effects of oral melatonin and oral alprazolam as premedication and their effects on post operative recovery characteristics in patients undergoing tympanoplasty

Premedication has some important goals like relief of anxiety, sedation and analgesia. Preoperative anxiety is commonly experienced by the patients who are admitted to hospital for any surgery which can be described as an unpleasant state of tension or uneasiness that results from a patient’s doubts or fears about the surgery and anaesthesia. It increases patient’s catecholamine secretions which may lead to hypertension, tachycardia, and arrhythmias. Anxiety in surgical patients increases the need of anaesthetic drugs.

Benzodiazepines (midazolam and alprazolam) are most commonly used as a premedication to alleviate perioperative anxiety and to produce amnesia and sedation; however, they may impair cognitive and psychomotor performance. Alprazolam (triazolobenzodiazepine) is a short-acting drug which has anxiolytic, sedative, hypnotic, anticonvulsant, and amnesic properties but may cause psychomotor impairment.

Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous neurohormone secreted by the pineal gland. It has unique property of producing anxiolysis with no impairment of cognitive and psychomotor function that is highly desirable in routine perioperative care when given orally as a premedication. It has inhibitory action on central nervous system. It also has sedative, hypnotic, analgesic, anti-inflammatory, antioxidative, and chronobiotic effects. The melatonin has been reported to be used as a premedication in a dose range of 3–15 mg given orally or sublingually 50–90 min preoperatively. The peak effect of oral melatonin ranges from 60 to 150 min. Hence, it is hypothesized that melatonin (6 mg) when given orally as a premedication 120 min before the induction of anaesthesia would provide adequate anxiolysis and arousable sedation with no effect on cognitive and psychomotor function along with stable hemodynamics and minimal side effects. In this study, we plan to compare the effects of oral melatonin and alprazolam as a premedication on various parameters including anxiety, sedation, cognition, psychomotor function and analgesia.