Benzodiazepine use before heart surgery: Should it be embraced or restricted?

Restricting the use of benzodiazepines during cardiac surgery does not appear to impact the likelihood of postoperative delirium or patient-reported intraoperative awareness, according to new study published in JAMA Surgery.[1]

Benzodiazepines are administered before a majority of cardiac surgeries, researchers noted, because it is believed they can lower the odds of intraoperative awareness. At the same time, however, recent studies have suggested benzodiazepines may be associated with a heightened risk of delirium in the days following treatment. 

To learn more about the potential impact of benzodiazepines, the study’s authors explored data from more than 19,000 cardiac surgery patients treated at one of 20 U.S. hospitals from November 2019 to December 2022. The mean patient age was 65 years old and 73.5% were male.

While approximately half of the patients were treated when benzodiazepines were restricted, the other half were treated during “liberal benzodiazepine periods” when benzodiazepines were administered unless anesthesiologists thought there was a clinical reason not to use them.   

“We undertook the B-Free trial to determine whether an institutional policy of restricted intraoperative benzodiazepine administration, compared to a policy of liberal use, would reduce the incidence of delirium after cardiac surgery,” wrote first author Jessica Spence, MD, PhD, an anesthesiologist with McMaster University and the Population Health Research Institute, and colleagues. “Our objective was to ascertain the effectiveness of restricting benzodiazepines in routine clinical care.”