Anxiolysis is a medical term for the reduction of anxiety, deriving from the Greek roots anxio-, relating to anxiety, and -lysis, meaning a loosening or release. This process is achieved through the administration of specific drugs, creating a state of calm, relaxation, and detachment from the immediate environment. The primary goal is to make a patient comfortable and cooperative for a medical procedure they might otherwise find distressing, while alleviating fear without causing a complete loss of consciousness.
Medical Applications of Anxiolysis
The use of anxiolysis is common across many fields of medicine to manage patient fear and discomfort. In dentistry, it helps patients who have significant phobias about dental work undergo procedures ranging from routine fillings to more complex extractions. For patients with claustrophobia, anxiolysis can make it possible to tolerate diagnostic imaging like MRI or CT scans, which require them to be in a confined space for a period of time.
Anxiolysis also serves as a bridge to more significant procedures. Before major surgery, it is often administered as a premedication to calm the patient in the preoperative phase, easing the transition to general anesthesia. Furthermore, it is frequently used for patient comfort during minimally invasive diagnostic procedures that can be unpleasant, such as endoscopies or colonoscopies. In these cases, the aim is to produce a relaxed state where the patient can tolerate the procedure without significant distress.
Methods and Medications
The administration of anxiolytic medications can be accomplished through several methods, chosen based on the patient and procedure. Oral sedation is a common approach, where a patient takes a pill, typically about an hour before their appointment. This method is straightforward but offers less control over the sedation level. For more rapid onset and greater control, intravenous (IV) administration is used, allowing the clinician to deliver the drug directly into the bloodstream and adjust the dosage in real-time.
Another method is inhalation, such as with nitrous oxide, or “laughing gas.” This gas is breathed in through a small mask placed over the nose, providing a quick-acting and rapidly reversible form of light sedation. The primary class of drugs used for anxiolysis is benzodiazepines. Medications such as diazepam, lorazepam, and midazolam are frequently chosen for their reliable anxiety-reducing and amnestic effects. Depending on the procedure, these may be combined with other agents, like small doses of opioids for pain relief, to enhance patient comfort.
Levels of Sedation
Anxiolysis exists on a spectrum of sedation. The lightest level is minimal sedation, which is synonymous with anxiolysis. At this level, patients are relaxed and calm but remain awake, able to breathe on their own, and can respond normally to verbal commands. This state is distinct from deeper levels of sedation and is not intended to render a patient unconscious.
Moderate sedation, often called “conscious sedation,” makes a patient drowsier and they may drift in and out of a light sleep, but are still easily awakened by voice or a light touch. Their cognitive function is more impaired than with minimal sedation. Deep sedation is a state where a patient is asleep and difficult to arouse, responding only to repeated or more intense stimulation.
The final level is general anesthesia, which induces a complete loss of consciousness. A patient under general anesthesia is unresponsive even to painful stimuli and often requires assistance with breathing.
The Patient Experience and Recovery
Patients are typically given specific instructions before receiving anxiolysis. This often includes a period of fasting, meaning no food or drink for several hours before the appointment, to reduce risks if a deeper level of sedation than intended were to occur. Because the medications impair coordination and judgment, it is mandatory for patients to arrange for a responsible adult to drive them home and stay with them for a period afterward.
During the procedure, patients commonly report feeling a profound sense of calm and relaxation. They are often indifferent to the sounds and activities happening around them. A frequent and often desirable side effect of the medications used is anterograde amnesia, where the patient has little to no memory of the procedure itself.
Following the procedure, patients can expect to feel groggy, sleepy, and somewhat uncoordinated for several hours, and should rest for the remainder of the day. It is strongly advised to avoid driving, operating machinery, or making any important personal or financial decisions for at least 24 hours to allow the medication to fully clear from the body.