Preoperative anxiety

Overview

Melatonin is the only supplement studied for preoperative anxiety, with 6 trials in adults. Studies suggest that oral melatonin (typically 3–10 mg, or weight-based dosing) taken 20–120 minutes before surgery may reduce anxiety before and after the procedure. Effects appear comparable to some conventional premedications such as midazolam, but without side effects like memory impairment, breathing difficulties, or slowed reaction times.

Results in children are less clear. See the heatmap and evidence reviews below for trial details.

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Melatonin	★★★★★	Medium

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Studies

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MelatoninView supplement →

Consider purchase★★★★★

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Effect SizeMediumEvidenceHighTrustVery High

Evidence Review

Taking melatonin before surgery may help reduce anxiety in adults. Studies show that taking it by mouth (3–10 mg or doses based on body weight) about 20–120 minutes before surgery lowers anxiety before and after the procedure. Melatonin seems to work as well as medicines like midazolam and similar drugs, but without side effects such as memory problems, breathing difficulties, or slower thinking and reaction times.
In children, the results are less clear. Some studies show melatonin is not as effective as midazolam, while others show similar effects or no difference compared to placebo. Because of these mixed results, it is uncertain how helpful melatonin is for children before surgery.

Browse 6 studies

RCTOral melatonin as part of multimodal anxiolysis decreases emergence delirium in children whereas midazolam does not: A randomised, double-blind, placebo-controlled study2021n=132

In 132 children aged 3–8 undergoing sevoflurane anesthesia, oral melatonin as part of multimodal anxiolysis reduced emergence delirium, while midazolam did not.

Effect: Benefit
Dose: 0.3 mg/day
Population: Children/adolescents
Participants: 132
Ages: 3–8

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MetaMelatonin for preoperative and postoperative anxiety in adults2020n=2,319

A Cochrane review found melatonin may reduce preoperative and postoperative anxiety compared with placebo, with effects similar to some benzodiazepines at lower sedation risk.

Effect: Benefit
Population: Adults
Participants: 2,319
Ages: 15–90

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RCTMelatonin and clonidine premedication has similar impact on the pharmacokinetics and pharmacodynamics of propofol target controlled-infusions2015n=32

In 32 sinus surgery patients, melatonin premedication altered propofol pharmacokinetics similarly to clonidine without worsening hemodynamic stability.

Effect: No Benefit
Population: Adults undergoing sinus surgery
Participants: 32

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RCTPremedication with oral alprazolam and melatonin combination: a comparison with either alone--a randomized controlled factorial trial2014n=80

In 80 preoperative patients, alprazolam plus melatonin improved anxiolysis more than either drug alone or placebo before anesthesia.

Effect: Benefit
Dose: 3 mg/day
Population: Adults
Participants: 80
Ages: 18–65

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RCTPreoperative melatonin and its effects on induction and emergence in children undergoing anesthesia and surgery2009

In children undergoing surgery, oral melatonin 0.05–0.4 mg/kg reduced preoperative anxiety similarly to midazolam 0.5 mg/kg in a randomized trial.

Effect: No Benefit
Dose: 0.5 mg/kg
Population: Adults

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RCTMelatonin vs. midazolam premedication in children: a double-blind, placebo-controlled study2005n=15

In 105 children, melatonin premedication reduced anxiety without the cognitive impairment seen with midazolam in this dose-ranging trial.

Effect: Benefit
Dose: 15 mg/kg
Population: Adults
Participants: 15

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Evidence visualised

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Purchase-guidance distribution

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Effect-size distribution

How large the reported benefits tend to be

Study distribution across 1 supplements for preoperative anxiety (6 studies total).
Supplement	DEX	Studies	Meta-analyses	Share
Melatonin	★★★★★72%	6	0	100%

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