Evaluation of the effect of preoperative anxiety on intraoperative hemodynamic stability and drug consumption in patients who underwent BIS-guided total intravenous anesthesia (TIVA) for neurophysiological monitoring in spine surgery

In our study, the aim was to evaluate the effects of preoperative anxiety measured by Spielberger’s State-Trait Anxiety Inventory-State (STAI-S) and State-Trait Inventory-Trait (STAI-T) scores on intraoperative hemodynamic stability, drug consumption and recovery in patients who underwent spinal surgery with neurophysiological monitoring and total intravenous anesthesia with bispectral index (BIS) monitoring, without the use of muscle relaxants. Eighty patients with planned spinal surgery and neurophysiological monitoring were included in this prospective observational study. Anxiety scores were recorded by applying Spielberger’s STAI-T and STAI-S scoring questionnaires to all patients included in the study 1 hour before the operation. Age, gender and American Society of Anesthesiologists (ASA) scores of the patients who were taken to the operating table without premedication were recorded. Before anesthesia induction, standard monitoring including electrocardiography (ECG), noninvasive blood pressure, peripheral oxygen saturation (SpO2), BIS was applied. The correlation between STAI-T and STAI-S scores with demographic characteristics of patients, preoperative, post-induction, 5th minute, 10th minute, 30th minute, 50th minute, 70th minute, 90th minute heart rate (HR), mean arterial pressure (MAP), SpO2, operation time, recovery time, and total amount of propofol and remifentanil used during the operation were evaluated statistically. A significant negative correlation was observed between STAI-S anxiety scoring and age (p < 0.05). A significant positive correlation was found between the total amount of remifentanil and propofol used with the STAI-S score (p < 0.05). Significant positive correlations were observed between the STAI-S score and the HR value preoperatively, and in the 5th, 30th, 50th, 70th, and 90th minutes (p < 0.05). Our study showed that preoperative anxiety increases intraoperative drug consumption and heart rate. It is of great importance to keep the amount of intraoperative medication at optimal levels, to measure preoperative anxiety, and to eliminate it with multimodal treatments, especially for the accurate detection of neurological damage in patients with neurophysiological monitoring.

Corrigendum to “Comparing the effects of nursing versus peer-based education methods on the preoperative anxiety in infertile women: An RCT” [Int J Reprod BioMed 2019; 17: 883-890]

This is a Corrigendum to “Comparing the effects of nursing versus peer-based education methods on the preoperative anxiety in infertile women: An RCT” [Int J Reprod BioMed 2019; 17: 883-890] and does not have an abstract. Please download the PDF or view the article HTML.

Comparison of different scales for the evaluation of anxiety and compliance with anesthetic induction in children undergoing scheduled major outpatient surgery

Introduction Anxiety in children triggered by a scheduled surgical intervention is a major issue due to its frequency and consequences. Preoperative anxiety is associated with increased patient fear and agitation on anesthetic induction. The aim of this study is to compare three preoperative anxiety scales for children undergoing elective outpatient surgery, and to correlate each of these tools with the degree of patient compliance on induction, as assessed by the Induction Compliance Checklist (ICC). Methods An observational prospective study was performed on a cohort of children with ages between 2 and 16 years old, scheduled for outpatient surgery. Anxiety was assessed upon arrival to the hospital (M0), during transfer to the surgical unit (M1), and in the operating room during anesthetic induction (M2). Anxiety in the parents (measured with the State-Trait Anxiety Inventory, STAI) and in the children (measured with the Spence Anxiety Scale-Pediatric, SCAS-P, the State-Trait Anxiety Inventory Children, STAIC, and Modified Yale Preoperative Anxiety Scale, m-YPAS) was assessed. Compliance with anesthetic induction was assessed with ICC. Results The study included 76 patients (72.4% male, median age 7.9 years). Anxiety scores (m-YPAS) increased as the moment of surgery approached, being greater at the entrance to the surgical unit (M0 = 26.1 ± 9.5; M1 = 31.8 ± 18.1; M2 = 33.5 ± 21.1). A strong correlation was found between ICC scale and m-YPAS at M1 (0.738) and M2 timepoints (0.794), but not with the rest of scales at M0. Conclusions Standard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale.

Preoperative anxiety as predictor of perioperative clinical events following carotid surgery: a prospective observational study

Background Psychological factors like anxiety and depression are recognised to play a causal role in the development of cardiovascular disease and they may also influence outcome after vascular surgery procedures. The aim of this study was to investigate the association of anxiety and depression with postoperative outcome following elective carotid surgery. Methods Single centre prospective observational study of patients treated for asymptomatic carotid artery stenosis at an academic vascular surgery centre. Preoperative anxiety and depression were evaluated using self-reporting questionnaires: Spielberger State-Trait Anxiety Inventory (STAI-S/-T) and Hospital Anxiety and Depression Scale (HADS-A/-D). Postoperative morbidity and mortality were assessed with the primary composite endpoint of stroke, myocardial infarction (MI) and death. Standard reporting guidelines for carotid disease were applied. Results From June 2012 to November 2015, 393 carotid endarterectomies (CEA) were performed at our institution. Out of those, 98 asymptomatic patients were available for analysis (78% male; median age, 71.1 years). Median scores of self-reporting questionnaires did not differ from published data of the general population (STAI-T, trait component, median, 36; IQR, 31-42.75; STAI-S, state component, median, 38; IQR, 32-43; HADS-A median, 6; IQR, 3-8; HADS-D median, 4; IQR, 2-7). Cardiovascular risk factors were similar in anxious and non-anxious patients. The composite endpoint of stroke, MI and death occurred significantly more often in patients presenting with a preoperative HADS-A score higher than 6 (10.5%, 95% CI, 3-25; p =.020). Conclusions The present study indicates that preoperative anxiety is associated with the occurrence of intra- and postoperative neurological events in patients undergoing CEA. Patients who had a preoperative HADS-A score of 6 or less had a very low probability of experiencing these complications.