The relation between preoperative anxiety and awareness during anesthesia: an observational study

Altinsoy, Savas; Caparlar, Ceyda Ozhan; Ergil, Jülide

doi:10.1016/j.bjane.2020.07.003

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Revista Brasileira de Anestesiologia

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Clinical Research • Rev. Bras. Anestesiol. 70 (4) • Jul-Aug 2020 • https://doi.org/10.1016/j.bjane.2020.07.003 copy

The relation between preoperative anxiety and awareness during anesthesia: an observational study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Anxiety is a state of worry caused by the anticipation of external or internal danger. Awareness During Anesthesia (ADA) is an unexpected memory recall during anesthesia. In this study, we aimed to determine the factors that affect preoperative anxiety and observe the incidence of ADA, as well as to determine the anxiety levels of these patients with a history of ADA.

Methods:

This study was planned to be prospective, observational, and cross-sectional. Patients in whom septoplasty was planned, who was admitted to the anesthesiology outpatients between March 2018 and September 2018, were ASA I-II, and aged 18-70 years were included in the study. The demographic characteristics of patients were recorded. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety during a preoperative evaluation. The modified Brice awareness score was used simultaneously to determine previous ADA.

Results:

The anxiety scores of patients who were conscious during anesthesia were higher than other patients. The mean STAI score was 40.85 ± 14.8 in the 799 patients who met the inclusion criteria of this study. When the anxiety scores were compared, the scores were higher in females than in males (p < 0.05). The mean STAI score was found as 40.3 ± 13.8 in patients who dreamed during anesthesia.

Conclusion:

It is important to determine the anxiety levels of patients in the preoperative period to prevent the associated complications. Preoperative anxiety, besides preventing ADA, should be dealt with in a multidisciplinary manner. ADA should be carefully questioned while evaluating previous anesthesia experiences.

KEYWORDS
Preoperative anxiety; Awareness during anesthesia; State-trait anxiety inventory

Number	Feelings	Not at all	Somewhat	Moderately so	Very much so
1	I feel calm	(1)	(2)	(3)	(4)
2	I feel secure	(1)	(2)	(3)	(4)
3	I am tense	(1)	(2)	(3)	(4)
4	I feel strained	(1)	(2)	(3)	(4)
5	I feel at ease	(1)	(2)	(3)	(4)
6	I feel upset	(1)	(2)	(3)	(4)
7	I am presently worrying over possible misfortunes	(1)	(2)	(3)	(4)
8	I feel satisfied	(1)	(2)	(3)	(4)
9	I feel frightened	(1)	(2)	(3)	(4)
10	I feel comfortable	(1)	(2)	(3)	(4)
11	I feel self-confident	(1)	(2)	(3)	(4)
12	I feel nervous	(1)	(2)	(3)	(4)
13	I am jittery	(1)	(2)	(3)	(4)
14	I feel indecisive	(1)	(2)	(3)	(4)
15	I am relaxed	(1)	(2)	(3)	(4)
16	I feel content	(1)	(2)	(3)	(4)
17	I am worried	(1)	(2)	(3)	(4)
18	I feel confused	(1)	(2)	(3)	(4)
19	I feel steady	(1)	(2)	(3)	(4)
20	I feel pleasant	(1)	(2)	(3)	(4)

	STAI score (mean ± SD, median [min-max])	High/Low anxiety (n)
Gender
Female (n = 362)	39.4 ± 15.33	149/213
Female (n = 362)	36 (20-80)	149/213
Male (n = 437)	42.61 ± 13.97	137/300
Male (n = 437)	42 (20-80)	137/300
p-value	< 0.001^a a Mann-Whitey U test.	0.004^c c Pearson's Chi-Square test.
Age
< 30 (n = 248)	39.42 ± 16.51	66/182
< 30 (n = 248)	36 (20-80)	66/182
31-50 (n = 371)	41.89 ± 14.06	151/220
31-50 (n = 371)	40 (21-80)	151/220
> 51 (n = 180)	40.69 ± 13.67	69/111
> 51 (n = 180)	38 (20-70)	69/111
p-value	0.124^b b Kruskal Wallis test.	< 0.001^c c Pearson's Chi-Square test.
Operation type
Emergency (n = 194)	42.03 ± 16.78	65/129
Emergency (n = 194)	37 (20-80)	65/129
Elective (n = 605)	40.48 ± 14.11	221/384
Elective (n = 605)	38 (20-80)	221/384
p-value	0.722^a a Mann-Whitey U test.	0.445^c c Pearson's Chi-Square test.
ASA score
I (n = 458)	40.88 ± 15.12	158/300
I (n = 458)	38 (20-80)	158/300
II (n = 341)	40.82 ± 14.39	128/213
II (n = 341)	38 (20-80)	128/213
p-value	0.726^a a Mann-Whitey U test.	0.375^c c Pearson's Chi-Square test.
Educational status
Primary school (n = 187)	41.19 ± 14.91	67/120
Primary school (n = 187)	38 (20-80)	67/120
Middle school (n = 279)	39.96 ± 14.84	94/185
Middle school (n = 279)	38 (20-80)
High school (n = 192)	41.6 ± 14.91	72/120
High school (n = 192)	39 (20-80)	72/120
University (n = 141)	41.14 ± 14.53	53/88
University (n = 141)	38 (20-80)
p-value	0.551^b b Kruskal Wallis test.	0.807^c c Pearson's Chi-Square test.

Number	Gender	Age	ASA	Operation type	Type of surgery	Educational status	STAI score
1	F	43	II	Emergency	ObsGyn	Primary school	70
2	F	51	II	Elective	CVS	University	70
3	M	24	I	Emergency	ORT	High school	64

Number	Gender	Age	ASA	Operation type	Type of surgery	Educational status	STAI score
1	M	44	I	Elective	GS	Primary school	34
2	M	24	I	Elective	ENT	Middle school	43
3	M	25	I	Emergency	GS	High school	37
4	F	56	II	Elective	ORT	University	64
5	M	24	I	Elective	GS	High school	26
6	F	61	I	Elective	URO	University	49
7	F	34	II	Elective	GS	Primary school	23
8	F	37	I	Elective	GS	High school	51
9	F	48	II	Elective	CVS	University	24
10	M	34	I	Elective	ENT	Primary school	52

	STAI score, mean ± SD (median min-max)	High anxiety/Low anxiety (n)	p-values
General surgery	42.12 ± 16.13	111/182	< 0.001^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	37 (20-80)
Neurosurgery	38.72 ± 13.91	25/51	< 0.001^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	36 (20-70)
Cardiovascular surgery	40.19 ± 14.26	9/12	0.513^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	30 (21-66)
Ear-nose-throat surgery	38.22 ± 14.92	42/115	< 0.001^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	36 (20-80)
Orthopedy	42.51 ± 14.34	42/60	0.075^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	41 (20-74)
Plastic and reconstructive surgery	41.2 ± 13.62	22/39	0.030^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	38 (21-72)
Urology surgery	41.55 ± 11.71	28/46	0.036^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	39 (26-76)
Ophthalmology	33.13 ± 9.36	1/7	0.034^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	27 (27-52)
Obstetrics and ginecology	46.86 ± 7.45	6/1	0.059^a a Chi-Square godness of fit test for number of high/low anxiety patients; the STAI values were given as mean ± standart deviation and median (min-max); STAI, State-Trait Anxiety Inventory.
	50 (30-50)

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[1] * Corresponding author. E-mail savasaltinsoy@gmail.com (S. Altinsoy).