Excerpts

In a 2012 study [9] utilizing a simple patient questionnaire to determine if the patient was experiencing acute anxiety in the preoperative holding area, 66 % of the patients' reported symptoms of significant preoperative anxiety. Interestingly, only 4 % of these patients received an anxiolytic drug for premedication [9].

Preoperative anxiety associated with both anesthesia and surgery is not only common but is perceived by many patients as “the worst aspect of the surgical experience.” [11]

Macario et al. [17] also reported that preoperative anxiety was one of the five most important adverse clinical outcomes that anesthesiologists found patients wanted to avoid in the perioperative period.

high baseline levels of anxiety in patients scheduled for elective surgical procedures was associated with increased intraoperative anesthetic and analgesic requirements [26], a higher incidence of bronchospasm in asthmatic patients [27], higher incidences of PONV, and prolonged discharge times [1,28]. In female patients, high levels of preoperative anxiety were also predictive of increased postoperative pain [29]. Additionally, high levels of preoperative anxiety have been reported to delay postsurgical wound healing [10] and is considered a risk factor for increased mortality in patients undergoing major surgical procedures (e.g., cardiac surgery) [30].

Hicks and Jenkins [35] also reported a poor correlation between the measured anxiety level and the anesthesiologist's visual assessment of the patient's level of preoperative anxiety.

that it is time for anesthesia practitioners and/or perioperative nurses to consider performing an assessment of acute (state) anxiety in the preoperative holding area using a simple numeric (e.g., visual analog scale, categorical anxiety scale) [8] or emoji-based anxiety scale [7]. The use of one of these simple anxiety assessment tools would require <15 s to determine the patients' level of acute anxiety regarding the impending surgical procedure and could potentially improve both patient comfort and the decision-making process regarding the administration of anxiolytic premedication in the immediate preoperative period.

The failure of practitioners to accurately assess a patient's level of acute anxiety in the immediate preoperative period as part of their routine preoperative evaluation may also be contributing to a higher incidence of perioperative complications.

Citation

White PF, Elvir-Lazo OL. Rationale for assessing preoperative anxiety as part of the preoperative evaluation process. J Clin Anesth. 2024 Oct 22:111656. doi: 10.1016/j.jclinane.2024.111656. Epub ahead of print. PMID: 39443263.

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