Background: This study aims to define incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance dependent patients following general anesthesia to elaborate the risk factors and precise management of them.Methods: 1136 adult patients underwent elective surgeries under general anesthesia were recruited in this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS≥ +1 point, and hypoactive emergence was defined as a RASS≤ -2 points. Subgroup analyses were then conducted on patients with substance dependence.Results: Inadequate emergence in the PACU occurred in 20.3% patients including 13.9% patients with emergence agitation and 6.4% patients with hypoactive emergence. There were 95 patients with a history of substance dependence. The single and married patients undergoing gynecological and thoracic surgeries had a lower risk of agitation compared to the divorced patients. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and analgesic drugs administration in PACU were associated with increased risk of agitation. Hypertension and psychological disorders, intraoperative opioids and Foley catheter fixation in PACU were associated with increased risk of hypoactive emergence. Substance dependent patients were at a higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). Conclusions:Inadequate emergence in PACU following general anesthesia is a significant problem that is correlated with several perioperative factors. It seems that patients with a history of substance dependence are more at the risk of inadequate emergence than normal population. This article is

Background: Despite the growing advancements of surgical and anesthetic techniques resulting in decreased morbidity and mortality, the period before surgery remains stressful for most patients. Considering the adverse effect of preoperative anxiety on anesthesia and surgery outcomes, we conducted this study to evaluate the level of anxiety in the anesthesia clinic among Iranian patients undergoing surgery and also to determine its associated factors. Methods: This was a cross-sectional study performed on 231 patients admitted to the anesthesia clinic of Imam Khomeini hospital, Tehran, Iran. Data were collected by using a three-part questionnaire consisting of demographic data, clinical findings and the translated version of Spielberger state-trait anxiety inventory (STAI). Chi-square test and binary logistic regression model were performed for univariate and multivariate analysis, respectively. A p-value< 0.05 was considered statistically significant. Results: The mean (SD) score for state and trait anxiety were 39.8 (13.4) and 36.5 (12.2), respectively. A significant association was seen between state anxiety and age, gender, occupation, level of education, marital status, patients’ awareness of type of anesthesia and patients’ awareness of anesthesia adverse events (p< 0.05). The most predictive factors for state anxiety were age, patients’ awareness of anesthesia adverse events and female gender, and for trait anxiety these factors were age, place of residence and female gender. Conclusion: Screening for anxiety and identifying individuals vulnerable to preoperative anxiety (e.g. younger patients, females…) can help reduce undesirable surgery outcomes and their economic burden on the healthcare system.

No abstract

Background: Patients undergoing surgery experience significant anxiety in the preoperative period. The aim of the present study was to identify the level of preoperative anxiety among Iranian patients in surgery clinics and its predictive factors. Methods: In this cross-sectional study, the State-Trait Anxiety Inventory questionnaire was used to assess the patients’ preoperative anxiety. Results were analysed using the Chi-square test and binary logistic regression analysis. Results: 246 patients were randomly selected, 222 of which were finally included in our analysis. In this study, the state and trait anxiety levels were moderate and low, respectively. Both state and trait anxiety levels were significantly higher among females (p-value 0.03 and 0.009, respectively). Also, patients with higher education had higher state and trait anxiety levels (p-value 0.001 and <0.001, respectively). Patients undergoing aesthetic surgeries had significantly higher state anxiety levels compared to other surgeries (p-value 0.04). Interestingly, the history of surgery was not significantly associated with state anxiety (p-value 0.96). Logistic regression analysis revealed that age, marital status, and education were the most predictive factors for state anxiety. These factors along with the place of residence were also predictive for trait anxiety (p-value <0.05). Conclusion: Since these predictive factors are not amenable to change before elective surgery, identification of patients with higher anxiety levels is essential. Further studies investigating preoperative anxiety a few days prior to surgery in the Iranian population should be warranted.