Preoperative anxiety: An important, but neglected issue

Abstract

Preoperative anxiety refers to a state of discomfort caused by an upcoming operation, anesthesia, the disease itself, or hospitalization. Although the reported incidence of preoperative anxiety varies in a wide range, the majority of surgical patients experience at least some degree of anxiety preoperatively and it can be frequently seen in the preoperative setting. The specific factor that contributes most to the emergence of perioperative anxiety has not been identified yet. Still, older age and female gender have been consistently marked as independent predictors of preoperative anxiety. Several different scales have been proposed in recent decades for the measurement of preoperative anxiety. Since high-level preoperative anxiety is associated with severe postoperative complications and can significantly alter surgical treatment outcomes, this issue should not be neglected. Timely identification of anxious patients may reduce the incidence of preoperative anxiety and its possible consequences.

Preoperative Anxiety Impact on Anesthetic and Analgesic Use

“…Subjective scales are the most commonly used method for assessing preoperative anxiety. Several reliable scales are available, such as the Hospital Anxiety and Depression scale (HADS) [38], Visual Analogue Scale for Anxiety (VAS-A) [39,40], State-Trait Anxiety Inventory (STAI) [41], Amsterdam Preoperative Anxiety and Information Scale (APAIS) [42], Linear Analog Anxiety Scale (LAAS), and Multiple Affect Adjective Check List (MAACL) [43]. The VAS-A is the simplest to use, consisting of a 100 mm horizontal line, marked with zero at its left end and 100 at its right end.…”

“…While numerous studies have demonstrated its effectiveness [38][39][40], questions persist regarding the optimal methods for delivering patient education. Some experts advocate for the use of phone, written materials, or video resources [41,42], while other research suggests that direct personal interaction and verbal communication significantly alleviate anxiety symptoms [43,44]. Additionally, modern technologies, including mobile applications [46], online resources [47], and even virtual reality tools [48], have proven effective in managing anxious patients.…”

“…Nonetheless, it is important to note that some authors refute the anxiolytic effects of frequently used medications, and pharmacotherapy has its limitations and can increase treatment costs. Therefore, alternative and less expensive methods for managing anxious patients have gained significant interest in recent years [43]. These include aromatherapy [47,48], music therapy [49], acupuncture [50], and even therapeutic inhaled essential oils [51].…”

Preoperative Anxiety Impact on Anesthetic and Analgesic Use

“…While age and female gender have consistently emerged as distinct predictors of preoperative anxiety in numerous research investigations [29][30][31], a singular, definitive factor contributing to preoperative anxiety remains elusive. Further research endeavors are essential to shed light on the specific patient attributes and surgical variables responsible for the onset of preoperative anxiety.…”

“…The assessment of preoperative anxiety can be accomplished using either objective or subjective methods [32]. Objective approaches encompass both indirect and direct evaluations of anxiety levels, involving the estimation of sympathoadrenal system activation and the measurement of stress hormones, respectively [29,32]. Numerous studies have demonstrated that elevated preoperative anxiety levels are associated with increased heart rate, blood pressure, plasma cortisol, and catecholamine levels, alongside a reduction in heart rate variability and oxygen saturation [29,33].…”