Preoperative anxiety and postoperative adverse events: a narrative overview

Abstract

Patients awaiting surgical procedures often experience obvious anxiety due to discomfort and uncertain events, which is one of the most common clinical manifestations in perioperative patients. Numerous studies have confirmed that preoperative anxiety is closely related to the occurrence of postoperative adverse events, such as insomnia, pain, nausea and vomiting and neurocognitive dysfunction. Appropriate intervention or treatment for preoperative anxiety may contribute to reducing the incidence of postoperative adverse events. Although people have long known about the negative effects of preoperative anxiety and have taken certain measures, the underlying mechanism has yet to be fully elucidated. In this paper, we focus on several typical postoperative adverse events that are, particularly concerning to anesthesiologists, review their relationships with preoperative anxiety, describe the intervention strategies and provide a certain summary and outlook.

Preoperative Anxiety Impact on Anesthetic and Analgesic Use

“…Nevertheless, conflicting findings have emerged in the literature, as certain studies have documented divergent outcomes; one set of studies has shown that reducing preoperative anxiety results in a reduction in postoperative pain, while another set of studies has observed no alteration in the postoperative pain response [26,29,30]. The variability in findings may be due to the lack of homogeneity in the populations studied with respect to gender, medical and psychological history, indication for the surgical procedure, and anesthetic management [31]. Hence, only a comprehensive, large-scale study capable of mitigating the influence of these confounding factors will have the capacity to provide a conclusive answer to this question [31].…”

“…The variability in findings may be due to the lack of homogeneity in the populations studied with respect to gender, medical and psychological history, indication for the surgical procedure, and anesthetic management [31]. Hence, only a comprehensive, large-scale study capable of mitigating the influence of these confounding factors will have the capacity to provide a conclusive answer to this question [31].…”

“…Age has been found to be significantly correlated with the intensity of postoperative pain, with elderly patients typically requiring less postoperative analgesia than younger patients undergoing similar procedures [32]. Nevertheless, it is essential to exercise caution when interpreting these findings, as evaluations of pain and requests for pain management may be affected by confounding factors such as cognitive functioning and physical capabilities [31].…”

“…The assessment of preoperative anxiety can be accomplished using either objective or subjective methods [31]. 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 [28,31].…”

“…The assessment of preoperative anxiety can be accomplished using either objective or subjective methods [31]. 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 [28,31]. 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 [28,32].…”