The effect of pre‐operative anxiety on induction of anaesthesia with propofol*

Abstract

Summary In this prospective study, we investigated the effects of anxiety on the induction dose of propofol and subsequent cardiovascular changes in 197 patients. Pre‐operative state and trait anxiety scores were measured using the State Trait Anxiety Inventory. Propofol was administered at 40 mg.kg−1.h−1. Propofol dose was recorded at loss of verbal response and when EEG Bispectral Index decreased to 50. Thereafter, propofol infusion rate was reduced to 8 mg.kg−1.h−1. Cardiovascular data were collected for 15 min after starting induction. Maximum percentage decreases in heart rate and mean arterial pressure, and the point at which the latter occurred, were recorded. On multivariate analysis, anxiety scores did not significantly affect propofol dose or cardiovascular end‐points, although Bispectral Index at loss of verbal response decreased with increasing trait anxiety (p = 0.02). Anxiety, measured using State Trait Anxiety Inventory, does not appear independently to affect the induction characteristics of propofol.

Effect of pre-anesthetic anxiety and heart rate on propofol dose requirement for induction: A correlation study

“…We also observed that STAI-S measured in the operating room had a strong positive correlation with HR ( Figure 5). This is in agreement with Morely et al 9 and Gras S et al 10 Conflicting results have been reported in the previous studies concerning the effects of anxiety on Propofol dose requirement for induction. Maranets et al found that increased preoperative STAI-T on the day of surgery was associated with higher Propofol bolus dose to achieve a BIS (bispectral index) value between 40 and 60.…”

“…9 Gras S et al found no strong correlation between state and trait anxiety with propofol dose requirement for loss of consciousness (LOC). 10 They found significant positive correlation between HR in the operating room and propofol dose and also between STAI-S in the operating room and HR, thereby supporting an indirect effect of pre-anesthetic anxiety through changes in the HR.…”

“…5,8 But some recent studies have come with different results. 9,10 Anxiety and acute mental stress are associated with increased heart rate (HR) and cardiac output 11,12 and studies have shown that increased cardiac output increases the propofol requirements. [13][14][15][16] Hence hemodynamic status during induction of anesthesia may modify propofol Effect of pre-anesthetic anxiety and heart rate on propofol dose requirement for induction: A correlation study requirements.…”

The Effect of Preoperative Heart Rate and Anxiety on the Propofol Dose Required for Loss of Consciousness

“…13 This is a validated tool for self-reporting anxiety, already used during the perioperative period. [1][2][3]14 It comprises 2 sets of 20 statements.…”

“…1,2 However, this assumption has been recently challenged. 3 Some studies that investigated the effects of perioperative anxiety recorded the propofol dose required to obtain loss of consciousness (LOC) or a defined level of sedation 1,2 but did not consider the hemodynamic effects of anxiety. Anxiety and acute mental stress are associated with increased heart rate (HR) and cardiac output.…”