The Effect of Preoperative Pain, Fear, and Anxiety on Postoperative Pain in Urological Surgery Patients: A Descriptive and Correlational Study

PURPOSE

The study was conducted to determine the effect of preoperative pain, fear, and anxiety on postoperative pain and analgesia use in urology patients.

DESIGN

A descriptive and correlational design was used.

METHODS

The population of the study consisted of patients who were hospitalized in the Urology clinic of a university hospital and were planning surgery. The sample consisted of 106 patients who met the inclusion criteria and agreed to participate in the study. The study's data was collected using the Personal Information Form, Analgesia Follow-up Form, Surgical Fear Questionnaire, Surgical Anxiety Questionnaire, and Visual Analog Scale prepared in line with the literature. Descriptive statistics, Pearson correlation coefficient, and linear regression analysis were used to evaluate the data.

FINDINGS

A positive linear relationship was found between postoperative pain and surgical anxiety, surgical fear, and preoperative pain (P < .05). Regression analysis revealed that preoperative pain (P = .006) affected the level of postoperative pain. In addition, fear of surgery (P = .035) and postoperative pain (P = .000) were found to affect the use of postoperative 24-hour analgesia.

CONCLUSIONS

The study revealed a relationship between the postoperative pain experienced by the patients and preoperative pain, fear, and anxiety.

A bibliometric analysis of research on pediatric preoperative anxiety (2007-2022)

Objective

This study aimed to analyze the current state of research on preoperative anxiety in children through CiteSpace, VOSviewer, and the identification of hot spots and frontiers.

Method

Relevant data were retrieved from the Web of Science Core Collection using the search terms children and preoperative anxiety. Data were analyzed using VOSviewer (version 1.6.18), CiteSpace (5.7. R5) software, and Scimago Graphica.

Results

A total of 622 articles were published between 2007 and 2022, with an increasing trend over time. Kain, Zeev N. (13; 2.09%) and Dalhousie University (15; 2.41%) were the most influential authors and most prolific institutions, respectively. The United States (121; 19.45%) was the country with the most publications. Pediatric anesthesia (55; 8.84%) had the most publications. High-frequency keywords were categorized into three themes, including nonpharmacologic interventions for preoperative anxiety in children, preoperative medications, and risk factors for anxiety; of these, "predictor" (38; 2016) and "sedative premedication" (20; 2016) were the most studied keywords over the past 6 years. "Distraction" (67; 2019) and "dexmedetomidine" (65; 2019) have been the main areas of interest in recent years.

Conclusion

Research on preoperative anxiety in children has been the focus of increasing attention over the past fifteen years, with the majority of publications from high-income countries. This review provides a useful perspective for understanding research trends, hot topics, and research gaps in this expanding field.

Factors related to preoperative anxiety in older patients with sensory impairment: A cross-sectional study

AIM

To identify the factors related to preoperative anxiety in older adults with sensory impairment.

DESIGN

Descriptive quantitative research design.

METHODS

Study participants were 120 older adults admitted to a tertiary hospital in Seoul, South Korea to undergo eye or ear surgery. Data were collected from 11 February to 30 April 2023. The collected data were analysed using descriptive statistics, t-tests, ANOVA, and multiple regression analysis using SPSS 28.0. The study was reported following the STROBE checklist.

RESULTS

Preoperative anxiety differed significantly according to gender (p = .002), average monthly household income (p < .001), subjective health status (p = .003), subjective vision loss (p = .004), one-sided or both-sided eye discomfort (p = .002), use of glasses (p = .010), subjective hearing loss (p = .022) and anxiety coping mechanisms (p < .001). The results of a multiple regression analysis on the significant variables identified that gender (β = .178, p = .036) and anxiety coping mechanisms (β = .336, p < .001) had the most significant effect on preoperative anxiety, with an explanatory power of 34.5%.

CONCLUSION

The development and practical application of tailored nursing interventions catering to specific genders and anxiety coping mechanisms would contribute to reducing preoperative anxiety and providing efficient nursing care for older adults with sensory impairment.

Anxiolytic and Sedative Properties of Melatonin Premedication in Pediatrics Undergoing Elective Cardiac Catheterization: A Randomized Placebo Study

BACKGROUND

Preoperative anxiety in children has been linked to various postoperative consequences, such as postoperative regressive behavioral issues, extended distress during the recovery period, eating disorders, and bedwetting. The current study aimed to investigate the efficacy of low-dose oral melatonin in alleviating preoperative anxiety among children in the Iraqi population.

STUDY DESIGN

A randomized, double-blinded comparative study was undertaken, involving children aged four to 14 years scheduled for elective cardiac catheterization under general anesthesia. The study comprised a total of 80 children. The involved individuals were randomly assigned to two groups, each with 40 subjects. Group A received 0.5 mg/kg melatonin as premedication, while Group B received a placebo.

RESULTS

The two groups demonstrated similarity in mean age, weight, cardiac disease, and gender distribution. Statistically significant reductions in anxiety scores were observed in the melatonin group compared to the placebo group. Particularly, children administered 0.5 mg/kg melatonin exhibited the most substantial anxiolysis and venipuncture compliance (P < 0.05). Additionally, children who were premedicated with melatonin experienced decreased cognition, maximum sedation, successful parental separation, and psychomotor impairment (P < 0.05).

CONCLUSIONS

Melatonin demonstrated an effective sedation level without significant side effects, making it a preferred choice due to its efficacy, safety, current availability, and cost-effectiveness compared to other anesthetic agents used in premedication procedures.

The Impact of Educational Sessions on Anxiety Levels among Women Undergoing Caesarean Section: A Quasi-Experimental Study

Although the Caesarean section (CS) is considered a harmless surgery, it has various complications. Women scheduled for elective CSs often have high levels of anxiety due to a lack of knowledge. The aim of this quantitative quasi-experimental study was to determine the relationship between preoperative educational sessions and anxiety levels among women undergoing CSs. The study was conducted at the antenatal unit in the King Faisal Medical Complex (KFMC) in Taif, Saudi Arabia, using a structured interview questionnaire, the State-Trait Anxiety Inventory (STAI), and satisfaction interviews. A total of 50 pregnant women participated in this study, who were divided into two groups: 25 participants in the intervention group and 25 in the control group. Most participants (92%) in the intervention group had low anxiety levels following educational sessions, and 96% of the participants were very satisfied with the preoperative information they had been given. Women in the control group (again, 92%) had high anxiety levels, and there was a significant difference in the anxiety levels of the intervention and control groups (p ≤ 0.5) after the educational sessions. Providing proper preoperative education about CSs can reduce preoperative anxiety, improve patient outcomes, and enhance patients' involvement in their care and decision-making.

Psychometric Properties of the Turkish Version of the Surgical Anxiety Questionnaire (SAQ)

PURPOSE

This study aimed to determine the psychometric properties of the Turkish surgical anxiety questionnaire (SAQ) version.

DESIGN

This study design was methodological.

METHODS

The study was evaluated with construct validity, exploratory (EFA) and confirmatory factor analysis (CFA), and convergent and discriminant validity. For scale reliability, internal consistency, Cronbach Alpha Coefficient, Pearson Correlation Analysis, and Inter-item Correlation Analysis, test-retest, and parallel forms methods were used.

FINDINGS

The Turkish version of the surgical anxiety questionnaire consisted of a 3-factor structure, and the Cronbach's alpha value was 0.93. The CFA factor loads varied between 0.48-0.98. A positive, high correlation was found between SAQ and the Amsterdam Preoperative Anxiety and Knowledge Scale (APASIS). A positive, moderate correlation between SAQ and State-Trait Anxiety Inventory-1(STAI-1) was found.

CONCLUSION

SAQ has strong validity and reliability in the Turkish society. Nurses could use the SAQ to determine the anxiety level in surgical patients.

The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial

BACKGROUND AND AIMS

Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention.

METHODS

Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale.

RESULTS

The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention.

CONCLUSION

To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.

Reactive Hypoglycemia in Patients Prior to Cataract Surgery: A Case Series

Cataract surgery is one of the most frequently performed surgical procedures and is often performed under topical anesthesia in conscious patients. Sweating, palpitations, and anxiety may be seen in patients about to undergo surgery. However, these are typical adrenergic symptoms of hypoglycemia and should be further investigated if occurring before surgery. Here, we report five cases of postprandial or reactive hypoglycemia observed in hospital settings just before conducting cataract surgeries in non-diabetic 52-78-year-old patients from 2019 to 2023.

Effective doses of midazolam oral solution for the prevention of preoperative anxiety in paediatric patients

BACKGROUND

More than 60% children exhibit anxiety before undergoing an anesthetic-surgical procedure, particularly among pre-school paediatric patients. Oral midazolam can provide procedural sedation for children prior to anesthesia. However, extemporaneous solutions of midazolam are usually prepared from injectable drug solutions, leading to inconsistent efficacy due to variable preparation methods. Xiaoerjing® is the first commercially available oral formulation of midazolam for procedural sedation in children in China. Despite the recommended dosage range of 0.25-0.5 mg/kg, its effective dose is still largely unknown.

AIM

To determine the 95% effective dose (ED95) of midazolam oral solution (Xiaoerjing®) for alleviating preoperative anxiety in children prior to mask induction of general anesthesia.

DESIGN

The study included 61 children between the ages of 1 and 6 years undergoing elective surgery under general anesthesia. The first patient received a single dose of 0.5 mg/kg midazolam oral solution, which was adjusted for subsequent patients using the biased coin design method based on their response to the previous dose. Doses were increased or decreased at the rate of 0.1 mg/kg. An effective response was defined as having a modified Ramsay sedation score ≥3a, separation anxiety score ≤2, and mask acceptance score ≤2 during inhalational anesthesia induction.

RESULTS

Fifty-six children were included in the final analysis. Of those, sedation was successful in 50 patients, with a median separation time of 15 (IQR: 25) min. Midazolam oral solution has an ED95 of 0.8254 mg/kg (95% CI: 0.6915-0.8700 mg/kg) for relieving preoperative anxiety in children. No adverse events occurred following drug administration.

CONCLUSION

Midazolam oral solution is a safe and effective medication for relieving preoperative anxiety in children. The ED95 of a single oral dose of midazolam oral solution is 0.8254 mg/kg (95% CI: 0.6915-0.8700 mg/kg).

Effect of video distraction on preoperative anxiety scores in pediatric patients undergoing general anesthesia in ophthalmic daycare procedures: A randomized controlled trial

Background and Aims

Parental separation, fear, and exposure to the operating room environment lead to stress and anxiety in pediatric patients. This study aims to identify the research gaps in the effect of video distraction on pediatric patients of Indian origin. We hypothesized that video distraction along with parental presence would reduce preoperative anxiety in pediatric patients undergoing ophthalmic procedures under general anesthesia compared with parental presence alone.

Material and Methods

In this prospective randomized trial, 145 patients aged 2-8 years, ASA I-II, with at least one functional eye undergoing elective ophthalmic daycare procedures were enrolled. They were randomly allocated to two Groups: Group V had distraction by watching a video/playing a video game together with parental presence, whereas control Group C had parental presence alone without any video distraction. The primary objective of the study was to compare preoperative anxiety using the Modified Yale Preoperative Anxiety score (mYPAS) and heart rate (HR), whereas the secondary objective was to compare child fear, emergence delirium, and parental satisfaction between the two groups. The three time points for intergroup comparisons were the preoperative holding area 10 min before induction (T0), transport of the child to the operating room (T1), and face mask introduction (T2).

Results

There was a statistically significant difference between mYPAS score in groups V and C at all time points (P = 0.036, P = 0.0001, P = 0.0000), parental satisfaction score at all three time points (P = 0.0049, P = 0.0000, P = 0.0000), and Child Fear Score at T1 and T2 (P = 0.0001, P = 0.0001, respectively). However, there was no statistically significant difference in the emergence of delirium between the two groups.

Conclusions

Video distraction together with parental presence has a promising role for implementation in hospitals with heavy workload settings where pharmacological intervention would not be feasible, to alleviate preoperative anxiety in children. However, preoperative anxiety may not translate into increased postoperative emergence delirium as was earlier believed.

The Influence of Pre-operative Pain and Anxiety on Acute Postoperative Pain in Cardiac Surgery Patients Undergoing Enhanced Recovery after Surgery

Objective

Perioperative multimodal analgesia is an important step in enhanced recovery after surgery (ERAS) care. Many factors, such as preoperative chronic pain and anxiety, may provide information about the expected postoperative pain. In this study, we evaluated preoperative pain and anxiety and investigate their effects on acute postoperative pain in patients undergoing elective cardiac surgery.

Methods

After ethics committee approval, 67 consenting patients undergoing on-pump cardiac surgery under the ERAS program were included in our prospective observational study. Pre- and postoperative pain scores were obtained using a numeric rating scale (NRS) at rest and during movement. Preoperative anxiety was assessed on a 0-10 scale, and data were recorded. The relationships between pre-operative pain/anxiety and postoperative pain were evaluated using correlation analysis.

Results

In preoperative pain assessment, the percentage of patients with a pain score above 4 with NRS was 1.5%, regardless of whether they were at rest or mobilize. In postoperative pain assessment, there were 20.9% and 34.3% patients with NRS >4 at rest and mobilization, respectively. 7.5% of patients had preoperative anxiety of grade 5 or higher. While preoperative pain was not correlated with postoperative pain, preoperative anxiety had a moderate positive correlation with postoperative pain (r=0.382, P=0.003).

Conclusion

The prevalence of preoperative pain in patients who underwent cardiac surgery is quite low and is not associated with postoperative pain. There is also a significant relationship between the severity of preoperative anxiety and postoperative pain.

Psychometric Evaluation of the Farsi Version of the Surgical Anxiety Questionnaire

PURPOSE

The aim of this study was to evaluate the psychometric properties of the Farsi version of the Surgical Anxiety Questionnaire.

DESIGN

Cross-sectional study.

METHODS

This study was performed on 402 patients who were candidates for elective surgery in Mashhad [East Iran) hospitals in winter 2021. After forward-backward translation, face and content validity checks were performed qualitatively. The construct validity was assessed by exploratory and confirmatory factor analysis. Data analysis was performed with SPSS 16 and AMOS 26.

FINDINGS

In exploratory factor analysis, two factors were extracted: concerns about surgery and anesthesia; and postdischarge concerns, which explained 52% of the total variance. The Cronbach's alpha for the entire questionnaire was 0.91 and for the subscales ranged from 0.80 to 0.87. The final model had a good fit as determined by confirmatory factor analysis.

CONCLUSIONS

The Farsi version of the surgical anxiety questionnaire has acceptable validity and reliability. The existence of this scale measuring domain-specific anxiety allows for further research in this area.

The Effect of Listening to Music Presurgery on the Anxiety Level of Individuals who are Planned for Urological Surgery: Randomized Controlled Study

PURPOSE

This study aims to evaluate the effects of listening to music on preoperative anxiety levels in individuals planned for urological surgery.

DESIGN

The study was a pretest-post-test randomized controlled study.

METHODS

This research was conducted with 80 (intervention=40, control=40) individuals who applied to the urology clinic of a university hospital between September 2021 and February 2022 with surgery planned. The data were collected via the information form, state-trait anxiety inventory (STAI= STAI-S: state anxiety, STAI-T: trait anxiety), anxiety specific to surgery questionnaire (ASSQ).

FINDINGS

The mean STAI-S scores for the pretest and post-test intervention group were 37.15 ± 8.04 and 34.67 ± 9.09; while scores for the control group were 36.23 ± 9.44 and 37.23 ± 9.78. While the difference in the intervention group was statistically significant (P = .006), there was no difference observed in the control group (P = .256). The pretest and post-test STAI-T mean scores for the intervention group were 39.73 ± 7.71 and 39.88 ± 8.22; the control group scores were 40.68 ± 4.91 and 41.25 ± 5.87; the difference between the intervention (P = .840) and control (P = .346) groups was not statistically significant. The pretest and post-test surgery-specific anxiety scale mean scores of the intervention group were 18.08 ± 4.52 and 16.55 ± 4.79; the control group were 20.50 ± 7.31 and 20.95 ± 7.69. While the difference in the intervention group was statistically significant (P = .011), no difference (P = .498) was determined in the control group.

CONCLUSIONS

Individuals planned for urological surgery who listened to music for 30 minutes had reduced state and surgery-specific anxiety for 15 minutes after listening, however, this did not affect trait anxiety. The practice of listening to music before surgery may be recommended for individuals who are scheduled for urological surgery to reduce patient anxiety.

Preoperative Anxiety Impact on Anesthetic and Analgesic Use

Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual's pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences.

Preoperative anxiety and associated factors among adult surgical patients in public hospitals, eastern Ethiopia

Objective

This study aimed to assess the prevalence of preoperative anxiety and associated factors among adult surgical patients in public hospitals of eastern Ethiopia from 25 April to 26 May 2022.

Methods

An institutional-based cross-sectional study was undertaken using a systematic sampling technique among 423 participants from patients eligible for elective surgery. The prevalence of preoperative anxiety was assessed using the state and trait anxiety inventory measurement scale. Data were analyzed using SPSS version 26. Descriptive and summary statistics were computed. Binary and multivariable logistic regression were computed. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and statistical significance was declared at a p-value < 0.05.

Results

The prevalence of preoperative anxiety among patients scheduled for elective surgery was 51.2%. Being 31-45 aged adult (AOR = 0.36; 95% CI = 0.17, 0.78), having moderate (AOR = 0.46; 95% CI = 0.22, 0.96) and strong social support (AOR = 0.04; 95% CI = 0.02, 0.08), being single (AOR = 0.19; 95% CI = 0.04, 0.89), listening to music (AOR = 0.37; 95% CI = 0.18, 0.74) and finding social and religious support (AOR = 0.15; 95% CI = 0.07, 0.33), and orthopedic surgery (AOR = 0.21; 95% CI = 0.10, 0.43) were significantly associated with lower odds of preoperative anxiety, whereas having fear of death (AOR = 1.16; 95% CI = 0.64, 2.09) was significantly associated with increased odds of preoperative anxiety.

Conclusion

In the current study, the magnitude of preoperative anxiety was high. Being an older adult and having social and treatment support was associated with lower odds of preoperative anxiety. In contrast, lower psychological readiness (fear of death) was associated with increased odds of preoperative anxiety. Patients should be routinely assessed for anxiety during the preoperative appointment, and the proper coping mechanisms and anxiety-reduction approaches should be used. It is also advisable that appropriate policies and procedures for reducing preoperative anxiety should be devised.

Psychometric evaluation of Urdu-translated Amsterdam preoperative anxiety and information scale and assessment of preoperative anxiety in adult surgical patients of Karachi, Pakistan: A cross-sectional study

Objective

The primary aim of this study was to develop an Urdu-translated version of the Amsterdam preoperative anxiety and information scale and perform a psychometric evaluation of it. A secondary aim was to estimate the prevalence of preoperative anxiety using Urdu-translated Amsterdam preoperative anxiety and information scale in patients undergoing surgery in Karachi, Pakistan, and the factors contributing to anxiety among them.

Method

This cross-sectional survey included 267 patients enrolled for elective surgery under general anesthesia from March 5 to November 20, 2022. In psychometric analysis, face validity, criterion validity, construct validity, and reliability of Urdu-translated Amsterdam preoperative anxiety and information scale were determined. Face validity was evaluated by performing blind-back translation and a pilot study. Criterion validity was evaluated by correlating the Amsterdam preoperative anxiety and information scale with the visual analog scale for anxiety. Exploratory factor analysis and Cronbach's α test were used to analyze construct validity and reliability, respectively. The associate variables were identified by performing a one-sample t-test and one-way analysis of variance on SPSS 26.

Results

Cronbach's α test is 0.85 for the Amsterdam preoperative anxiety and information scale anxiety scale and 0.70 for the need for information. 65.3% of the total variance is explained by the Urdu version of Amsterdam preoperative anxiety and information scale items in factor analysis and the intercorrelation of all items was >0.20 (mean: 0.575). Urdu-translated Amsterdam preoperative anxiety and information scale and visual analog scale for anxiety showed a good correlation (r = 0.664, p < 0.001). The overall prevalence of preoperative anxiety among patients is 52.4% suggested by the Amsterdam preoperative anxiety and information scale cutoff score of more than 11. Females, students, and patients elected for major surgery shared significantly higher anxiety levels (p < 0.05). The commonest factors contributing to anxiety are postoperative pain in 140 (52.4%) patients, fear of death in 115 (43.1%), and financial loss in 91 (34.1%).

Conclusions

The Urdu-translated Amsterdam preoperative anxiety and information scale is a reliable, valid, and acceptable screening tool for preoperative anxiety. The prevalence of preoperative anxiety was high. The preoperative anxiety level is significantly associated with gender, employment status, and type of surgery.

Allaying Pediatric Preoperative Anxiety, Where are we Now? - A Nationwide Survey

Background

Preoperative anxiety (PA) in children is a common phenomenon associated with various negative patient outcomes. Allaying PA is accepted as a standard of care, but its use is not universal and often overlooked. This survey is designed to evaluate the nationwide current practice patterns and attitudes of anesthesiologists toward the practice of allaying PA in children.

Materials and Methods

A questionnaire of 25 questions, including information on methods of relieving PA in children, reasons for noncompliance, and associated complications, was framed. It was circulated among members of the Indian Society of Anaesthesiologists through an online survey of Google Forms and manually.

Results

Four hundred and fifty anesthesiologists were surveyed. Responses were predominantly from anesthesiologists practicing in medical colleges across the country. Although 97% of the surveyed respondents practiced anxiety-relieving strategies, only 37% used it consistently. Seventy-three percent of anesthesiologists practiced both pharmacological and nonpharmacological techniques. The most common reason for avoiding premedication was an anticipated difficult airway (88%). Inadequate sedation was a commonly reported problem. Ninety-five percent of participants felt that PA-relieving strategies should be integral to pediatric anesthesia practice. The most common reason for not following these practices was an inadequate hospital infrastructure (67%). Ninety-seven percent of the participants believed that more awareness is required on this crucial perioperative issue.

Conclusion

Only 37% of the surveyed anesthesiologists consistently used some form of PA-relieving strategy and the practice varied widely. Further improvement and team approach involving anesthesiologists, surgeons, and nurses is required to ensure the quality of pediatric PA-relieving services and establish it as a standard of care.

A noninferiority trial on information-based video versus self-selected video distraction technique for preoperative anxiety reduction in school children: Prepare trial

BACKGROUND

Distraction techniques using smartphones to watch cartoon videos and play videogames have been successfully used to reduce preoperative anxiety in school children. However, the literature about the use of video-based preoperative information technique for anxiety reduction in that age group still remains understudied with conflicting results. We hypothesized that there would be no meaningful difference in anxiety score at induction period between the information-based video versus self-selected video distraction technique.

METHODS

Eighty-two children between 6 and 12 years undergoing surgery were randomized to self-selected video (n = 41) and information-based video (n = 41) distraction group in this prospective, randomized, noninferiority trial. Children in self-selected video group were shown video of their choice using smart phones, while children in the information-based video group were shown video of operation theater (OT) set up and induction procedure. The children were taken inside operating room along with parents watching the respective videos. Modified Yale Preoperative Anxiety Scale (m-YPAS), just before induction of anesthesia was recorded as the primary outcome. Induction compliance checklist score, anxiety of the parents, and short-term postoperative outcomes in 15 days (telephonically) were recorded as secondary outcomes.

RESULTS

The mean difference in the baseline mYPAS score (95% CI) between the two groups was -2.7 (-8.2 to 2.8, p = .33) and -6.39 (-12.74 to -0.44, p = .05) just before the induction period. The upper bound of the 95% CI did not cross the value of 8, which was the noninferiority margin decided prior to study commencement. 70.73% cases had perfect induction in the self-selected video distraction group, compared to 68.29% in the information-based video group. After 15 days of postoperative follow-up, participants in the self-selected video group had a larger proportion of negative outcomes (53.7%) compared to information-based video group (31.7%), p = .044.

CONCLUSION

Information-based technique using smart phone is non inferior to self-selected video-based distraction-based technique in decreasing PA with an additional advantage of decreasing postoperative short-term negative outcomes.

TRIAL REGISTRATION

CTRI identifier: CTRI/2020/03/023884.

Is Preoperative Anxiety Affected by Watching Short Videos on Social Media? A Prospective Randomized Study

PURPOSE

The purpose of this study was to investigate the impact of watching short videos in the preoperative waiting room on preoperative anxiety in children.

DESIGN

This study was designed as a prospective, randomized trial including 69 ASA I-II patients aged 5 to 12 years who were scheduled for elective surgery.

METHODS

The children were randomly allocated to two groups. The experimental group browsed short videos on a social media platform (eg, YouTube short, TikTok, Instagram reels) for 20 minutes in the preoperative waiting room, but the control group did not. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points: on arrival in the preoperative waiting room (T1), right before being taken to the operating room (OR) (T2), on entering the OR (T3), and during anesthesia induction (T4). The primary outcome of the study was children's anxiety scores at T2.

FINDINGS

The mYPAS scores at T1 were similar in both groups (P = .571). The mYPAS scores at T2, T3, and T4 were significantly lower in the video group than in the control group (P < .001).

CONCLUSIONS

Watching short videos on social media platforms in the preoperative waiting room lowered preoperative anxiety levels in pediatric patients aged 5 to 12.

Children's Shyness, Frontal Brain Activity, and Anxiety in the Perioperative Context

Although preoperative anxiety affects up to 75% of children undergoing surgery each year and is associated with many adverse outcomes, we know relatively little about individual differences in how children respond to impending surgery. We examined whether patterns of anterior brain electrical activity (i.e., a neural correlate of anxious arousal) moderated the relation between children's shyness and preoperative anxiety on the day of surgery in 70 children (36 girls, Mage = 10.4 years, SDage = 1.7, years, range 8 to 13 years) undergoing elective surgery. Shyness was assessed using self-report approximately 1 week prior to surgery during a preoperative visit (Time 1), preoperative anxiety was assessed using self-report, and regional EEG (left and right frontal and temporal sites) was assessed using a dry sensory EEG headband on the day of surgery (Time 2). We found that overall frontal EEG alpha power moderated the relation between shyness and self-reported preoperative anxiety. Shyness was related to higher levels of self-reported anxiety on the day of surgery for children with lower average overall frontal alpha EEG power (i.e., higher cortical activity) but not for children with higher average overall frontal alpha EEG power (i.e., lower cortical activity). These results suggest that the pattern of frontal brain activity might amplify some shy children's affective responses to impending surgery. Findings also extend prior results linking children's shyness, frontal brain activity, and anxiety observed in the laboratory to a real-world, ecologically salient environment.

ED95 of remimazolam in nasal administration for attenuating preoperative anxiety in children

Background

Preoperative anxiety often prevails in children at higher levels than adults, which is a common impediment for surgeons and anesthesiologists. It is of great necessity to explore an appropriate medication to improve this situation. Remimazolam, a type of benzodiazepine drug, has been indicated for the induction and maintenance of procedural sedation in adults since 2020. To date, rare studies were reported to investigate the effect of remimazolam on children. In this study, we investigated the safety and efficacy of intranasal drops of remimazolam and tried to determine the 95% effective dose (ED95) of remimazolam in single intranasal administration in attenuating preoperative anxiety in children.

Methods

In this study, 114 children were enrolled who underwent laparoscopic high-level inguinal hernia ligation between January 2021 and December 2022 and were divided into an early childhood children group and a pre-school children group. The biased coin design (BCD) was used to determine the target doses. A positive response was defined as the effective relief of preoperative anxiety (modified Yale Preoperative Anxiety Scale, mYPAS < 30). The initial nasal dose of remimazolam was 0.5 mg·kg-1 in the two groups. An increment or decrement of 0.1 mg·kg-1 was applied depending on the sedative responses. Isotonic regression and bootstrapping methods were used to calculate the ED95 and 95% confidence intervals (CIs), respectively.

Results

A total of 80 children completed the study, including 40 in the early childhood group and 40 in the pre-school children group. As statistical analysis indicated, the ED95 of a single intranasal infusion of remimazolam for the relief of preoperative anxiety is 1.57 mg·kg-1 (95% CI: 1.45-1.59 mg·kg-1) in early childhood children and 1.09 mg·kg-1 (95% CI: 0.99-1.11 mg·kg-1) in pre-school children, and the CIs did not overlap each other.

Conclusion

Remimazolam is an effective medication to relieve preoperative anxiety in children. Moreover, the ED95 of single nasal administration of remimazolam for effective relief of preoperative anxiety was 1.57 and 1.09 mg·kg-1 in early childhood children and pre-school children, respectively.

The Effect of Health Literacy on Preoperative Anxiety Levels in Patients Undergoing Elective Surgery

Objective

This study aimed to determine preoperative anxiety levels, their associated factors, and the relationship between health literacy and preoperative anxiety in adult patients undergoing elective surgery.

Materials and Methods

This descriptive cross-sectional study was conducted in a tertiary hospital between December 21, 2021, and June 20, 2022, and included 466 adult patients. Participants were administered the demographic data and basic health status form, Health Literacy Scale (HLS), and Beck Anxiety Inventory (BAI). Statistical significance was set at p < 0.05.

Results

The participants' mean BAI score was low to moderate (9.28±10.85). The total HLS score was 105.89±24.42. For the BAI, a negative correlation was found between the access to information sub-dimensions of the HLS and BAI (p=0.043, r=-0.094). In addition, a negative correlation was detected between patients' age and HLS and its sub-dimensions (p<0.001, respectively [r=-0.188, r=-0.193, r=-0.205, r=-0.161]), and a positive correlation was observed among the HLS sub-dimensions (p<0.001, respectively [r=0.873, r=0.057, r=0.966, r=0.915]). Higher HLS and sub-dimension averages were observed in single, high school, university graduates, and civil servant participants. In addition, higher BAI averages were detected in females, homemakers, urban residents, participants living only with their children, and those with additional diseases (respectively, p<0.001, p<0.001, p=0.007, p=0.0034, p<0.01).

Conclusion

As the level of health literacy increased, preoperative anxiety levels decreased. Preoperative assessment and education are fundamental to perioperative patient care, particularly in the surgical setting.

Preoperative Anxiety in Patients with Pancreatic Cancer: What Contributes to Anxiety Levels in Patients Waiting for Surgical Intervention

Pancreatic cancer is one of the most lethal malignancies. Currently, the only treatment is surgical resection, which contributes to significant preoperative anxiety, reducing quality of life and worsening surgical outcomes. To date, no standard preventive or therapeutic methods have been established for preoperative anxiety in pancreatic patients. This observational study aims to identify which patients' socio-demographic, clinical and psychological characteristics contribute more to preoperative anxiety and to identify which are their preoperative concerns. Preoperative anxiety was assessed the day before surgery in 104 selected cancer patients undergoing similar pancreatic major surgery, by administering the STAI-S (State-Trait Anxiety Inventory Form) and the APAIS (Amsterdam Preoperative Anxiety and Information Scale). Our data suggest that patients with high STAI-S showed higher levels of APAIS and that major concerns were related to surgical aspects. Among psychological characteristics, depressive symptoms and trait anxiety appeared as risk factors for the development of preoperative anxiety. Findings support the utility of planning a specific psychological screening to identify patients who need more help, with the aim of offering support and preventing the development of state anxiety and surgery worries in the preoperative phase. This highlights also the importance of good communication by the surgeon on specific aspects related to the operation.

Prevalence of preoperative anxiety in patients posted for surgical procedures and its relation to the doses of anesthetic drugs: A cross-sectional study

Background

In patients undergoing surgical procedures, preoperative period is one of the most worrying periods. There are only few studies which revealed that increased preoperative anxiety is associated with increased requirements of doses of anesthetic agents.

Aim

The aim of this study is to assess the prevalence of preoperative anxiety in patients posted for surgical procedures and its relation to the doses of anesthetic drugs.

Materials and Methods

This is a cross-sectional, analytical study done between January 2021 and April 2021. A total of 100 patients undergoing surgery have given consent to participate in the study by filling self-designed questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS). Data analysis was done by SPSS version 24 using appropriate statistical tests.

Results

Preoperative anxiety was noted in 21% of the patients who were undergoing surgery. The association between preoperative anxiety and need for increase in the doses of anesthetic agents during intraoperative period was found to be statistically significant (P < 0.004).

Conclusion

A significant number of patients required increased amounts of anesthetic drugs to reduce anxiety during intraoperative period. Therefore, appropriate methods have to be introduced to address the concerns of patients undergoing surgery and thereby reducing anxiety.

Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children

BACKGROUND

Anesthesia preinduction anxiety in children can according to some studies lead to long-term anxiety and negative behavioral changes (NBC), while other studies have not found this effect. This secondary analysis from a recent premedication trial comparing clonidine and midazolam aimed to test the relation between preoperative anxiety assessed with modified Yale Preoperative Anxiety Scale (mYPAS) and postoperative NBCs assessed with Post Hospital Behavior Questionnaire (PHBQ), regardless of premedication type.

METHODS

This is a planned secondary analysis from a published premedication comparison trial in an outpatient surgery cohort, children aged 2-7 years. Participant and preoperative factors, particularly preoperative anxiety as mYPAS scores, were assessed for association with development of postoperative NBCs.

RESULTS

Fifty-four of the 115 participants had high preinduction anxiety (mYPAS >30), and 19 of 115 developed >3 postoperative NBCs 1 week after surgery. There was no association between preinduction anxiety level as mYPAS scores and the development of postoperative NBCs at 1 week after surgery (10 of 19 had both, p = .62) nor after 4- or 26-weeks post-surgery. Only lower age was associated with development of NBCs postoperatively.

CONCLUSIONS

Based on the findings from this cohort, high preinduction anxiety does not appear to be associated with NBCs postoperatively in children premedicated with clonidine or midazolam.

Virtual reality psychological intervention helps reduce preoperative anxiety in patients undergoing carotid artery stenting: a single-blind randomized controlled trial

Objective

This study aimed to explore the effectiveness and applicability of a psychological intervention using virtual reality (VR) to reduce preoperative anxiety in patients undergoing carotid artery stenting (CAS).

Methods

A total of 114 patients aged 18-86 years who were scheduled to undergo CAS were randomized to the VR and control groups. Patients in the VR group used a VR headset to view a 16-min psychological intervention video, while those in the control group used a tablet for viewing. The primary assessment instrument was the State Anxiety Inventory (S-AI), which was given 20 min before and after the intervention and 24 h after surgery. Secondary assessment tools were the Self-efficacy for Managing Chronic Disease (SEMCD-6) scale, which was completed before the intervention and 24 h after the operation, a smart bracelet to assess sleep quality, monitored in the evening before the operation, and the VR Suitability and Satisfaction Questionnaire, completed 24 h after the operation.

Results

The two groups were similar in terms of demographic information, preintervention STAI scores and preintervention SEMCD-6 scores (p > 0.05). S-AI scores were lower in both groups after the intervention and surgery, and the scores of the VR group were lower than those of the control group (p = 0.036, p = 0.014). SEMCD-6 scores post-surgery had improved in both groups, but the VR group had significantly higher scores than the control group (p = 0.005). Smart bracelet measurements showed no significant differences in postintervention sleep quality between the two groups (p = 0.540). For satisfaction, the VR group scored higher in all aspects except scheduling. A total of 47 (85.45%) patients reported having a comfortable experience, and only 5 (9.09%) experienced mild adverse effects.

Conclusion

The use of a virtual reality psychological intervention was beneficial to reduce the anxiety of patients before CAS and improved their self-efficacy. As virtual reality devices evolve and demonstrate better comfort and safety, more comprehensive and in-depth research of the use of VR to reduce patient anxiety should be performed in the future.Clinical trial registration:https://www.chictr.org.cn/showproj.aspx?proj=186412, identifier ChiCTR2200066219.

[Progress on the researches of acupuncture preconditioning before surgery]

This paper reviews the researches on acupuncture preconditioning before surgery in recent years and explores its application value from three aspects, i.e. relieving preoperative anxiety, preventing from postoperative cognitive dysfunction, and preventing from postoperative gastrointestinal dysfunction. As a relatively safe non-drug treatment, acupuncture has the underlying advantages in participating into multidisciplinary coordination in the enhanced recovery after surgery (ERAS). By building up higher-quality medical evidences and revealing the effect mechanism of acupuncture from multi-dimenisonal aspects, it is expected that acupuncture technology can be coordinated with ERAS to optimize the clinical path in the perioperative period, and boost the development of the perioperative medicine ultimately.

Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials

AIMS

To synthesise and evaluate the effectiveness of virtual reality interventions in preoperative children.

BACKGROUND

Children consider operations as a predictable threat and stressful event. Children's anxiety before an operation increases as the time draws closer. Children could understand the operating room environment and process before the operation using virtual reality, which may reduce their anxiety before an operation.

DESIGN

A systematic review and meta-analysis of randomised controlled trials following the Cochrane method were conducted.

METHOD

CINAHL, Cochrane Library, Embase, Joanna Briggs Institute, MEDLINE and PubMed databases were searched for randomised controlled trials published before February 2021. A random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals was performed. Conduction of the review adheres to the PRISMA checklist.

RESULTS

Of 257 articles screened, six interventions involving 529 participants aged 4-12 years were included in the analysis. All study evidence levels were B2/Level 2, the quality was medium to high on the modified Jadad scale, with a low risk of bias. The results revealed that virtual reality significantly reduced preoperative anxiety in children (SMD: -0.91, 95% CI: -1.43 to -0.39, p = .0006). Furthermore, virtual reality significantly improved children's compliance with anaesthesia (SMD: 3.49, 95% CI: 1.32 to 9.21, p = .01).

CONCLUSION

Children who used virtual reality before an operation felt more familiar with the operating room environment and understood the preoperative preparation procedures. Virtual reality effectively reduced children's anxiety and improved their compliance with anaesthesia.

RELEVANCE TO CLINICAL PRACTICE

This systematic review and meta-analysis investigated the effect of virtual reality on preoperative anxiety in children and the findings supported its positive effects. The results could provide a reference for incorporating virtual reality into preoperative preparation guidelines.

Prevalence and Predictors of Anxiety among Surgical Patients in the Preoperative Holding Area of National Orthopaedic Hospital, Enugu, Nigeria: A Cross-Sectional Study

Background

High preoperative anxiety in surgical patients impacts anesthetic management, postoperative pain scores, patient satisfaction, and postoperative morbidity. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) offers an attractive option for the assessment of preoperative anxiety on account of its brevity and validity.

Aim

Our aim was to determine the prevalence and predictors of preoperative anxiety in our surgical patients.

Materials and Methods

We conducted a cross-sectional study among surgical patients by means of interviewer-administered structured questionnaire. The questionnaire incorporated both the APAIS and numeric rating scale for anxiety instruments, with the patients' demographic and clinical details. The data collection was carried out from January 2021 to October 2022. Data entry and analysis were done using IBM Statistical Product and Service Solutions, statistical software version 25. Continuous variables were summarized using mean and standard deviation, while categorical variables were presented using frequencies and proportions. Chi square test, Student t test, correlation analysis, and multivariate analysis using binary logistic regression were used in the analysis. Statistical significance was determined by a P value of <0.05.

Results

A total of 451 patients participated in the study, with a mean age of 39.4 ± 14.4 years. The prevalence of clinically significant anxiety was 24.4% (110/451). The predictors of high preoperative anxiety in our cohort were female gender, tertiary education attainment, lack of previous surgical experience, ASA grade 3, and patients scheduled for major surgery.

Conclusion

A substantial proportion of the surgical patients experienced clinically significant preoperative anxiety.

The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to investigate the effects of a virtual reality (VR) application on preoperative anxiety (PA) in patients undergoing colorectal and abdominal wall surgery.

DESIGN

A prospective, parallel two-armed, randomized controlled trial.

METHODS

Eighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43). The experimental group received a preoperative VR application for 10 minutes. The routine preoperative procedure used at the clinic was used for the patients in the control group. The anxiety level was assessed using the Anxiety Specific to Surgery Questionnaire (ASSQ) and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO₂), before and after the VR application.

FINDINGS

The VR application reduced PA levels in the experimental group (P < .001) and changes in the SBP (P < .001), DBP (P < .001), HR (P < .001), RR (P = .041) and SpO₂(P = .019) values) compared to the levels in the control group.

CONCLUSIONS

VR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.

A Comparative Study on Effectiveness of Parental Presence versus Sedative Premedication for Reducing Anxiety in Children Undergoing General Anesthesia

Background

Preoperative anxiety is an important, yet often unattended problem in children. Minimizing anxiety and distress at the time of anesthetic induction may reduce adverse psychological and physiological outcomes. Sedative premedication and parental presence during anesthesia induction are among the most commonly employed strategies for reducing child anxiety.

Aims and Objective

The study aimed to compare the effectiveness of a pharmacological intervention (premedication with midazolam) versus behavioral intervention (parental presence) in reducing preoperative anxiety in children undergoing general anesthesia.

Methodology

Sixty patients of age group of 4-12 years, of ASA Grade 1 and 2 and either sex posted for elective surgery under general anesthesia were divided into two groups of 30 each Group M (midazolam group) and Group P (parental presence). Group M received intravenous midazolam 0.03-0.05 mg/kg preoperatively and anxiety was measured in preoperative room, during separation from parents and during introduction of anesthesia mask, whereas in Group P, parents accompanied the child inside the operation theater and anxiety was measured at preoperative room and during introduction of mask. Parental anxiety was measured in both groups at preoperative room and waiting room. Modified Yale Preoperative Anxiety Scale (mYPAS) and State Trait Anxiety Inventory (STAI) tool was used to measure anxiety in children and parents, respectively.

Results

The mean mYPAS score while the introduction of anesthesia mask in Group M was 31.30 ± 12.04 and in Group P was 63.19 ± 25.31, and the difference was found to be statistically significant (P = 0.001). In preoperative room, there was no significant difference in anxiety in the two study groups. The mean STAI score in Group P was 45.63 ± 1.45 and in Group M was 41.10 ± 1.69, and the difference was found to be statistically significant (P = 0.001). In preoperative room, parental anxiety was found to be comparable among the two groups. The mean duration of induction of anesthesia in Group M was 5.53 ± 1.01 min, and in Group P, it was 8.77 ± 2.03 min. The difference was found to be statistically significant (P = 0.001).

Conclusion

Both interventions were effective in reducing anxiety in children, but midazolam was more effective compared to parental presence. Parents in Group M were less anxious in the waiting room than Group P. Children in Group M were more compliant during the induction of anesthesia, hence a lesser duration of induction than Group P.

Implementation of Aromatherapy, a Nonpharmacological Intervention, to Reduce Anxiety During the Preoperative Period

PURPOSE

The purpose of the project was to answer the following question: Does the implementation of aromatherapy before surgery reduce preoperative anxiety in adult surgical patients undergoing elective surgery?

DESIGN

This evidence-based project was a quality improvement initiative that used pre- and poststate anxiety evaluations to determine the effect of aromatherapy on preoperative anxiety among adults undergoing elective surgery.

METHODS

The project team conducted a literature review to evaluate the appropriateness of using aromatherapy to decrease preoperative anxiety. The team delivered pre- and postaromatherapy State Trait Anxiety Inventory for Adults (STAIAD) Short form Y-1 questionnaire and administered an aromatherapy diffuser clip comprised of three evidence-based scented oils to determine the effect of aromatherapy on preoperative anxiety among adults undergoing elective surgery.

FINDINGS

Pre- and postaromatherapy (STAIAD) Short Form Y-1 questionnaires indicated that exposure to aromatherapy significantly reduced preoperative anxiety. There was a statistically and clinically significant difference in state anxiety score after aromatherapy exposure, with a mean state change of 17.42 points (P < .001). This exceeded the effect size benchmark derived from the evidence, which defined a significant change in state score as 5 points. Participants above the median age exhibited the most profound decrease in anxiety regardless of gender. Qualitative survey responses indicated that 96% of patients would use preoperative aromatherapy in the future and 91% experienced increased satisfaction with their perioperative care.

CONCLUSIONS

Heightened physiological response to increased anxiety leads to increased perioperative nausea and vomiting, higher pain scores, and susceptibility to prolonged recovery from surgery. Implementing aromatherapy can reduce anxiety, thereby attenuating these complications and preventing additional accrued cost. Furthermore, this evidence-based project has the added benefit of increasing overall patient satisfaction with the perioperative process.

Comparison of the Effect of Chlordiazepoxide and Transcranial Alternating Current Stimulation on Blood Potassium Loss Due to Preoperative Anxiety

PURPOSE

This study evaluated and compared the effect of chlordiazepoxide and transcranial alternating current stimulation (tACS) on changes in blood potassium levels caused by preoperative anxiety.

DESIGN

This randomized, double-blind placebo control study was performed on 100 patients undergoing surgery with the American Society of Anesthesiologists physical status (ASA I) who went through surgery for the first time.

METHODS

Patients were classified into four groups of real or sham tACS, chlordiazepoxide, and placebo. The Amsterdam Preoperative Anxiety information Scale (APAIS) and serum potassium levels were used to collect data. The results were analyzed using the Kolmogorov-Smirnov tests, independent t test, Pearson correlation, and χ² test.

FINDINGS

There was no baseline difference between the groups. A significant difference was found between real tACS and the chlordiazepoxide group in plasma potassium level (P = .017).

CONCLUSIONS

The results showed that real tACS was more effective than chlordiazepoxide in preventing the decrease of plasma potassium level in the preoperative period. Assessing the efficacy of the other types of brain electrical interventions is suggested for future studies.

Assessment of potential predictors affecting preoperative anxiety in Indian children- A prospective observational study

Background and Aims

Preoperative anxiety is a common problem among children undergoing surgery. The aim of the study was to assess the incidence and identify various predictors of preoperative anxiety in Indian children.

Material and Methods

A prospective, observational study was conducted on 60 children of the American Society of Anesthesiologists Physical status 1/2, aged 2-6 years and scheduled for elective surgery under general anesthesia in a tertiary care teaching hospital. Preoperative parental anxiety was assessed using the State-Trait Anxiety Inventory questionnaire. The children's anxiety was assessed in the preoperative room, at the time of parental separation, and at the induction of anesthesia using modified Yale Preoperative Anxiety Scale (mYPAS) scoring by an anesthesiologist and a psychologist. Sedative premedication was employed prior to parental separation. Logistic regression analysis was carried out to identify the possible predictors of anxiety.

Results

The incidence of high preoperative anxiety among the studied children was 76% in the preoperative room, 93% during parental separation, and 96% during anesthetic induction. Among the nine possible predictors identified on univariate regression, the presence of siblings was found to be a significant independent predictor on multivariate regression analysis (P = 0.04). The inter-rater agreement was excellent for the assessment of preoperative anxiety using mYPAS by the anesthesiologist and psychologist (weighted Kappa, k = 0.79).

Conclusion

The incidence of preoperative anxiety in Indian children in the age group of 2-6 years is very high. The preop anxiety escalates progressively at parental separation and induction of anesthesia despite sedative premedication. The presence of siblings is a significant predictor of preoperative anxiety.

Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study

Background Parental presence at induction of anesthesia remains controversial and has been reported to provide mixed results. As such, parental presence at induction of anesthesia is not practiced routinely everywhere. There are currently limited data describing the practice of parental presence at induction of anesthesia or the experiences and perceptions of parents in Canada. Objectives We sought to investigate (1) the frequency of parental presence at induction of anesthesia and (2) the experiences and perceptions of parents accompanying their child into the operating room compared to those who did not at a tertiary Canadian pediatric hospital. Methods Institutional quality improvement approval was obtained. This study was a cross-sectional survey. Parents waiting in the parent surgical waiting room during the procedure were invited to complete a web-based survey. Consent was implied via completing the survey. The cross-sectional survey elicited the prevalence of parental presence during induction of anesthesia as well as their experience and perceptions. We also investigated the parents' preferences for preoperative education. Results Of the 448 parents approached, 403 completed the survey between May and June 2017. Sixty-eight (16.9% [13.4-20.9]) parents accompanied their child into the operating room (parental presence at induction of anesthesia), while 335/403 (83.1% [79.1-86.7]) did not (no-parental presence at induction of anesthesia). Reasons for not accompanying their child into the operating room included "not being aware they could" (158/335, 47.2% [41.9-52.5]), "I didn't think my child needed me" (107/335, 31.9% [27.2-37.1]), "my child was coping well" (46/335, 13.4% [10.5-17.8]), and "I was anxious" (47/335, 14.0% [10.7-18.2]). Most of the parents in the parental presence at induction of anesthesia cohort (66/67, 98.5% [95.6-101.2]) reported that they believed their child benefited/would have benefited from their presence during induction of anesthesia compared to those in the no-parental presence at induction of anesthesia cohort (137/335, 40.9% [35.8-46.2]), P < 0.001. Overall, 51/335 (14.7%) parents in the no-parental presence at induction of anesthesia cohort and 3/67 (4.5%) of those in the parental presence at induction of anesthesia cohort felt that offering parental presence at induction of anesthesia should depend on factors including child's age as well as the level of coping and anxiety. More patients in the no-parental presence at induction of anesthesia cohort felt that parental presence at induction of anesthesia should also depend on the child's age and whether the child was coping. Parents felt that face-to-face discussions with clinicians are most effective for discussing future parental presence at induction of anesthesia. Conclusions We have shown that most parents at our institution do not undergo parental presence at induction of anesthesia and are for the most part comfortable with their child going unaccompanied into the operating room. Administrators and clinicians seeking to implement parental presence policies should consider navigating parental presence at induction of anesthesia with evidence-based approaches tailored to each parent and their child.

Effects of Preoperative Anxiety on Postoperative Outcomes and Sleep Quality in Patients Undergoing Laparoscopic Gynecological Surgery

OBJECTIVE

Preoperative anxiety is a psychological state that commonly occurs before surgery and may have a negative impact on postoperative outcomes. This study aimed to investigate the effects of preoperative anxiety on postoperative sleep quality and recovery outcomes among patients undergoing laparoscopic gynecological surgery.

METHODS

The study was conducted as a prospective cohort study. A total of 330 patients were enrolled and underwent laparoscopic gynecological surgery. After assessing the patient's preoperative anxiety score on the APAIS scale, 100 patients were classified into the preoperative anxiety (PA) group (preoperative anxiety score > 10) and 230 patients into the non-preoperative-anxiety (NPA) group (preoperative anxiety score ≤ 10). The Athens Insomnia Scale (AIS) was assessed on the night before surgery (Sleep Pre 1), the first night after surgery (Sleep POD 1), the second night after surgery (Sleep POD2), and the third night after surgery (Sleep POD 3). Postoperative pain was evaluated by the Visual Analog Scale (VAS), and the postoperative recovery outcomes and adverse effects were also recorded.

RESULT

The AIS score in the PA group was higher than that of the NPA group at Sleep-pre 1, Sleep POD 1, Sleep POD 2, and Sleep POD 3 (p < 0.05). The VAS score was higher in the PA group than in the NPA group within 48 h postoperatively (p < 0.05). In the PA group, the total dosage of sufentanil was significantly higher, and more rescue analgesics were required. Patients with preoperative anxiety showed a higher incidence of nausea, vomiting, and dizziness than those without preoperative anxiety. However, there was no significant difference in the satisfaction rate between the two groups.

CONCLUSION

The perioperative sleep quality of patients with preoperative anxiety is worse than that of patients without preoperative anxiety. Moreover, high preoperative anxiety is related to more severe postoperative pain and an increased requirement for analgesia.

Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise

OBJECTIVES

The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level.

BACKGROUND

Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes.

METHODS

Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units.

RESULTS

Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units).

CONCLUSIONS

The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.

Development and validation of a prediction model for preoperative anxiety in children aged 2-12 years old

BACKGROUND

Children with preoperative anxiety are at risk of perioperative adverse events, such as reflux aspiration, prolonged induction time, wake agitation, and delirium. Identifying children at high risk of severe preoperative anxiety may help anesthesiologists intervene and manage them in advance.

AIM

The authors hypothesized that the risk of developing serious preoperative anxiety in children is predictable by variables related to basic information about the parent and child. We developed a clinical prediction model to identify patients vulnerable to severe preoperative anxiety among children aged 2-12 years.

METHODS

We enrolled patients aged 2-12 years who underwent elective surgery under general anesthesia and divided them into derivation (n = 340, 70.8%) and validation (n = 140, 29.2%) groups. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale, and a high level of preoperative anxiety was defined as a score of >30. The following predictors were collected preoperatively: gender, age, weight, children's education level, only child, history of surgery, waiting time in the anesthesia waiting area, parental education level, parental anxiety, whether venous access had been established in the ward, and whether they had received anti-anxiety interventions. A prediction model was built using binary logistic regression analysis; bootstrap was applied for internal validation, and external validation was performed using the validation datasets.

RESULTS

The prediction model had good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.961 (95% CI = 0.943-0.979) and 0.896 (95% CI = 0.842-0.950) in the derivation and validation cohorts, respectively. The predictive variables included in the final clinical model were pharmacological intervention (OR = 0.008, 95% CI = 0.002-0.025), nonpharmacological intervention (OR = 0.342, 95% CI = 0.104-1.127), parental education level (OR = 0.211, 95% CI = 0.108-0.411), parental anxiety (OR = 6.15, 95% CI = 2.396-15.786), only child (OR = 2.417, 95% CI = 1.065-5.488), history of surgery (OR = 3.513, 95% CI = 1.137-10.860), and age (OR = 0.692, 95% CI = 0.500-0.957).

CONCLUSIONS

In this study, a clinical prediction model was developed and validated for the first time. The proposed clinical prediction model can help doctors identify children most likely to develop a high level of preoperative anxiety.

CLINICAL TRIAL REGISTRATION IDENTIFIER

ChiCTR2100054409 (https://www.chictr.org.cn/index.aspx).

New perspectives in patient education for cardiac surgery using 3D-printing and virtual reality

Background

Preoperative anxiety in cardiac surgery can lead to prolonged hospital stays and negative postoperative outcomes. An improved patient education using 3D models may reduce preoperative anxiety and risks associated with it.

Methods

Patient education was performed with standardized paper-based methods (n = 34), 3D-printed models (n = 34) or virtual reality models (n = 31). Anxiety and procedural understanding were evaluated using questionnaires prior to and after the patient education. Additionally, time spent for the education and overall quality were evaluated among further basic characteristics (age, gender, medical expertise, previous non-cardiac surgery and previously informed patients). Included surgeries were coronary artery bypass graft, surgical aortic valve replacement and thoracic aortic aneurysm surgery.

Results

A significant reduction in anxiety measured by Visual Analog Scale was achieved after patient education with virtual reality models (5.00 to 4.32, Δ-0.68, p < 0.001). Procedural knowledge significantly increased for every group after the patient education while the visualization and satisfaction were best rated for patient education with virtual reality. Patients rated the quality of the patient education using both visualization methods individually [3D and virtual reality (VR) models] higher compared to the control group of conventional paper-sheets (control paper-sheets: 86.32 ± 11.89%, 3D: 94.12 ± 9.25%, p < 0.0095, VR: 92.90 ± 11.01%, p < 0.0412).

Conclusion

Routine patient education with additional 3D models can significantly improve the patients' satisfaction and reduce subjective preoperative anxiety effectively.

Psychoeducation Programs to Reduce Preoperative Anxiety in Adults: A Scoping Review

BACKGROUND

Surgical procedure is a critical event that causes anxiety for patients. One of the possible intervention strategies to reduce anxiety in the preoperative period is psychoeducation.

METHODS

A scoping review was conducted according to the JBI methodology and PRISMA-ScR to map knowledge about psychoeducation programs to reduce preoperative anxiety in adults. The data were extracted by the researchers, according to the objective of the study. Finally, the data synthesis was presented in narrative format and tables.

RESULTS

four studies were included in the review with different characteristics of psychoeducation programs. The approach of these programs consisted of teaching about anxiety, instruction and training in anxiety control techniques. The contents referred to included the surgical process and intervention techniques to reduce anxiety. Program sessions lasted from 45 to 150 min, with a frequency of 1 to 6. The assessment instrument used was the State-Trait Anxiety Inventory. The dynamisers were nurses, psychotherapists and clinical psychologists.

CONCLUSIONS

Psychoeducation programs can be useful and effective in reducing anxiety. More studies are needed to confirm these results.

Parental presence and intranasal dexmedetomidine for the prevention of anxiety during anesthesia induction in children undergoing tonsillectomy and/or adenoidectomy surgery: A randomized controlled trial

Background: During the perioperative period of pediatric surgery, it is extremely stressful for children and parents to enter the operating room and receive the anesthesia induction. This study was designed to evaluate the perioperative outcomes with parental presence at induction of anesthesia (PPIA), intranasal dexmedetomidine, and combined use of PPIA and intranasal dexmedetomidine. Methods: In this prospective study, 124 children were randomly divided into four groups: control (no parental presence or intranasal dexmedetomidine), PPIA (parental presence), DEX (intranasal dexmedetomidine (1.0 μg/kg)), and PPIA + DEX (parental presence and intranasal dexmedetomidine (1.0 μg/kg)). The anxiety of children was mainly evaluated by the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary evaluation methods were, for example, the Induction Compliance Checklist (ICC), the Pediatric Anesthesia Emergence Delirium Scale (PAED), the COMFORT Behavior Scale (COMFORT-B Scale), the State-Trait Anxiety Inventory (STAI), and the Visual Analog Scale (VAS). Results: Children in the PPIA + DEX group exhibited significantly lower mYPAS-SF and ICC scores compared with all three other groups (p < 0.001), and children in that group exhibited significantly lower mYPAS-SF and ICC scores compared with the PPIA and DEX groups (p < 0.05). The children's PAED scores in the PPIA, DEX, and PPIA + DEX groups were significantly lower than the control group (p < 0.001).The STAI-S scores of the PPIA, DEX, and PPIA + DEX groups were significantly lower than the score of the control group (p < 0.001). The VAS scores of the PPIA, DEX, and PPIA + DEX groups were significantly higher than that of the control group (p < 0.001), while the score of the PPIA + DEX group was significantly higher than those of the PPIA and DEX groups (p < 0.05). Conclusion: The combined use of PPIA and intranasal dexmedetomidine is more effective than PPIA or intranasal dexmedetomidine for alleviating the preoperative anxiety of children, improving children's induction compliance and parental satisfaction.

The Use of Therapeutic Inhaled Essential Oils (TIEO) as a Holistic Approach to Decrease Preoperative Anxiety in ERAS Gynecological Surgery

INTRODUCTION

Preoperative anxiety is a negative symptom frequently experienced by surgical patients. This evidence-based-practice (EBP) project evaluated the effectiveness of therapeutic inhaled essential oils (TIEO) on anxiety levels during the preoperative phase of surgery in enhanced recovery after surgery (ERAS) gynecological patients ages 18 to 65 years old.

METHODS

A prospective, preposttest, quasiexperimental design was used to evaluate preoperative anxiety scores. Patients (N = 53) scheduled for gynecological surgeries were enrolled at a level II trauma center. Upon arrival to the preoperative area on the day of surgery, patients were asked to score their anxiety level using the Visual Analog Scale for Anxiety (VAS-A). Patients were provided the TIEO intervention during their preoperative phase of surgery ranging from 15 to 60 minutes. Patients were encouraged to take mindful deep breaths and inhale the essential oil vapor. Before being transported into the operating room, patients were asked to re-evaluate their anxiety level using the VAS-A.

RESULTS

A matched paired t-test revealed the post-VAS-A measurements were significantly lower (n = 52, M = 31.37, SD = 24.334) than the pre-VAS-A measurements (n = 52, M = 53.50, SD = 26.863), t₅₁ = 8.756, P = .000). On average, postanxiety scores were 22.135 mm lower than pre-anxiety scores (95% CI [17.060, 27.209]).

CONCLUSIONS

The use of TIEO demonstrated a statistically significant decrease in preoperative anxiety scores within the ERAS gynecological population. TIEO can be used as an adjunct intervention to manage preoperative anxiety. TIEO can be successfully administered in the preoperative area. Decreasing anxiety in the preoperative period may lead to many perioperative benefits such as improving surgical outcomes, patient satisfaction, and quality of care.

Nausea and Vomiting After Laparoscopic Cholecystectomy: Analysis of Predictive Factors

PURPOSE

The purpose of this study was to identify the factors predictive of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.

DESIGN

This is a descriptive, cross-sectional study.

METHODS

In total, 172 patients completed the study. "The Questionnaire Form," "Visual Analog Scale," "Nausea Scale," and "Anxiety Specific to Surgery Questionnaire" created by the researchers were used for data collection.

FINDINGS

At the second postoperative hour, 55.8% of the patients had nausea, 20.3% had vomiting and 75% had severe pain. The severity of nausea, vomiting, and pain decreased with time. Age, gender, smoking, motion sickness, postoperative pain, opioid use, preoperative fasting time, time of first postoperative fluid intake and preoperative anxiety score were found to be among the factors predictive of PONV (P < .05).

CONCLUSIONS

High rates of postoperative nausea and vomiting were recorded.  The factors predictive of PONV can be evaluated in the preoperative period, and PONV can be controlled with early interventions and treatment of patients in the risk group.

The Relationship Between COVID-19 Anxiety and Preoperative Anxiety during the Pandemic

PURPOSE

The aim of this study was to determine the relationship between COVID-19 anxiety levels and preoperative anxiety in patients who will undergo elective surgery during the pandemic period.

DESIGN

This study was an analytical cross-sectional study.

METHODS

The study was carried out with 228 patients between May and December 2021 in the surgical clinics of a training and research hospital. The data were collected using patient information form, Coronavirus Anxiety Scale (CAS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS).

FINDINGS

The patients' APAIS total score level was 15.86 ± 6.44, and the CAS score was 6.63 ± 3.61. A positive, moderate and statistically significant relationship was found between the CAS score and the APAIS total score (r = 0.547; P = .000) and, the CAS score and anxiety due to anesthesia surgery (r = 0.545; P = .000) and information (r = 0.501; P = .000) sub-dimensions.

CONCLUSIONS

The results of this study showed that the preoperative anxiety level increased in individuals with increased coronavirus anxiety levels.

Personality, Preoperative Anxiety, and Postoperative Outcomes: A Review

Research has shown that personality is associated with anxiety levels in the general population. However, little is known about the relationship between personality and preoperative anxiety and the subsequent health outcomes in patients undergoing surgery. Therefore, this review aimed to identify studies that explored the relationship between personality traits and preoperative anxiety, as well as their association with postoperative outcomes. Existing literature shows that anxiety may play an intermediary role in the relationship between personality and postoperative outcomes. Severe anxiety may partially explain the adverse effects of certain personality traits, such as neuroticism, on postoperative outcomes. However, the relationship between personality traits, preoperative anxiety, and postoperative outcomes remains unclear. Interventions such as clinical evaluation, preoperative counseling, and management strategies can be of great value in identifying and resolving patients' anxiety and negative emotions to improve postoperative outcomes.

Comparing Preoperative Anxiety Effects of Brachial Plexus Block and General Anesthesia for Orthopedic Upper-Extremity Surgery: A Randomized, Controlled Trial

Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.

Research Progress on Risk Factors of Preoperative Anxiety in Children: A Scoping Review

Preoperative anxiety has adverse effects on children and negative impacts on postoperative rehabilitation. Anesthesiologists can accurately identify children with preoperative anxiety, and individualized intervention can effectively improve their psychological state and clinical prognosis. However, a comprehensive summary of the current available evidence has yet to be conducted. Searches were conducted in Medline databases from inception to March 2022. Primary studies that reported preoperative anxiety in children and its attendant effects on postoperative recovery and prognosis were screened and included. Among the 309 publications identified, 12 related studies (n = 3540 patients) met the eligibility criteria. The incidence of preoperative anxiety in children in the included studies ranged from 41.7% to 75.44%. While 16 influencing factors were identified, only 5 factors had a significant impact on preoperative anxiety in children: younger age (n = 8), parental anxiety (n = 7), negative previous hospitalizations (n = 3), less sociableness (n = 2), and surgical setting (n = 1). The current scoping review identified risk factors for preoperative anxiety in children. Healthcare workers should identify and manage preoperatively anxious children. There are still some factors that are controversial, and large-scale clinical studies are needed.

The overlooked problem among surgical patients: Preoperative anxiety at Ethiopian University Hospital

Introduction

Anxiety was repeatedly reported as the worst aspect of the perioperative time. The objective of this study was to assess the prevalence of preoperative anxiety among adult surgical patients at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

Methodology

A hospital-based cross-sectional study was conducted among surgical patients at the university hospital. After obtaining ethical approval, 407 surgical patients were approached during the preoperative period. Preoperative anxiety was assessed by State-Trait Anxiety Inventory. The association between variables was determined by using binary logistic regression analysis. Strength of association was described in adjusted odds ratio (AOR), and a p-value < 0.05 at 95% confidence interval was considered statistically significant.

Results

A total of 400 patients were included in this study with a 98.3% response rate. Preoperative anxiety was observed among 237 (59.3%) patients, and the median (IQR) STAI score was 50 (40-56.7); age, ≥ 60 years (AOR: 5.7, CI: 1.6-20.4, P: 0.007); emergency surgery (AOR: 2.5, CI: 1.3-4.7, P: 0.005); preoperative pain (AOR: 2.6, CI: 1.2-5.4, P: 0.005); and rural residency (AOR: 1.8, CI: 1.1-2.9, P: 0.031) were found significantly associated with preoperative anxiety.

Conclusion

The prevalence of preoperative anxiety among surgical patients was high. Older age (≥ 60 years), emergency surgery, preoperative pain, and rural residency were found significantly associated with preoperative anxiety. Assessment for preoperative anxiety should be a routine component of preoperative assessment of both elective and emergency surgical patients. Preoperative pain should be appropriately managed as it can help to reduce preoperative anxiety. Optimal anxiety reduction methods should be investigated and implemented in the hospital.