Volume 2 Issues 10 October, 2021
Consultation Liaison Psychiatry Focus: Anaesthesia
Normally, Patients while facing a uneasy reality, such as a surgery, develop tension levels that compromise the emotional, physiological and cognitive abilities. The perioperative anxiety is defined as an emotional state with psychological and physiological elements with diffuse apprehension feelings, uncertainties, unpleasant and discomfort sensations, of a vague and unspecified nature associated to alienation and insecurity. The reported
incidence of preoperative anxiety in adults ranges from 11% to 80% and Up to 65% of all children. Surprisingly interdepartmental research in this area is sparse. Three distinct dimensions of anxiety related to operation are: 1) The fear of the unknown (fear of not knowing what occurs while unconscious during anaesthesia). 2) The fear of feeling ill (fear of perioperative pain, post operative recovery as before). 3) The fear for one’s life (“Not regaining consciousness after the induction of anaesthesia,” i.e., a fear of dying or remaining in a coma and fear of anaesthesia‐induced physical or mental harm). The dimension of the anxiety can be measured by “Amsterdam Preoperative Anxiety Information Scale (APAIS)”, “Spielberg’s State‐Trait Anxiety Inventory (STAI‐State)”, “100mm visual analogue scale (VAS)”, “Multiple Affect Adjective Check List (MAACL), or Yale Preoperative Anxiety Scale for children. The STAI is used frequently. Recently, VAS is popular in evaluating preoperative anxiety & fear.
Risk factors for preoperative anxiety: Young patients, Women & Children, History of alcoholism & smoking, psychiatric disorders especially anxiety disorders like phobias, depressive symptoms, high trait‐anxiety, negative future perception & patients with no previous anaesthetic experience / previous negative anaesthetic experience.
Adverse effects: Preoperative anxiety adversely influences anaesthetic induction and recovery, increased need for intra‐operative sedation and anaesthetic requirements. Postoperative emergence delirium, Postoperative maladaptive behaviors, in children such as new onset enuresis, feeding difficulties, separation anxiety, apathy, withdrawal, and sleep disturbances, temper tantrums may also result from anxiety before surgery. In addition to behavioral manifestations, preoperative anxiety activates the human stress response, leading to increased serum cortisol, epinephrine, and natural killer cell activity. This is associated with alterations of immune function and susceptibility to infection.
Management: Most important role of surgeon or anaesthesiologist is to empathetically educate & reassure the patient before surgery and after recovering. Referral to psychiatry, if anxiety is difficult to handle or patient has phobia or past history of psychiatric illness. Referral may be important when history of alcohol use is present because withdrawal symptoms may complicate recovery. Normally, intervention to reduce preoperative anxiety includes pharmacological anxiolytics with Benzodiazepines like Alprazolam (Caution about continued use & dependence) and Pregabalin has also been recently tried. Preoperative education program, provision of information, distraction, attention focusing and relaxation (music, humour and guided imagery) procedures, acknowledging and reassuring parental anxiety are the important keys in children.
JSS Medical College, Mysore.
