Factors Responsible For Pre-Operative Anxiety In Elective Surgical Patients At A University Teaching Hospital: A Pilot Study.

摘要

BackgroundAnxiety is common in surgical patients during the preoperative period. High levels of preoperative anxiety have unfavorable effects on induction and maintenance of anaesthesia as well as on the recovery from anaesthesia and surgery. The incidence of preoperative anxiety for surgical patients in the Niger Delta region is not known, ObjectiveTo determine the factors responsible for preoperative anxiety in surgical patients at the University of Port Harcourt Teaching Hospital, its level and how they can be minimized.MethodAll eligible adult patients admitted for elective surgical procedures within a six-month study period completed a questionnaire on the evening preceding their surgical operations. They were 125 in number. The questionnaire contained a list of items from which the patients selected the anxieties they had. The volunteers assessed the level of their anxieties using the visual analogue scale. Frequency tables were generated for causes of preoperative anxiety, gender, age, educational levels and surgical exposures of the participants. Chi square test was used where appropriate to find out significant difference between two groups. ResultsAbout 90 percent of the participants had one or more anxieties in the preoperative period. Possibility of having the surgical procedure postponed was responsible for preoperative anxiety in the highest number (87) of the volunteers while the least number (10) of them were concerned about postoperative nausea and vomiting. A higher percentage of females than males had preoperative anxiety but this was not statistically significant. Only previous surgical treatment was associated with significantly lower levels of preoperative anxiety (p<.05). ConclusionThe incidence of preoperative anxiety in our surgical population is fairly high. Fear of possible postponement of surgery was the most common anxiety found in this study. Reasons for postponement of elective surgical procedures should be studied. This and other causes of preoperative anxiety for surgical patients should be minimized. Further study of this subject with a larger sample size is suggested. Introduction Preoperative anxiety is described as an unpleasant state of uneasiness or tension that is secondary to a patient being concerned about a disease, hospitalization, anesthesia and surgery, or the unknown (1). Preoperative anxiety and stress are common in patients awaiting surgical procedures (2). Anxious patients require higher doses of anaesthetic induction agents and postoperative analgesic drug (3.4). The most important single reason for pre-medicating patients before surgery is to reduce anxiety because if anxiety is sufficiently marked, it causes all the signs of sympathetic stimulation and stress. The heart rate and systolic pressure rise, the skin is pale and often sweaty, and the veins are characteristically constricted. There may be ventricular ectopic beats or in extreme circumstances ventricular fibrillation (5). Greater distress or anxiety prior to surgery is associated with a slower and more complicated postoperative recovery (6).The incidence of preoperative anxiety has been estimated to vary from 11 to 80% in the adult (4). The incidence of preoperative anxiety among surgical patients in the Niger Delta region is not known.Anxieties of postoperative nausea or pain, intra-operative awareness, waiting for operation, loss of control during anaesthesia and venous cannulation are common in the preoperative period (2). To reduce the incidence and intensity of anxiety among preoperative patients there is a need to identify the associated factors which can be modified. Determining the reasons and factors influencing preoperative fear and anxiety in the local population may help clinicians in the management of patients. Proper management of fear and anxiety by anesthesiologists may provide better preoperative assessment, less pharmacological premedication, smoother induction and may be even better outcome(7).The