Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section

Darshana Maheshwari, Samina Ismail, Darshana Maheshwari, Samina Ismail

Abstract

Background and aims: We aimed to measure the frequency of preoperative anxiety in patients undergoing elective cesarean section (CS) and its impact on patients decision regarding the choice of anesthesia.

Material and methods: This cross-sectional study included 154 consecutive patients, who were scheduled for elective CS. Visual analog scale (VAS) for anxiety was the study tool, and VAS ≥50 was considered as significant anxiety. Enrolled patients were interviewed by the primary investigator the day before the surgery and their VAS score and choice of anesthesia technique either general anesthesia (GA) or regional anesthesia (RA) were recorded. Additional data included demographics, parity, educational status, previous anesthesia experience and source of information.

Results: Preoperative anxiety (VAS ≥ 50) was seen in 72.7% of patients, which was significantly higher (P < 0.005) in patients selecting GA (97.18%, n = 71/154) as compared to those selecting RA (51.81%, n = 83/154) for elective CS. Statistically significant association of anxiety (P < 0.005) was seen with age <25 years, nulli and primiparous, higher education status, previous anesthesia experience and source of information from nonanesthetist.

Conclusion: Patients scheduled for elective CS were found to have high frequency of anxiety (72.7%), and GA was observed to be the choice of anesthesia technique in anxious patients.

Keywords: Anxiety; cesarean section; general anesthesia; regional anesthesia.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Comparison of incidence of anxiety between patients with general and regional anesthesia (97.18 vs. 51.81%; P = 0.0005; odds ratio = 32.09 95% confidence interval: 7.37-139.62)

References

    1. Carvalho B, Cohen SE, Lipman SS, Fuller A, Mathusamy AD, Macario A. Patient preferences for anesthesia outcomes associated with cesarean delivery. Anesth Analg. 2005;101:1182–7.
    1. Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety before elective surgery. Neurosciences (Riyadh) 2007;12:145–8.
    1. Shevde K, Panagopoulos G. A survey of 800 patients’ knowledge, attitudes, and concerns regarding anesthesia. Anesth Analg. 1991;73:190–8.
    1. Kennedy BW, Thorp JM, Fitch W, Millar K. The theatre environment and the awake patient. J Obstet Gynaecol. 1992;12:407–11.
    1. Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc. 2009;59:359–63.
    1. Beilin Y, Rosenblatt MA, Bodian CA, Lagmay-Aroesty MM, Bernstein HH. Information and concerns about obstetric anesthesia: A survey of 320 obstetric patients. Int J Obstet Anesth. 1996;5:145–51.
    1. Lack JA. Raising the standard: A compendium of audit recipes. [Last accessed on 2014 Apr];R Coll Anaesth. 2006 3:166–7. Available from: .
    1. Ismail S, Shafiq F, Malik A. Technique of anaesthesia for different grades of caesarean section: A cross-sectional study. J Pak Med Assoc. 2012;62:363–7.
    1. Vallejo MC, Phelps AL, Shepherd CJ, Kaul B, Mandell GL, Ramanathan S. Nitrous oxide anxiolysis for elective cesarean section. J Clin Anesth. 2005;17:543–8.
    1. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11:213–8.
    1. Senel AC, Mergan F. Premedication with midazolam prior to caesarean section has no neonatal adverse effects. Braz J Anesthesiol. 2014;64:16–21.
    1. Jlala HA, Bedforth NM, Hardman JG. Anesthesiologists’ perception of patients’ anxiety under regional anesthesia. Local Reg Anesth. 2010;3:65–71.
    1. Jenkins JG, Khan MM. Anaesthesia for Caesarean section: A survey in a UK region from 1992 to 2002. Anaesthesia. 2003;58:1114–8.
    1. Halpern SH, Soliman A, Yee J, Angle P, Ioscovich A. Conversion of epidural labour analgesia to anaesthesia for caesarean section: A prospective study of the incidence and determinants of failure. Br J Anaesth. 2009;102:240–3.
    1. Aiman J, Mahmood KT, Hussain R, Naeem R. Comparison of spinal/epidural and general anaesthesia in elective C-section patient's vs doctor's choice. Int J Pharma Sci. 2010;2:98–106.
    1. Kan RK, Lew E, Yeo SW, Thomas E. General anesthesia for cesarean section in a Singapore maternity hospital: A retrospective survey. Int J Obstet Anesth. 2004;13:221–6.
    1. Ebirim LN, Tobin M. Factors responsible for pre-operative anxiety in elective surgical patients at a University Teaching Hospital: A pilot study. Int J Anesthesiol. 2010;29:1–10.
    1. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg. 2000;90:706–12.
    1. Domar AD, Everett LL, Keller MG. Preoperative anxiety: Is it a predictable entity? Anesth Analg. 1989;69:763–7.
    1. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) Anesth Analg. 1996;82:445–51.
    1. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45:298–307.
    1. Boker A, Brownell L, Donen N. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Can J Anaesth. 2002;49:792–8.
    1. Uddin I, Abdullah K, Tahir J, Rahila I. Preoperative anxiety in patients admitted for elective surgery in King Saud Hospital Unaizah, Alqassim Kingdom of Saudi Arabia. Pak J Med Sci. 2002;18:306–10.
    1. Thorp JM, Kennedy BW, Millar K, Fitch W. Personality traits as predictors of anxiety prior to caesarean section under regional anaesthesia. Anaesthesia. 1993;48:946–50.
    1. Ahmad I, Afshan G. Knowledge and attitudes of Pakistani women towards anaesthesia techniques for caesarean section. J Pak Med Assoc. 2011;61:359–62.
    1. Egbert LD, Battit G, Turndorf H, Beecher HK. The value of the preoperative visit by an anesthetist. A study of doctor-patient rapport. JAMA. 1963;17(185):553–5.
    1. Ngan Kee WD, Hung VY, Roach VJ, Lau TK. A survey of factors influencing patients’ choice of anaesthesia for caesarean section. Aust N Z J Obstet Gynaecol. 1997;37:300–3.

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