The relationship between preoperative anxiety levels and vasovagal incidents during the administration of spinal anesthesia

Mürsel Ekinci; Birzat Emre Gölboyu; Onur Dülgeroğ; lu; Murat Aksun; Pı; nar Karaca Baysal; Erkan Cem Çelik; Ayş; e Nur Yeksan

doi:10.1016/j.bjane.2016.07.017

Scientific Article

The relationship between preoperative anxiety levels and vasovagal incidents during the administration of spinal anesthesia

A relação entre os níveis de ansiedade no período pré-operatório e os incidentes vasovagais durante a administração de raquianestesia

Mürsel Ekinci; Birzat Emre Gölboyu; Onur Dülgeroğ; lu; Murat Aksun; Pı; nar Karaca Baysal; Erkan Cem Çelik; Ayş; e Nur Yeksan

http://dx.doi.org/10.1016/j.bjane.2016.07.017 Braz J Anesthesiol, vol.67, n4, p.388-394, 2017

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Abstract

Abstract Background: It was aimed to investigate the relationship between preoperative anxiety and vasovagal symptoms observed during the administration of spinal anesthesia in patients undergoing surgery in the perianal and inguinal regions. Methods: The study included patients with planned surgery for inguinal hernia repair, anal fissure, hemorrhoid and pilonidal sinus excision. The study included a total of 210 patients of ASA I-II, aged 18-65 years. Patients were evaluated in respect of demographic characteristics, smoking and alcohol consumption, ASA grade and educational level. Correlations were evaluated between the number of attempts at spinal anesthesia and anesthesia history with vasovagal symptoms and educational level, gender, smoking and alcohol consumption and anesthesia history with anxiety scores. The instant (transient) state anxiety inventory part of the Transient State/Trait Anxiety Inventory (State Trait Anxiety Inventory - STAI) was used to determine the anxiety levels of the participants. Clinical findings of peripheral vasodilation, hypotension, bradycardia and asystole observed during the administration of spinal anesthesia were recorded. Results: Vasovagal incidences during the administration of spinal anesthesia were seen to increase in cases of high anxiety score, male gender, and an absence of anesthesia history. Educational level and the number of spinal needle punctures were not found to have any effect on vasovagal incidents. Conclusion: The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents.

Keywords

Anxiety, Spinal anesthesia, Syncope, Vasovagal

Resumo

Resumo Justificativa: O objetivo deste estudo foi investigar a relação entre a ansiedade no período pré-operatório e os sintomas vasovagais observados durante a administração de raquianestesia a pacientes submetidos à cirurgia nas regiões perianal e inguinal. Métodos: O estudo incluiu pacientes com cirurgias agendadas para correção de hérnia inguinal, fissura anal, hemorroidas e excisão de fístula pilonidal. Foram incluídos 210 pacientes entre 18-65 anos e estado físico ASA I-II. A avaliação dos pacientes compreendeu história de tabagismo e consumo de álcool, classificação ASA e nível de escolaridade. As correlações foram avaliadas entre o número de tentativas de aplicação da raquianestesia e história de anestesia com sintoma vasovagal, nível de escolaridade, sexo, tabagismo e consumo de álcool, história anestésica e escores de ansiedade. O inventário do estado (transitório) de ansiedade, parte do Inventário de Ansiedade Traço-Estado (State Trait Anxiety Inventory - IDATE), foi usado para determinar os níveis de ansiedade dos participantes. Achados clínicos de vasodilatação periférica, hipotensão, bradicardia e assistolia observados durante a administração da raquianestesia foram registrados. Resultados: Observamos aumento dos incidentes vasovagais durante a administração da raquianestesia em casos com escores elevados de ansiedade, pacientes do sexo masculino e pacientes sem história anestésica. O nível de escolaridade e o número de punções com agulha espinhal não mostraram ter qualquer efeito sobre os incidentes vasovagais. Conclusão: Determinar as causas que desencadearam os incidentes vasovagais observados durante a aplicação da raquianestesia, fornecer boa informação ao paciente sobre a anestesia regional e promover alívio da ansiedade com tratamento ansiolítico no pré-operatório contribuirão para eliminar possíveis incidentes vasovagais.

Palavras-chave

Ansiedade, Raquianestesia, Síncope, Vasovagal

References

Brignole M, Alboni P, Benditt D. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive summary. Eur Heart J. 2004;25:2054-72.

Abboud F. Neurocardiogenic syncope. N Engl J Med. 1993;328:1117-20.

Badner NH, Nielson WR, Munk S. Preoperative anxiety detection and contributing factors. Can J Anaesth. 1990;37:444-7.

Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth. 2001;86:859-68.

Doyle DJ, Mark PW. Reflex bradycardia during surgery. Can J Anaesth. 1990;37:219-22.

Prakash ES. When the heart is stopped for good: hypotensionbradycardia paradox revisited. Adv Physiol Educ. 2005;29:15-20.

Apt L, Isenberg SJ. The oculo-cardiac reflex as a surgical aid in identifying a slipped or ‘lost’ extraocular muscle. Br J Ophthalmol. 1980;64:362-5.

Bekaroğlu M, Uluutku N, Alp K. Ameliyat öncesi kaygı ve depresyon durumunun ameliyat komplikasyonlarına ve yatış süresine etkisi üzerine bir çalışma. Türk Psikiyatri Dergisi. 1991;2:285-8.

Kindler CH, Harms C, Amsler F. The visual analog scale allows effective measurement of pre-operative anxiety and detection of patient's anesthetic concerns. Anesth Analg. 2000;90:706-12.

Ramsay MAE. A survey of pre-operative fear. Anaesthesia. 1972;27:396-402.

Kain ZN, Sevarino F, Pincus S. Attenuation of the preoperative stress response with midazolam: effects on postoperative outcomes. Anesthesiology. 2000;93:141-7.

Savage DD, Corwin L, McGee DL. Epidemiologic features of isolated syncope: the Framingham Study. Stroke. 1985;16:626-9.

Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med. 1985;55:45-54.

Kapoor W. Evaluation and management of syncope. JAMA. 1992;268:2553-60.

Le Compte WA, Ömer N. Development of the Turkish edition of state-trait anxiety inventory. Cross-cultural anxiety. 1976:51-68.

Jang YE, Do SH, Song I. Vasovagal cardiac arrest during spinal anesthesia for Cesarean section - a case report. Korean J Anesthesiol. 2013;64:77-81.

Kim KO, Oh JS. Vagally mediated atrioventricular block with ventricular asystole immediately after assuming prone position under spinal anesthesia: a case report. Korean J Anesthesiol. 2016;69:63-5.

Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189-98.

Aykent R, Kocamanoğlu S, Üstün E. Preoperatif anksiyete nedenleri ve değerlendirilmesi: APAIS ve STAI skorlarının karşılaştırılması. Turkiye Klinikleri J Anest Reanim. 2007;5:7-13.

Wetsch WA, Pircher I, Lederer W. Preoperative stress and anxiety in day-care patients and inpatients undergoing fast-track surgery. Br J Anaesth. 2009;103:199-205.

Mitchell M. Conscious surgery: influence of the environment on patient anxiety. J Adv Nurs. 2008;64:261-71.

Caumo W, Schmidt AP, Schneider CN. Risk factors for postoperative anxiety in adults. Anaesthesia. 2001;56:720-8.

Domar AD, Everett LL, Keller MG. Preoperative anxiety: is it a predictable entity?. Anesth Analg. 1989;69:763-7.

Moerman N, van Dam FS, Muller MJ. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996;82:445-51.

Deyirmenjian M, Karam N, Salameh P. Preoperative patient education for open-heart patients: a source of anxiety?. Patient Educ Couns. 2006;62:111-7.

Bayar A, Tuncay İ, Atasoy N. The effect of watching live arthroscopic views on postoperative anxiety of patients. Knee Surg Sports Traumatol Arthrosc. 2008;16:982-7.

Warner DO, Patten CA, Ames SC. Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery. Anesthesiology. 2004;100:1125-37.

Malhotra SK, Singh S, Bajaj A. Induction-intubation response, smokers vs non-smokers. Middle East J Anesthesiol. 2005;18:529-40.

The relationship between preoperative anxiety levels and vasovagal incidents during the administration of spinal anesthesia

A relação entre os níveis de ansiedade no período pré-operatório e os incidentes vasovagais durante a administração de raquianestesia

Mürsel Ekinci; Birzat Emre Gölboyu; Onur Dülgeroğ; lu; Murat Aksun; Pı; nar Karaca Baysal; Erkan Cem Çelik; Ayş; e Nur Yeksan

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