Dear Editor,

Quality and safety have historically been measured in anesthesia by analyzing perioperative morbidity and mortality. However, these measures are often associated with factors beyond the control of anesthesiologists. Patient satisfaction and their perception of outcomes have recently become essential to service quality in anesthesia. [1] Gathering information on the patient's experience from their perspective can assist healthcare professionals in making decisions about various available pharmacological options considering patient preferences, not just the anesthesiologist's view. [2]

The Heidelberg Peri-Anaesthetic Questionnaire (HPAQ) [3] was developed in Germany to evaluate patient satisfaction in the peri-anesthetic period. It consists of 38 questions, with responses ranging from 0 (unimportant to me) to 3 (very important to me) on a Likert scale. It assesses satisfaction in five main dimensions: “trust and atmosphere”, “fear”, “discomfort”, “treatment by personnel”, and “information and waiting”. However, a validated Brazilian version of the HPAQ is still unavailable.

The aim of this letter is to inform that the HPAQ was cross-culturally adapted [4] to ensure its suitability for the Brazilian Portuguese language and culture. Two translators were enlisted for the initial translation stage: one native German speaker and one bilingual Brazilian with no medical or academic affiliations. Following a synthesis stage, a back translation was carried out by a native German speaker with no medical or academic affiliations who translated the Brazilian Portuguese version back to German. An expert committee assessed the semantic, idiomatic, experimental, and conceptual equivalence of the Brazilian Portuguese version of the HPAQ. The committee comprised two PhD professors with experience in epidemiological studies using questionnaires, one anesthesiologist, one surgeon, and three medical students. The committee conducted a comparative analysis between the questionnaire's backtranslated and original German versions to identify any discrepancies in the translation process. The committee members discussed the issues and potential solutions were proposed. As a result of this evaluation, a prefinal version of the HPAQ-Br was developed.

This version of the HPAQ-Br was then administered to 10 patients who had undergone general anesthesia in a private plastic surgery clinic in Florianópolis/SC, Brazil. This aimed to identify comprehension problems and other difficulties in understanding the meaning of each item. The participants were selected based on being native Brazilian Portuguese speakers, above 18 years old, and having undergone general anesthesia. The results showed that no further modifications were necessary, indicating the adequacy of the translation and adaptation process. Therefore, a final version of the HPAQ-Br was proposed (Table 1). The successful translation and cross-cultural adaptation of HPAQ to Brazilian Portuguese led to the development of HPAQ-Br.

Table 1. Proposed version of The Heidelberg Peri-Anaesthetic Questionnaire in Brazilian Portuguese (HPQ-Br).

While the HPAQ has already been translated and validated into Portuguese in the context of Portugal culture, [5] discrepancies between the original and Brazilian Portuguese translations were identified and resolved by our research committee. Similar linguistic differences were also reported in the Portuguese (Portugal) version. Notably, the translation and transcultural adaptation conducted by Moura et al. [5] differed from our process as they translated the questionnaire from an English-published version into Portuguese, which may have influenced the results.

Now, it is necessary to determine the psychometric properties of validity and reliability of the Brazilian version proposed. However, the availability of the HPAQ in a Brazilian Portuguese version offers a valuable tool for improving perianesthetic care assessment in Brazil.