Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) in Serbia

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

BACKGROUND

Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and more attention in society. Ketamine has been confirmed for its rapid antidepressant effect in women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence of PPD.

METHODS

All the parturients enrolled in the study were randomly assigned to two groups: the esktamine group (0.2 mg/kg esketamine) and the control group (a same volume of saline). All the drugs were pumped for 40 min started from the beginning of the surgery. The Amsterdam Anxiety and Information Scale (APAIS) scores before the surgery, the Edinburgh postnatal depression scale (EPDS) scores at 4 d and 42 d after surgery, the Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, 24 h and 48 h post-operation were evaluated, as well as the adverse reactions were recorded.

RESULTS

A total of 319 parturients were analyzed in the study. The incidence of PPD (EPDS score > 9) in the esketamine group was lower than the control group at 4 days after surgery (13.8% vs 23.1%, P = 0.0430) but not 42 days after surgery (P = 0.0987). Esketamine 0.2 mg/kg could reduce the NRS score at 6 h,12 h and 24 h after surgery, as well as the use of vasoactive drugs during surgery (P < 0.05). The incidences of maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) and drowsiness (3.8%) in the esketamine group were higher than those of control group (P < 0.05).

CONCLUSIONS

Intraoperative injection of esketamine (0.2 mg/kg) prevented the occurrence of depression (EPDS score > 9) at 4 days after delivery but not 42 days. Esketamine reduced the NRS scores at 6 h, 12 h and 24 h after surgery, but the occurrence of maternal side effects such as dizziness, blurred vision, drowsiness and hallucination were increased.

TRIAL REGISTRATION

Registered in the Chinese Clinical Trial Registry (ChiCTR2100053422) on 20/11/2021.

Preoperative anxiety

PURPOSE OF REVIEW

With first research reports dating back to the 1970s, the important role of anxiety in the perioperative period has been recognized for a long time and remains in effect.

RECENT FINDINGS

The global pooled prevalence of preoperative anxiety among 14 000 surgical patients was reported to be 48%. The underlying fears among surgical patients include: fear of surgical complications, worry about the duration and degree of disability after the procedure, concerns about general anesthesia and the associated loss of control, as well as fear of waking up and experiencing discomfort and pain during or after surgery. The type and invasiveness of the planned procedure contribute to differences in preoperative anxiety levels. While preoperative anxiety is higher in younger, female patients as well as in those with a high need for information, prior exposure to anesthesia or surgery was associated with lower anxiety levels. High levels of preoperative anxiety may lead to poor postoperative pain control and increased morbidity. Due to adverse effects such as delirium, the use of benzodiazepines to manage preoperative anxiety has decreased.

SUMMARY

Preoperative anxiety remains a critical issue in the perioperative period. Further research is needed to develop effective management strategies, which may need to be tailored to the patient's individual need.

Preoperative Anxiety among Patients Undergoing Elective Surgery in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Preoperative anxiety is universal in patients before surgery. It is mostly unaddressed by health professionals due to a lack of time. The objective of this study was to find out the prevalence of preoperative anxiety among patients undergoing elective surgery in a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted on 385 surgical patients in the Department of Anaesthesia, from 27 November 2021 to 20 April 2022 in a tertiary care hospital posted for elective surgery. Ethical approval was obtained from the Institutional Review Committee (Reference number: MEMG/481/IRC). A convenience sampling was used. The level of anxiety and need for information was assessed using the Amsterdam Preoperative Anxiety and Information Scale questionnaire in a preoperative holding area. Point estimate and 95% Confidence Interval were calculated.

Results

Out of 385 patients posted for elective surgery, preoperative anxiety was present in 88 (22.85%) (18.66-27.04, 95% Confidence Interval) patients. The mean Amsterdam Preoperative Anxiety and Information Scale score for total anxiety and need for information was 13.59±2.47 and 5.91±3.06 respectively. Anxiety was present in 60 (68.18%) females, 45 (51.13%) young patients aged <30 years and 50 (56.81%) patients without prior experience with surgery and anaesthesia.

Conclusions

The prevalence of preoperative anxiety among surgical patients was lower than in previous studies done in similar settings. Preoperative anxiety was common in females, young patients and patients without previous experience with anaesthesia and surgery.

Keywords

anxiety; patient; preoperative; surgical.

Preoperative Anxiety is Associated With Postoperative Complications in Vascular Surgery: A Cross-Sectional Study

BACKGROUND

Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery.

METHODS

Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation.

RESULTS

Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (r_pb = 0.193, p = 0.001) and pulmonary complications (r_pb = 0.104, p = 0.042). Postoperative nausea (r_pb = 0.111, p = 0.03) and postoperative mental disorders (r_pb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety.

CONCLUSIONS

Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.