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Print version ISSN 0034-7094
Rev. Bras. Anestesiol. vol.54 no.6 Campinas Nov./Dec. 2004
Heart rate and blood pressure are not good parameters to evaluate preoperative anxiety*
La presión arterial y la frecuencia cardíaca no son buenos parámetros para evaluación del nivel de ansiedad pre-operatoria
Diogo Bruggemann da Conceição, M.D.I; Leonardo Schonhorst, M.D.II; Mário José da Conceição, TSA, M.D.III; Getúlio Rodrigues de Oliveira Filho, TSA, M.D.III
do CET/SBA Integrado de Anestesiologia da SES/SC
IIME3 do CET/SBA Integrado de Anestesiologia da SES/SC
IIICo-responsável pelo CET/SBA Integrado de Anestesiologia da SES/SC
OBJECTIVES: Surgical patients are subject to different levels of preoperative
distress. Anxious patients may present unfavorable psychophysical reactions,
such as hypertension and tachycardia. This study aimed at evaluating the level
of preoperative anxiety in a population of surgical patients, and at detecting
heart rate and blood pressure changes and their relationship with age, gender,
education and previous surgical experience.
METHODS: Participated in this randomized study 145 adult patients of both genders, physical status ASA I - III, perfectly oriented in time and space, literate and scheduled for elective surgeries, to whom the Amsterdam preoperative anxiety questionnaire was applied during preanesthetic evaluation. Patients with scores > 11 were considered anxious. Age, gender, education, systolic and diastolic blood pressure, heart rate, previous surgical experience and history of hypertension were recorded.
RESULTS: Sixty-nine patients (47.58%) were considered anxious, while 76 (52.41%) were considered not anxious. There were no significant differences between anxious and non-anxious patients in age, systolic and diastolic blood pressure, and heart rate. Among anxious patients 68.12% were females and 31.88% were males (p < 0.05). There were no significant differences in education, previous surgical experience and history of hypertension between anxious and non-anxious patients.
CONCLUSIONS: Heart rate and blood pressure do not reflect the level of preoperative anxiety. Females are more anxious then males in the preoperative period.
Key Words: PREOPERATIVE EVALUATION: psychological status
Y OBJETIVOS: Los pacientes quirúrgicos sufren variados grados de estrés
psicológico en el período pre-operatorio. Pacientes ansiosos pueden
presentar reacciones sicosomáticas como hipertensión arterial
y taquicardia. El objetivo de este estudio fue el de evaluar el nivel de ansiedad
pre-operatoria en una población de pacientes quirúrgicos, detectar
alteraciones de la frecuencia cardiaca y presión arterial y su relación
con edad, sexo, grado de instrucción y experiencia quirúrgica previa.
MÉTODO: A 145 pacientes adultos, de ambos sexos, estado físico (ASA) I, II ó III, escogidos aleatoriamente, perfectamente orientados en el tiempo y en el espacio, alfabetizados y escalados para cirugías electivas, fue aplicado el cuestionario de ansiedad pre-operatoria de Amsterdan durante la consulta pre-anestésica. Fueron considerados ansiosos los pacientes con contaje igual o mayor que once. Para cada paciente se anotó sexo, edad, grado de instrucción, presión arterial sistólica (PS) y diastólica (PAD), frecuencia cardíaca (FC), experiencia quirúrgica previa e historia de hipertensión arterial.
RESULTADOS: Sesenta y nueve pacientes (47,58%) presentaron contajes de ansiedad igual o mayor que once (ansiosos), mientras 76 pacientes (52,41%) presentaron contajes menores que once (no ansiosos). No hubo diferencia significativa entre pacientes ansiosos y no ansiosos en cuanto a la edad, PS, PAD y FC. Entre los pacientes ansiosos, 68,12% fueron del sexo femenino y 31,88%, del sexo masculino, p < 0,05. Los pacientes ansiosos no difirieron significativamente de los no ansiosos con relación a las superioridades de experiencia quirúrgica previa, grados de instrucción e historia de hipertensión arterial.
CONCLUSIONES: La presión arterial y la frecuencia cardíaca no reflejan el nivel de ansiedad pre-operatoria. Pacientes del sexo femenino tienen mayores probabilidades de presentar ansiedad pre-operatoria,que pacientes del sexo masculino.
Surgical patients suffer different levels of perioperative psychological distress 1. Preoperative anxiety is directly related to unfamiliar environment, loss of control and fear of postoperative pain and death.
Anxiety leads to refusal of some anesthetic techniques and to psychophysical reactions, such as increased heart rate and blood pressure, although some studies question them as preoperative anxiety evaluation parameters 2,3.
This study aimed at evaluating the level of preoperative anxiety in a population of surgical patients, and at detecting heart rate and blood pressure changes and their relationship with age, gender, education and previous surgical experience.
After the Hospital's Ethics Committee approval and their informed consent, participated in this randomized study 145 adult patients of both genders, physical status ASA I - III, perfectly oriented in time and space, scheduled for elective surgeries. Exclusion criteria were patients aged below 18 and above 65 years, with mental disease of any origin, systemic disease with cognitive impairment and illiterate.
During preanesthetic evaluation the day before surgery, Amsterdam preoperative anxiety questionnaire (Attachment 1) was applied to all patients and education (elementary, high school or university), previous surgical experience (yes or no), systolic (SBP) and diastolic (DBP) blood pressure, heart rate and history of hypertension (no, yes treated, and yes not treated) were recorded.
For each question, patients would choose the answer in a scale graded 1 to 5 (Attachment 2). Patients with scores > 11 were considered anxious. Students t, Chi-square and logistic regression tests were used for statistical analysis. Statistical significance was 5% (p < 0.05).
Sixty-nine patients (47.58%) had anxiety scores > 11 (anxious), while 76 patients (52.41%) had scores < 11.
There were no statistically significant differences in age between anxious and non-anxious patients. Among anxious patients, 68.12% were females and 31.88% were males (odds ratio [95% confidence levels] = 2.63[1.33 and 5.23], p < 0.05). There were no statistically significant differences in SBP, DBP and HR between anxious and non-anxious patients (Figures 1 and 2).
Preoperative anxiety may be evaluated in different ways. Most popular methods are scales such as analog visual scale or State-trait Anxiety Inventory (STAI) 6. Our study adopted the Amsterdam scale for preoperative anxiety because it is a valid scale, easily applicable as compared to the above-mentioned scales, in addition to having a higher reliability index as compared to the analog visual scale 1.
Higher preoperative anxiety was observed in female patients, below 40 years of age, smokers, good education level (high school or university), and with depressive status symptoms 4. Patients with previous surgical experience showed lower levels of anxiety 4.
Our study has observed a predominance of females among anxious patients, in line with other authors 4. However, as opposed to the literature, age, education or previous surgical experience were not significant in determining the level of anxiety.
Preoperative anxiety is related to fear of the unknown, to the unfamiliar and maybe hostile place, to loss of control of the situation and to fear of death 5. Anxious patients behave differently from non-anxious as to anesthesia 1. They refuse some anesthetic techniques more easily, complain more of pain and present several unfavorable psychophysical reactions, such as increased electro-dermal activity, increased plasma cortisol and catecholamines 1. Heart rate and blood pressure are commonly used in behavioral studies as dependent variables to evaluate anxiety 1.
Our study has not found statistically significant differences in heart rate and systolic and diastolic blood pressure between anxious and non-anxious patients. Wang et al. 3 have also obtained similar results with the STAI scale.
In conclusion, in the conditions of this study, it has been observed that female patients are more anxious in the preoperative period as compared to males and that blood pressure and heart rate were not good parameters to evaluate preoperative anxiety.
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02. Finco G, Ischia A, Fratucello GB et al - Psychologic implications in loco-regional anesthesia. Minerva Anesthesiol, 1993;59:125-128. [ Links ]
03. Wang SM, Kulkarni L, Dolev J et al - Music and preoperative anxiety: a randomized, controled study. Anesth Analg, 2002;94:1489-1494. [ Links ]
04. Caumo W, Schmidt A, Schneider CN et al - Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand, 2001;45:298-307. [ Links ]
05. Shafer A - Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents. Anesth Analg, 1996;83:1285-1291. [ Links ]
06. Spielberger C, Gorsuch R, Lushene R - State-Trait Anxiety Inventory Manual. Palo Alto, CA: Consulting Psychologists, Press, 1970. [ Links ]
Submitted for publication
May 6, 2004
Accepted for publication July 12, 2004
* Received from CET/SBA Integrado de Anestesiologia da SES/SC, Florianópolis, SC