Preoperative Anxiety and Propofol Requirement in Conscious Sedation for Ovum Retrieval

Abstract

The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microg/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieved. A weak correlation was observed between visual analogue scale (VAS) anxiety and the dose of propofol required for the induction of conscious sedation (r=0.22, p=0.0192). A weak correlation was also found between VAS anxiety and the sedation time needed to reach the proper conscious sedation level for the procedure (r=0.181, p=0.0484). Multiple regression analysis showed that VAS anxiety, preoperative baseline prolactin level, and cortisol level had statistically significant effects on the propofol induction dose for target controlled conscious sedation. We concluded that the induction dose and time requirements for propofol in anesthesiologist-controlled conscious sedation be modified based on the preoperative anxiety level and the baseline blood concentration of stress hormone, cortisol and prolactin.

The Effect of Preoperative Heart Rate and Anxiety on the Propofol Dose Required for Loss of Consciousness

“…1-3 Maranets and Kain 1 reported that increased STAI-trait but not STAI-state on the day of surgery was associated with higher propofol dose administered as a bolus to achieve a BIS value between 40 and 60. Similarly, Hong et al 2 reported that increased anxiety assessed by a visual analogic scale but not by the STAI scale on the day of surgery was associated with higher propofol dose administered with a target-controlled infusion to reach a predetermined level of sedation. On the contrary, Morley et al 3 did not observe any influence of the STAI-trait and STAI-state measured in the surgical ward and propofol dose administered at a 40 mg ⅐ kg Ϫ1 ⅐ h Ϫ1 infusion rate to achieve LOC or a BIS value of 50.…”

“…13 This is a validated tool for self-reporting anxiety, already used during the perioperative period. [1][2][3]14 It comprises 2 sets of 20 statements.…”

“…As suggested by clinical experience, the more anxious the patient, the higher the hypnotic dose required for induction of anesthesia (propofol being the hypnotic drug most frequently investigated). 1,2 However, this assumption has been recently challenged. 3 Some studies that investigated the effects of perioperative anxiety recorded the propofol dose required to obtain loss of consciousness (LOC) or a defined level of sedation 1,2 but did not consider the hemodynamic effects of anxiety.…”

Toward the Validation of Visual Analogue Scale for Anxiety

“…Apart from pain, the VAS has been used to test anxiety, well-being, satisfaction, and physical concerns in other medical conditions, such as irritable bowel syndrome, 58 rheumatoid arthritis, 38 pelvic disorders, 35 oocyte retrieval, 36 cesarean section, 59 and mechanical ventilation. 60 As far as anxiety in dentistry is concerned, the VAS-A has been checked in small series, correlating it with cortisol level 28 or other psychological tests.…”

Effect of pre-anesthetic anxiety and heart rate on propofol dose requirement for induction: A correlation study

“…[4][5][6][7] At present Propofol is the most frequently investigated hypnotic drug and have been proved to follow the same hypothesis of higher the anxiety, higher the amount of drug required. 5,8 But some recent studies have come with different results. 9,10 Anxiety and acute mental stress are associated with increased heart rate (HR) and cardiac output 11,12 and studies have shown that increased cardiac output increases the propofol requirements.…”