The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy

Ali, Achmet; Altun, Demet; Oğuz, Bahadır Hakan; İlhan, Mehmet; Demircan, Fatma; Koltka, Kemalettin

doi:10.1007/s00540-013-1712-7

Cited by 128 publications

(110 citation statements)

References 18 publications

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“…It has been shown to adversely affect the postoperative pain and bring enormous suffering to patients [6][7][8][9]. Although increasing clinical evidence has demonstrated the positive correlation between anxiety and pain during the perioperative period [5,7], few laboratory studies were conducted to investigate this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative anxiety is very common in patients undergoing surgery, with an incidence of 60 to 92 % [2,4,5]. Many studies have shown the positive correlation between preoperative anxiety and postoperative pain intensity as well as analgesic consumption [5][6][7][8][9]. The phenomenon that exposure to physical or psychological stressors can enhance nociception and pain sensitivity is described as stress-induced hyperalgesia (SIH) [10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Glucocorticoid-Potentiated Spinal Microglia Activation Contributes to Preoperative Anxiety-Induced Postoperative Hyperalgesia

et al. 2016

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Clinically, preoperative anxiety adversely affected postoperative hyperalgesia. As stress-induced glucocorticoids (GCs) were reported to sensitize the activation of microglia, the present study investigated whether and how GCs and microglia played in the process of preoperative anxiety-induced postoperative hyperalgesia. The study used an animal model that exposed rats to single prolonged stress (SPS) procedure to induce preoperative anxiety-like behaviors 24 h before the plantar incisional surgery. Behavioral testing revealed that preoperative SPS enhanced the mechanical allodynia induced by plantar incision. SPS was also found to induce elevated circulating corticosterone levels, potentiate the activation of spinal microglia, and increase the expression of spinal proinflammatory cytokines. Inhibition of microglia by pretreatment with minocycline attenuated the SPS-enhanced mechanical allodynia, and this was accompanied by decreased activation of spinal microglia and expression of proinflammatory cytokines. Another experiment was conducted by administering RU486, the GC receptor (GR) antagonist, to rats. The results showed that RU486 suppressed SPS-induced and SPS-potentiated proinflammatory activation of spinal microglia and revealed analgesic effects. Together, these data indicated that inhibition of stress-induced GR activation attenuated the preoperative anxiety-induced exacerbation of postoperative pain, and the suppression of spinal microglia activation may underlie this anti-hyperalgesia effect. Pending further studies, these findings suggested that GR and spinal microglia may play important roles in the development of preoperative anxiety-induced postoperative hyperalgesia and may serve as novel targets to prevent this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Glucocorticoid-Potentiated Spinal Microglia Activation Contributes to Preoperative Anxiety-Induced Postoperative Hyperalgesia

et al. 2016

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“…These include the prognosis of the intervention, fears about the anesthetic and postoperative pain, and concerns about the outcome of the procedure [4, 5]. However, a range of factors related to the sociodemographic and psychosocial characteristics of the patient also need to be considered, for example, personal anxiety levels, personality traits, sensitivity to pain, and the use of coping strategies.…”

Section: Introductionmentioning

confidence: 99%

“…It is amply demonstrated that anxiety levels increase before an intervention, triggering a stress response which includes the release of catecholamines, sympathetic hyperactivity, hyper-metabolism, neuroendocrine changes, electrolyte alterations and immunological modifications [7]. Patients with a high level of preoperative anxiety require higher doses of anesthetics and need more peri- and postoperative analgesia [4, 8]. This often results in a longer hospital stay, increases the risk of readmission after surgery and raises morbidity and mortality [9] rates.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Spanish version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

Vergara-Romero

Morales-Asencio

Morales-Fernández

et al. 2017

Health Qual Life Outcomes

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BackgroundPreoperative anxiety is a frequent and challenging problem with deleterious effects on the development of surgical procedures and postoperative outcomes. To prevent and treat preoperative anxiety effectively, the level of anxiety of patients needs to be assessed through valid and reliable measuring instruments. One such measurement tool is the Amsterdam Preoperative Anxiety and Information Scale (APAIS), of which a Spanish version has not been validated yet.ObjectiveTo perform a Spanish cultural adaptation and empirical validation of the APAIS for assessing preoperative anxiety in the Spanish population.MethodsA two-step forward/back translation of the APAIS scale was performed to ensure a reliable Spanish cultural adaptation. The final Spanish version of the APAIS questionnaire was administered to 529 patients between the ages of 18 to 70 undergoing elective surgery at hospitals of the Agencia Sanitaria Costa del Sol (Spain). Cronbach’s alpha, homogeneity index, intra-class correlation coefficient, and confirmatory factor analysis were calculated to assess internal consistency and criteria and construct validity.ResultsConfirmatory factor analysis showed that a one-factor model was better fitted than a two-factor model, with good fitting patterns (root mean square error of approximation: 0.05, normed-fit index: 0.99, goodness-of-fit statistic: 0.99). The questionnaire showed high internal consistency (Cronbach’s alpha: 0.84) and a good correlation with the Goldberg Anxiety Scale (CCI: 0.62 (95% CI: 0.55 to 0.68).ConclusionsThe Spanish version of the APAIS is a valid and reliable preoperative anxiety measurement tool and shows psychometric properties similar to those obtained by similar previous studies.

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“…However, a short duration of the surgery (62 min) made us to administer fentanyl in the midst of remifentanil infusion. Third, high preoperative anxiety was shown to be negatively associated with recovery from anesthesia and control of postoperative pain [23]. A use of anxiolytics in addition to analgesics might be an appropriate choice at the emergence from anesthesia since the patient could be expected to be susceptible to postoperative agitation, considering her fragile mentality [24].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Apnea Induced by Fentanyl and Other Multiple Respiratory-Modulating Factors

Matsuda¹,

Sato²

2014

OJAnes

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Purpose: Opioids are concerned as a major cause of postoperative respiratory depression. In the immediate postoperative period, however, other factors can produce instability of breathing such as pain, agitation, and residual effects of anesthetics. Such factors might be overlooked masked by the fear for opioid-induced respiratory depression. We report a case who presented apnea immediately after emergence from anesthesia that we considered was produced by an interaction among such factors accompanied with fentanyl-induced respiratory depression. Clinical Features: A 31-year-old woman underwent ovarian cystectomy under general anesthesia with continuous infusions of propofol and remifentanil, and bolus doses of fentanyl. Transversus abdominis plane blocks with ropivacaine were given upon completion of surgery. She complained of severe wound pain and was agitated at the emergence from anesthesia. Fentanyl 50 µg was administered intravenously. In several minutes, she developed apnea, unconsciousness, and difficulty of mechanical ventilation via a face mask. The estimated effect site concentration at the onset of the episode (2.9 ng•ml −1 ) was approximately the same (3.0 ng•ml −1 ) as after 30 min when she regained consciousness and spontaneous breathing. It indicated that not only direct inhibition of the respiratory center by fentanyl but also other stimulatory and inhibitory factors contributed to respiratory arrest. Conclusion: In the immediate postoperative period, transient factors, such as pain, mental instability and anesthetic residues, which are indirectly-related with breathing, can interact each other and with opioids. The interaction would induce apnea through mechanisms combined among direct inhibition of the respiratory center, and modulation of chemical and cortical controls of breathing.

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The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy

Cited by 128 publications

References 18 publications

Glucocorticoid-Potentiated Spinal Microglia Activation Contributes to Preoperative Anxiety-Induced Postoperative Hyperalgesia

Glucocorticoid-Potentiated Spinal Microglia Activation Contributes to Preoperative Anxiety-Induced Postoperative Hyperalgesia

Validation of the Spanish version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

Postoperative Apnea Induced by Fentanyl and Other Multiple Respiratory-Modulating Factors

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