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Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption

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Abstract

Preoperative anxiety has an incidence of 11–80% in patients undergoing surgical or interventional procedures. Understanding the role of preoperative anxiety on intraoperative anesthetic requirements and postoperative analgesic consumption would allow personalized anesthesia care. Over- or under-anesthetizing patients can lead to complications such as postoperative cognitive dysfunction in elderly patients, or procedural discomfort, respectively. Our scoping review focuses on the current evidence regarding the association between preoperative anxiety and intraoperative anesthetic and/or postoperative analgesic consumption in patients undergoing elective surgical or interventional procedures. Based on 44 studies that met the inclusion criteria, we found that preoperative anxiety has a significant positive correlation effect on intraoperative propofol and postoperative opioid consumption. The analysis of the literature is limited by the heterogeneity of preoperative anxiety tools used, study designs, data analyses, and outcomes. The use of shorter, validated preoperative anxiety assessment tools may help optimize the intraoperative anesthetic and postoperative analgesic regimen. Further research to determine the most feasible and clinically relevant preoperative anxiety tool and subsequent implementation has the potential to optimize perioperative care and improve patient outcomes.

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Abbreviations

DSM-V:

Diagnostic and statistical manual of mental disorders -V

ASA:

American society of anesthesiologists

BAI:

Beck anxiety inventory

STAI:

State-trait anxiety inventory

DAS:

Corah’s dental anxiety scale

GAD-7:

Generalized anxiety disorder-7

SAS:

Surgery anxiety scale

HADS:

Hospital anxiety and depression scale

Zung SAS:

Zung self-rating anxiety scale

ASI:

Anxiety sensitivity index

SSAS:

Somatosensory amplification scale score

VAS:

Visual analog scale (VAS)

m-YPAS:

modified Yale Preoperative Anxiety Scale

HRV:

Heart rate variability

VNS:

Verbal numeric score

OMEs:

Oral morphine equivalents

NSAIDs:

Non-steroidal anti-inflammatory drugs

PCA:

Patient-controlled analgesia

PROMIS:

Patient-reported outcomes measurement information system

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Paul Bains, Ph.D., MLIS, Reference and Instruction Librarian, from Harvard Medical School’s Countway Library for helping to refine search terms.

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  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America

    Yun-Yun K. Chen, Mieke A. Soens & Vesela P. Kovacheva

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Yun-Yun K. Chen, MD. This author helped design the study, perform data analysis, write the manuscript, and approve the final version. Mieke A. Soens, MD. This author helped perform data analysis and approve the final version. Vesela P. Kovacheva, MD, PhD. This author helped design the study, perform data analysis, write the manuscript, and approve the final version.

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Chen, YY.K., Soens, M.A. & Kovacheva, V.P. Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption. J Anesth 36, 532–553 (2022). https://doi.org/10.1007/s00540-022-03081-4

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