A Comparative Study between Melatonin and Midazolam as Premedication for Preoperative Anxiety in Patients Undergoing Cataract Surgery Under General Anesthesia: A Clinical Trial

Objective. To assess the factors related to perioperative state anxiety in paediatric patients and their parents. Methods. A cohort study was conducted on paediatric patients 9–17 years of age, who underwent the modified Ravitch procedure (n = 96), and their parents (n = 96). The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Multivariable linear regression models were calculated to find the relationships between the pre- and postoperative state anxiety of the patients/parents and the independent variables, both demographic (age, gender) and clinical (e.g., postoperative pain, trait anxiety). Results. Preoperative anxiety in the paediatric patients was positively correlated with their trait anxiety (β = 0.47; 95% CI: 0.29 to 0.64) and preoperative parental anxiety (β = 0.24; 95% CI: 0.07 to 0.42). The high level of preoperative anxiety (vs. low and moderate) (β = 0.40; 95% CI: 0.22 to 0.58), trait anxiety (β = 0.22; 95% CI: 0.04 to 0.40) and average postoperative pain at rest (β = 0.18; 95% CI: 0.01 to 0.34) had a positive impact on the postoperative anxiety in patients. However, the patients’ age was negatively correlated with postoperative anxiety (β = −0.19; 95% CI: −0.35 to −0.02). Three variables were found to predict preoperative parental anxiety: their trait anxiety (β = 0.41; 95% CI: 0.23 to 0.59), female gender (β = 0.18; 95% CI: 0.002 to 0.36) and the intravenous route for the postoperative pain management in the patients (β = −0.18; 95% CI: −0.36 to −0.001). The parental postoperative anxiety was influenced by their trait anxiety (β = 0.24; 95% CI: 0.04 to 0.43), preoperative anxiety in patients (β = 0.21; 95% CI: 0.02 to 0.40) and female gender of children (β = 0.19; 95% CI: 0.001 to 0.39). Conclusions. Trait anxiety was a strong factor positively affecting the perioperative state anxiety. In addition, paediatric patient anxiety before surgery was related to their parents’ anxiety, and, after surgery, this was associated with high preoperative anxiety, pain and age. The parents’ anxiety before surgery was influenced by gender and the type of postoperative analgesia in the patients, while, after surgery, this was influenced by the patients’ preoperative anxiety/gender.

Women with breast cancer are prone to moderate to severe preoperative anxiety. Effective measures for preventing and managing preoperative anxiety include drug therapy and non-drug intervention. The main evaluation method is scale assessment, which has certain limitations and may involve human concealment or evaluation errors. In this study, resting-state electroencephalography (EEG) was used to explore changes in power spectrum during the alleviation of preoperative anxiety in breast cancer patients, which is of great significance for objectively identifying and evaluating preoperative anxiety in patients. 40 breast cancer patients were randomly divided into two groups (20 patients per group), receiving either psychological intervention (PI) or intravenous midazolam (MID) before surgery. Visual Analog Scale for Anxiety (VAS-A) and Observer's assessment alert/Sedation (OAA/S) scores, clinical monitoring indexes and EEG data were measured before and after intervention. VAS-A scores significantly decreased in both groups (p < 0.05), the power in the theta band of the frontal parietal regions decreased (p < 0.05) and was positively correlated with VAS-A scores (p < 0.001). Network analysis revealed that the three highest centrality measures in the PI group were located in the alpha band frontal parietal region, frontal central region, and gamma band parietal region, while the OAA/S scores showed the highest centrality for all three measures in the MID group. Both PI and intravenous MID can effectively alleviate preoperative anxiety in breast cancer patients, but their neuroelectrophysiological mechanisms were not entirely the same. Regarding the relationship between brain region power and monitoring indexes, the power of three specific regions in certain frequency bands was the primary factor in the PI group, while the level of sedation was the determining factor in the MID group.

Background: Preoperative anxiety is a common concern among patients undergoing surgery and can negatively influence surgical outcomes. Despite its significant influence, there is a paucity of studies exploring preoperative anxiety in patients from Yemen. Objective: To determine the prevalence, predictors, and role of nonpharmacological interventions in mitigating preoperative anxiety in patients undergoing elective noncardiac surgery. Materials and Methods: A cross-sectional survey was administered to 534 patients who underwent noncardiac surgery using a convenience sampling. Data were collected using the Amsterdam Preoperative Anxiety and Information Scale, anxiety-responsible factors, and Multidimensional Scale of Perceived Social Support from November 1 to December 30, 2023. Results: The study found that 29.8% of patients experienced preoperative anxiety. Significant predictors included low education, prior surgery history, ASA physical status II, information needs, and anxiety-responsible factors (P &lt; 0.05). Path analysis showed a significant direct effect of social support on reducing preoperative anxiety (β = −0.61), and indirectly through its influence on anxiety-responsible factors (β = −0.78) and unmet information needs (β = −0.95). Conversely, increased anxiety-responsible factors and unmet information needs led to increased preoperative anxiety (β =0.16, β =0.24, respectively). Conclusion: This study underscored that preoperative social support and information provision are pivotal in mitigating preoperative anxiety. Therefore, it is imperative for health-care professionals, including nurses, physicians, and anesthetists working in hospitals, to enhance social support and provide comprehensive information related to anesthesia and surgery to patients.

Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (P<0.05). Amsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

To determine the effectiveness of preoperative administration of gabapentin in reduction of acute postoperative pain, morphine consumption and preoperative anxiety and sedation in obese patients undergoing laparoscopic sleeve gastrectomy. Double-blinded randomised control trial. King Khalid University Hospital, King Saud University Riyadh, Saudi Arabia, from July 2014 to January 2017. Fifty patients undergoing sleeve gastrectomy were enrolled in the study. The subjects received either 1200 mg gabapentin or placebo 2 hours before surgery. The amount of morphine consumption and postoperative pain at 4, 8,12,16, 20 and 24 hours of surgery were measured. Preoperative anxiety and sedation were recorded at 2 hours interval after the drug administration. There was no significant difference in patient characteristics in both groups. 24 hours PCA morphine consumption was significantly lower in gabapentin group than in the placebo group, 15.08±4.55 vs. 27.80±2.51 (p=0.001). Preoperative VAS anxiety, pre- verses post-drug, was significantly lower in gabapentin group 5.80±1.11 vs. 3.52±1.00 (p=0.001) than in placebo group 6.08 1.28 vs. 6.28 1.24 (p=0.635). Preoperative sedation score was not different in both groups. Preoperative oral gabapentin was effective in reducing the postoperative pain, morphine consumption and preoperative anxiety in morbid obese patients undergone laparoscopic sleeve gastrectomy.

Factors influencing the preoperative anxiety in lung cancer patients undergoing video-assisted thoracoscopic surgery: The role of information needs, illness perception and patient trust

Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined. To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery. Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018. All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria. Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model. Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery. A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety. This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.

Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity

Purpose: To evaluate the preoperative anxiety in patients undergoing cataract surgery. Patients and Methods: A descriptive cross-sectional study was carried out from July 10, 2024 to August 18, 2024 at the University Hospital Center of the Institute of Tropical Ophthalmology of Africa in Mali. Patients aged 18 and older who likely to understand and answer our questions were included. The Amsterdam Preoperative Anxiety and Information Scale was used to assess preoperative anxiety. Results: A total of 300 patients were included, among whom 161 women and 139 men for a sex-ratio of 0.9. The mean age was 63 ± 12.2 years. The mean preoperative anxiety score was 10.13 ± 4.79 and 42.7% of patients presented a high level of anxiety (score ≥ 11). The mean score related to the need for information was 7.52 ± 2.7 and 62 % of patients presented a high need for information (score &gt; 7). There was a statistically significant association between the high level of anxiety and age, previous surgery and complications. Conclusion: Cataract surgery is often accompanied by anxiety and the patients need information. Preoperative counselling could reduce anxiety and therefore complications.

Introduction: Anxiety has been studied as the common finding in preoperative patients. For the most recent, nursing interventions aim to reduce anxiety were rely on counseling method. This study aims to determine the effectiveness of counseling applied thinking, feeling dan acting (TFA) on the level of anxiety in appendicitis pre-operative patients. Method: This study was a Pre experimental one Group Pre-Test and Post Test Design. An Accidental Sampling, was applied to recruit 34 respondents. Data collection using the Anxiety Questionnaire The-Amsterdam Preoperative Anxiety and Information Scale (APAIS) for pretest before treatment with TFA and Post Test after the TFA approach counseling treatment. Data analysis using Statistical Test Paired Sample T-Test to determine the effectiveness of counseling with the TFA approach on reducing anxiety in appendicitis pre-operative patients. Results: Counseling by approach TFA on the level of anxiety in patients with pre-operation appendicitis with value p=0.000 or p &lt; 0.05 which means it effectively reduces anxiety levels. Counseling applied thinking, feeling, and acting (TFA) effectively reduced the anxiety level of appendicitis pre-operative patients. Conclusions: Counseling with approach TFA on the level of anxiety in preoperative patients with appendicitis. Patients were able to express their feelings properly, have more rational thinking and prioritize useful actions so that anxiety can be reduced or even eliminated. Further studies should provide a comprehensive assessment of mechanisms anxiety realising in appendicitis pre-operative patients.

Pregabalin acts as a membrane stabilizer and has both analgesic and anxiolytic effects. We hypothesized that one pre-operative dose of pregabalin would reduce pre-operative anxiety and post-operative pain in patients undergoing discectomy. We performed a randomized, placebo-controlled study of 150 mg pregabalin administered before lumbar discectomy in general anaesthesia. The primary endpoint was pain at rest [visual analogue scale (VAS)] 120 min after surgery. The secondary outcomes were morphine consumption, pre-operative anxiety (VAS) and the occurrence of side effects. The VAS scores for pain at rest and morphine consumption were higher in the placebo group during the 4-h stay in the post-anaesthetic care unit (PACU), but did not differ significantly 24 h after surgery. Pain scores at 7 days were similar and there was no difference in the occurrence of side effects. Pre-operative anxiety was significantly lower in the pregabalin group (2.23±1.11 vs. 4.17±2.37, 95% confidence interval: 0.82-3.05, P=0.001) and there was a significant positive correlation between the pre-operative anxiety score and post-operative pain at 120 min in the pregabalin group. A single dose of pregabalin (150 mg) reduced post-operative pain at rest and morphine consumption during the PACU period after lumbar discectomy. Pre-operative anxiety was lower, without increased incidence of side effects.

Anxiety disorder is observed in half of the patients in the preoperative period. Psychological disorders are also frequently observed in cancer patients and need to be supported. The aim of the present study is to determine the level of preoperative anxiety in patients with malignant and benign diagnoses who were planned for elective surgery and to reveal its relationship with socio-demographic data. A tertiary hospital-based cross-sectional study was conducted in the general surgery clinic between June 1, 2021- March 31, 2022, on 158 patients who underwent elective surgery. Participants were evaluated in two groups depending on their diagnosis; the cancer group and the benign group. The socio-demographic data were recorded and the level of anxiety was determined by the Beck Anxiety Inventory (BAI). The median age of participants was 55 (19-78) years. There were 72 (45.6%) patients in the cancer group and 86 (54.4%) patients in the benign group. There was no significant difference in age, gender, marital status, job, level of income, and family cancer history between the two groups. There were significant differences between the groups in level of education, and previous surgical history (p=0.035, and p=0.037, respectively). BAI scores of the cancer group and control group were 10.5 (0-35) and 5 (0-49), respectively (p&lt;0.001). The level of anxiety in the cancer group was also significantly higher than in the benign group (p&lt;0.001). Cancer patients have more anxiety during the preoperative period than patients who were with benign diseases. We believe that previous surgical history and education level are other factors that affect anxiety.

Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent craniotomy and investigate the effects on the development of postoperative acute-chronic pain. Materials and Methods: In this prospective, observational study, STAI-I (State-Trait Anxiety Inventory) and STAI-II were used to measure preoperative anxiety levels in a total of 104 patients who underwent craniotomy, and a visual analog score (VAS) was used to determine pain. Demographic data of the patients, ASA (American Society of Anesthesiologists) scores, comorbidities, preoperative and postoperative VAS scores, cause of preoperative anxiety, type, and duration of operation were recorded. Results: The mean values of STAI tests showed that 31.3% of our patients had mild preoperative anxiety, 58.7% had moderate and 10% had severe preoperative anxiety. In the STAI tests we performed before the operation, the mean values were 44 ± 11.2 for STAI-I and 44.5 ± 9.4 for STAI-II. The causes of preoperative anxiety in patients were determined as surgical operation (35.6%), anesthesia applications (17.3%), insufficient information (11.5%), and the possibility of postoperative pain (3.8%). It was observed that 60.6% of our patients had pain in the preoperative period, 51.9% of patients had acute pain in postoperative the 0th minute, 69.2% in 30th minute, 54.8% in 1st hour, 44.2% in 2nd hour, 34.6% in 24th hour, 22.1% in 48th hour, and 51% of patients had chronic pain in postoperative 6th month. We found a significant relationship between STAI-I and VAS scores at the 48th hour and, between STAI-II and VAS scores at the 2nd, 24th hour, and 6th month (p&amp;lt;0.05). Conclusion: It was observed that craniotomy patients mostly had moderate anxiety and moderate to severe pain before the operation, and moderate-severe acute and chronic pain developed after the operation. A significant correlation was found between preoperative anxiety and postoperative pain.

Background: Preoperative anxiety is a prevalent and potentially detrimental factor in the perioperative experience, affecting both patients and the healthcare team. This study aimed to investigate and compare the impact of multimedia and face-to-face education modalities on preoperative anxiety in patients undergoing coronary artery bypass surgery. Methods: This quasi-experimental study was conducted in 1403 in 98 CABG surgery patients. Patients were randomly assigned to two groups: multimedia and face-to-face. The multimedia group received education through an educational film, while the face-to-face group underwent traditional in-person instruction. Preoperative anxiety was assessed at three time points: before the intervention, immediately after the intervention, and one hour before surgery. The Amsterdam Preoperative Anxiety and Information Needs Scale (APAIS) was used to measure anxiety levels. Results: Regarding anxiety scores, no significant correlation was found between the two groups at any of the three time points examined (p &gt; 0.05). Both groups experienced a decrease in average anxiety scores following education. Conclusion: The findings of this study demonstrate that the implementation of theses educational methods, can effectively reduce preoperative anxiety in patients undergoing CABG surgery. By mitigating anxiety, these interventions can enhance patient cooperation with the treatment team, ultimately leading to improved treatment outcomes. Therefore, the utilization of educational strategies is strongly recommended to alleviate preoperative anxiety levels in this patient population

Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions. This randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores. Maximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores. Melatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.