Preoperative anxiety in patients undergoing various surgical procedures which imposed stress and un-satisfaction which resulted later to altered neurological as well as endocrinological issues and various complications during surgery.¹

In general, anxiety is defined as uneasiness of emotions which impacted on patient's hemodynamic parameters. It is most commonly observed in patients undergoing surgery which later on resulted in an increased need for anesthetic drugs.²

According to various studies found in the literature, approximate 50% of patients undergoing elective surgery reported preoperative anxiety which is ranged from 62% to 97%.³ It is mainly caused by different reasons i.e. smoking, preexisting mental disorders, fear of postoperative pain, and surgical outcome expectations. It is very difficult to assessing anxiety level because it influences how patients react to anesthetic and analgesic drugs, as well as their recovery from anesthesia and postoperative results.

A study done by Abate et al reported worldwide prevalence of preoperative anxiety 48% along with 56% preoperative anxiety in African and 54% preoperative anxiety in Asian populations.⁴

It is found that patients who had a knowledge and good understanding of the surgery and anaesthesia had higher levels of education reported to be less anxiety level.⁵ It has also seen in some studies that atmosphere of hospital / healthcare institution & behaviour of medical/paramedical staff also  plays a key role in reducing the anxiety level of the patients and caregivers.⁶ To assess anxiety levels, a variety of procedures found to be used, including measuring urine tests e.g. urinary catecholamine and plasma cortisol levels, as well as continuous monitoring of heart rate, pulse rate and blood pressure measurements.⁷ The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a widely used and validated preoperative anxiety assessment measure available in several languages.^8,9

Keeping in view the above mentioned facts, the present study was conducted in our hospital to assess the anxiety level changes and awareness about various anesthetic techniques and surgical procedures followed by prevalence and various contributing factors of preoperative anxiety levels among patients who underwent elective as well as emergency surgery

AIMS AND OBJECTIVES

1. To assess the anxiety level changes and awareness about various anesthetic techniques and surgical procedures.
2. To assess the prevalence and contributing factors of preoperative anxiety levels among patients who underwent elective as well as emergency surgery

The present study was conducted in the Department of Anaesthesiology and Critical Care World College of Medical Sciences & Research Hospital, Girawar, Jhajjar, Haryana (India) during 15th January 2025 to 15th March 2025. A total of 50 patients were enrolled in this study. To enroll the patients into the study, consecutive sampling method was used and informed written consent was obtained before inclusion into the study. All the patients were explained about the study protocol in their local language. Patients irrespective of gender from 18 to 60 years were included in the study were classified according to American Society of Anaesthesiologists (ASA) grade I-III. The data were further divided into three categories i.e. anxiety level related to anesthesia, related to surgery and if patient demanded any additional information.

Inclusion criteria

1. Age between 18-60 years
2. Willing for informed written consent

Exclusion criteria

1. Age less than 18 and more than 60 years
2. Not willing for written consent
3. Any cardiovascular disease or comorbid illness
4. Any psychiatric illness
5. Patients having central nervous system problem

Methodology

Individual patient was asked to read carefully the APAIS questionnaire which consisted a total of six questions and these were further translated into their local language.

1. I am worried about the anesthesia
2. The anesthesia is on my mind continually
3. I would like to know as much as possible about the anesthesia
4. I am worried about the procedure
5. The procedure is on my mind continually
6. I would like to know as much as possible about the procedure.

The measurement of agreement related to these statements was divided according to 5-point Likert scale i.e. from 1 which means not at all to 5 i.e. extremely.

The patients were then asked to put a √ mark as and where appropriate and to ask to sign the consent form (provided both English as well as Hindi). Patients were not counselled in any way during this procedure. The patients received drugs (i) oral alprazolam 0.25 mg & (ii) ranitidine 150 mg on previous night before the surgery.

Final outcome:

1. Anesthesia-related anxiety
2. Surgery-related anxiety

• Any additional need for further information

Additional, in the present study, The State-Trait Anxiety Inventory (STAI)^10,11, a well known tool most commonly used worldwide and accepted as “gold standard” was also used to know the anxiety level.

State Trait Anxiety Inventory

Statistical analysis

At the end of the study, the data was collected and analysed statistically by using descriptive statistics. Data was presented as Mean±SD, frequencies and percentages.

The present study was conducted in the Department of Anaesthesiology and Critical Care World College of Medical Sciences & Research Hospital, Girawar, Jhajjar, Haryana (India) during 15^th January 2025 to 15^th March 2025. A total of 50 patients were enrolled in this study.

Table 1 Demographic profile

Table 1 shows that in the present study, out of 50 patients, male were outnumbered as compared to female i.e. 28(56%) were male and 22(44%) were female. Maximum number of patients were in the age range of 31-40 years i.e. 20(40%) i.e. in younger age group. In elderly age group, only 2(4%) patients observed. Mean age of the patients was 42.14±12.16. Maximum number of patients belonged to rural areas i.e.  37(74%). With regard to their socioeconomic status, majority of patients belonged to middle class i.e. 28(56%). In 36(72%) patients previous history of surgery was observed out of which 31(62%) underwent anaesthesia  during surgery for 1 or more surgeries and 5(10%) had not experienced anaesthesia. Maximum patients were found to be literature. In 38(76%) patients, elective surgery was performed.

Table 2 Distribution of patients according to anxiety categories

Table 2 depicts that 22(44%) experienced anaesthesia related anxiety, 18(36%) had surgery related anxiety and 10(20%) demanded additional information.

Table 3 Distribution of patients as per awareness

In the present study, out of 50 patients, 34(68%) were aware about elective surgery and 16(32%) had knowledge about emergency  surgery (Table 3).

Table 4 Type of surgery

Table 4 demonstrated different type of surgeries performed in the present study. Maximum number of patients underwent orthopaedics surgery, general surgery, obstetrics and gynaecology surgery i.e. 18(36%), 15(30%) and 13(26%), respectively. Only 2(4%) patients underwent ophthalmology surgery.

Table 5 Anxiety level according to gender

As shown in table 5, present study observed that female had more anxiety level as compared to male i.e. 38% vs. 32%, respectively.

The present study focused a very crucial area in anesthesiology to identify the anxiety level preoperatively that patients encountered. It is commonly seen that in routine practice, anxiety level is not observed before surgery regularly. Use of high dose of different medications also caused various complications viz. anxiety, worry followed by morbidity and death. Although, it is not possible to define the anxiety level   in general way, but its importance cannot be ruled out. During literature search, we found various questionnaires related to anxiety level to assess preoperatively, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was found to be most commonly used tool with highly satisfactory parameters and validation followed by another questionnaire i.e. State-Trait Anxiety Inventory Form (STAI).

Caumo et al¹² in the year 2001 reported a relationship between surgery type and preoperative anxiety level and found that anxiety scores higher with surgical interventions which further resulted to organs loss.

Lim et al¹³ (2020) in their study reported higher percentage of female for perioperative anxiety which is comparable to the present study.

In the present study, we concluded that females and patients who underwent first-time surgery in their life had more anxiety as compared to male and patients already experienced surgery one or more, respectively. Females also experienced anxiety due to some psychological as well as biological factors. Present study also concluded that it is very important for the Anaesthesiologists to determine the anxiety levels of patients preoperatively to prevent various complications associated with the surgical procedures. We recommend that it is very important for the anaesthesiologist to observe preparation of patients preoperatively, counselling the patients to reduce their anxiety followed by perioperative outcomes. So, therefore, anesthesiologists should play a crucial role specially in female patients and patients suffering from some type of psychiatric illnesses.

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