title: Preoperative anxiety and intraoperative anesthetic requirements.
abstract: The purpose of this study was to determine whether larger doses of anesthetics are required in the anxious patient to establish and maintain a clinically sufficient hypnotic component of the anesthetic state. Fifty-seven women undergoing bilateral laparoscopic tubal ligation with a propofol-based anesthetic regimen were enrolled in this cross-sectional study. Trait (baseline) and state (situational) anxiety were assessed in all patients immediately before surgery, and the propofol doses required for the induction and maintenance of anesthesia were recorded. A bispectral index monitor was used to assure that the hypnotic component of the anesthetic state was the same in all patients. We found that patients with high trait anxiety required more propofol for both the induction (2.1+/-0.4 vs 1.8+/-0.3 mg/kg; P = 0.01) and maintenance of anesthesia (170+/-70 vs 110+/-20 microg x kg(-1) x min(-1); P = 0.02), compared with patients with low trait anxiety. State anxiety, however, was not found to affect the propofol doses required for the induction or maintenance of anesthesia. Multiple regression models confirmed that Trait anxiety is an independent predictor for intraoperative propofol requirements (P = 0.02). We conclude that increased baseline (i.e., trait) anxiety is associated with increased intraoperative anesthetic requirements. Thus, we suggest that the initial dose of anesthetic administered by an anesthesiologist should be modified based on the anxiety level exhibited by the patient.
  
  
  CONCLUSIONS
  The goal of this study was to assess the relationship between preoperative anxiety and intraoperative anesthetic requirements. We found that high baseline anxiety predicts increased intraoperative anesthetic requirements. We suggest that anesthesiologists should modify the initial induction dose based on the anxiety level exhibited by the patient.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine and Yale-New Haven Hospital, Connecticut 06510, USA.
authors.forename: I
authors.initials: I
authors.lastname: Maranets
authors.forename: Z N
authors.initials: ZN
authors.lastname: Kain
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001007:Anxiety / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D015742:Propofol / Q000008:administration & dosage*; D012044:Regression Analysis; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000379:methods
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015742:Propofol