Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery

• Published in: British journal of anaesthesia : BJA Vol. 109; no. 6; pp. 943 - 949
• Main Authors: Orbach-Zinger, S., Ginosar, Y., Elliston, J., Fadon, C., Abu-Lil, M., Raz, A., Goshen-Gottstein, Y., Eidelman, L.A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-12-2012; Oxford University Press
• Subjects: Adult; Amylases - metabolism; anaesthesia; Analysis of Variance; Anesthesia; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - administration & dosage; Anesthetics, Local - administration & dosage; anxiety; Anxiety - complications; Anxiety - metabolism; Anxiety - psychology; Biological and medical sciences; bupivacaine; Bupivacaine - administration & dosage; Caesarean delivery; Cesarean Section - psychology; complications, hypotension; Elective Surgical Procedures - psychology; Ephedrine - therapeutic use; Female; Fentanyl - administration & dosage; Humans; Hypotension - complications; Hypotension - drug therapy; Hypotension - psychology; intrathecal; Medical sciences; Middle Aged; Phenylephrine - therapeutic use; Pregnancy; Preoperative Period; Prospective Studies; Psychiatric Status Rating Scales - statistics & numerical data; Severity of Illness Index; spinal; Vasoconstrictor Agents - therapeutic use; Young Adult; intrathecal; anxiety; bupivacaine; Caesarean delivery; spinal; complications, hypotension; anaesthesia; Human; hypotension; complications; Local anesthetic; Bupivacaine; Carboxamide; Anesthesia; Complication; Organic amide; Anxiety; Preoperative; Anilide; Cesarean section
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aes313

We designed a prospective observational study to assess the effect of preoperative anxiety on hypotension after spinal anaesthesia.
After IRB approval and signed informed consent, 100 healthy term parturients undergoing elective Caesarean delivery under spinal anaesthesia were enrolled. Direct psychological assessments of preoperative anxiety were verbal analogue scale (VAS) (0–10) anxiety score and State-Trait Anxiety Inventory questionnaire (STAI-s); salivary amylase was measured as an indirect physical assessment of anxiety. Direct and indirect anxiety data were transformed into ordinal groups for low, medium, and high anxiety (VAS: low 0–3, medium 4–6, high 7–10; STAI-s: low <40, medium 40–55, high >55; log10 salivary amylase: low <3, medium 3–4, high >4). Spinal anaesthesia was performed using hyperbaric bupivacaine 10 mg and fentanyl 20 μg. All patients received i.v. crystalloid 500 ml prehydration and 500 ml cohydration. Hypotension was treated by standardized protocol (fluid bolus and ephedrine or phenylephrine depending on maternal heart rate). Systolic arterial pressure (SAP) was measured at baseline and every minute after spinal anaesthesia. The effect of low, medium, and high anxiety groups on the maximum percentage change in SAP (%ΔSAP) was assessed (one-way analysis of variance, Tukey’s honestly significant difference).
Ninety-three patients were included in analysis. There was a significant effect of direct psychological measures of anxiety on %ΔSAP (VAS P=0.004; STAI-s P=0.048). There was a significant difference between low and high anxiety groups (VAS P=0.003; STAI-s P=0.038), but not between other anxiety groups. Salivary amylase did not correlate with %ΔSAP.
Preoperative anxiety assessed by VAS had a significant effect on hypotension after spinal anaesthesia.