May 21, 2010

Patients Have Misconceptions And Anxiety About General Anesthesia

1 in 5 are very anxious about waking up during surgery

Eight-five percent of patients who took part in a survey shortly after day surgery said that they had been anxious about receiving a general anesthetic, according to research in the May issue of the Journal of Advanced Nursing.

Seventeen percent of respondents said they were very or extremely anxious, 22 percent said they were quite anxious, 46 percent said they were a little anxious and 15 percent experienced no anxiety at all.

Key concerns included dying while asleep, not waking up after surgery, waking up during surgery and anxiety while waiting to go into surgery or arriving at the theatre door.

"Our survey underlines the importance of patients receiving planned and timely information about anesthesia, prior to the day of surgery, in order to limit their anxiety" says Dr Mark Mitchell, senior lecturer in the Faculty of Health and Social Care at the University of Salford, UK.

"This should include information about how anesthesia is managed, the notion of carefully controlled and supervised anesthesia and dispelling misconceptions associated with general anesthesia."

Patients scheduled for elective surgery in three day surgery units in England were invited to take part in the survey and 460 patients "“ a response rate of 37 percent "“ completed the questionnaire within 24 to 48 hours of surgery.

The patients who took part were aged between 18 and 75, with an average age of 46, and 59 percent were female. The majority had undergone gynecological, general, orthopaedic, urological and ear, nose and throat surgery.

Patients were asked to indicate their anxiety levels about 24 different issues. This showed that:

* The top three concerns that made patients very anxious were the thought of not waking up (26 percent), dying while asleep (25 percent) and waking up during surgery (20 percent).

* When the researchers combined all the patients who were anxious, the top five concerns were: waiting for their turn in theatre (59 percent), the thought of arriving at the theatre door (56 percent), dying while asleep or not waking up afterwards (both 48 percent) and waking up during surgery (46 percent).

* Forty-one percent said that they didn't like the thought of having to put their trust in strangers and 12 percent felt very anxious about this.

* Anxiety levels were lowest when it came to interactions with medical staff and the support of a partner or friend. Thirty percent felt very calm about the anesthetist explaining the procedure, 28 percent about the anesthetist visiting and 17 percent about the nurse explaining the procedure. Twenty-six percent felt very calm about having a friend or partner with them during recovery.

"Undergoing day surgery and general anesthesia is very common" says Dr Mitchell. "The development of less invasive techniques means that the surgical effects on the body are now markedly reduced and, as a direct consequence, the amount of physical nursing care required before and after surgery is also considerable reduced.

"However, while patients need less physical nursing care, our survey shows that more attention needs to be paid to the psychological aspects of their care.

"The formal and timely provision of information about the planned surgery - together with a patient-centered approach to the provision of information, such as pre-assessment clinics - are vital first steps.

"It is clear from our study that many patients do not know how the anesthesia process works and that this has led to misconceptions about, for example, waking up during surgery. It is vital to tackle these misconceptions if we are to reduce patient anxiety before day surgery."

Reference: General anesthesia and day-case patient anxiety. Mitchell et al. 66.5, pp 1059-1071. Journal of Advanced Nursing. (May 2010). DOI: 10.1111/j.1365-2648.2010.05266.x


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