The Effects of Preoperative Anxiety on Intravenous Sedation

In: Health

15 Sep 2009

The Effects of Preoperative Anxiety on Intravenous Sedation

Anxiety describes an unpleasant emotional state or condition. Anxiety states are characterized by subjective feelings of apprehension, nervousness, tension, and worry when subjected to an anxiety-provoking stimulus, such as going to the dentist or oral surgeon. Anxiety-provoking stimuli also cause a neuroendocrine response that contributes to the anxious state. This neuroendocrine response is associated with characteristic hemodynamic and metabolic effects. The neuroendocrine response to an anxiety-provoking stimulus, along with the subjective feelings of anxiety, makes up the anxiety state of the individual.

Anxiety is also used in psychology to describe individual differences in anxiety proneness as a personality trait (trait anxiety). In contrast to the transitory nature of emotional states, personality traits are enduring differences among people in reacting or behaving in a certain way with predictable regularity. State anxiety is defined as the subjective feelings of nervousness, apprehension, and tension when one is subjected to an anxiety-provoking stimulus. The trait anxiety of an individual implies differences between people in the disposition to respond to stressful situations with varying amounts of state anxiety. Therefore, it follows that those individuals with higher trait anxiety should respond with an increased state anxiety in a situation that they perceive as hostile or dangerous, an anxiety-provoking situation. Those people in an anxiety-provoking situation have increased subjective feelings of worry and apprehension, as well as a more dramatic neuroendocrine response to the stimulus. This increased neuroendocrine response results in increased cardiovascular activity and a more altered or activated metabolism. viagra online pharmacy

During surgical procedures, many complications can arise. Intraoperative movement is one of these complications. Spontaneous movement, coughing, and hic-coughs can occur in unparalyzed patients during the most stimulating portion of a surgical procedure. In tooth extraction procedures, the most stimulating portions would be injection of the local anesthetic, drilling, and other surgical stimuli (incising tissue, developing a flap). It has been shown that larger amounts of anesthetic are required to blunt uninvited intraoperative movement, which could increase the time to anesthetic emergence and procedural costs and may result in increased postoperative emesis.

Studies have also examined a relationship between preoperative anxiety and the amount of anesthetic to maintain adequate anesthesia. It has been shown that high baseline anxiety predicts increased intraoperative anesthetic requirements to maintain a clinically sufficient hypnotic component of the anesthetic state. The finding that these patients require more intraoperative anesthetic suggests that the hypnotic state is clinically insufficient, and the patient may be prone to movement. This has been demonstrated in patients undergoing procedures with administration of general anesthesia. In 1996, Ellis was able to assess the relationship between preoperative anxiety and the amount of intraoperative movement of patients under intravenous sedation. The study used a subjective scale to grade the behavioral characteristics of patients while under intravenous sedation and showed that those who were very anxious were much more prone to movement during the procedure. The purpose of the current study is to evaluate the effects of preoperative anxiety on the amount of sedative medication administered and intraoperative movement in patients receiving intravenous sedation for extraction of third molars. levitra plus

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.