Relationship between patients’ pre-operative anxiety level and administration of anxiolytic premedication

Objective: To evaluate the relationship between the patient’s reported level of pre-operative anxiety, the anaesthesiologist’s assessment of the patients’ anxiety level and the administration of anxiolytic premedication in the immediate pre-operative period. Methods: Patients' pre-operative anxiety level was self-assessed using a simple visual analog scale (0 = no anxiety to 10 = severe anxiety) in the pre-operative holding area. The anaesthesiologist independently visually assessed the patient’s level of anxiety on a similar 0 to 10 anxiety rating scale at the time of their pre-operative interview. Immediately after this, the anaesthesiologist decided whether to administer an anxiolytic medication prior to the patient entering the operating room. Results: Based on the anxiety scores reported by patients on the numeric analog scale, 58% (n=171) reported no-to-low levels of anxiety (scores ≤3) and 42% (n=122) reported moderate-to-high levels of anxiety (scores ≥4). According to the observational assessment by the anaesthesiologists, 70% of the patients were assigned an anxiety score ≤3 and 30% were assigned an anxiety score ≥4. Overall, 188 out of the 293 patients (64%) received a parenteral anxiolytic premedication. However, only 50% (61/122) of the patients reporting moderate-to-high levels of anxiety received an anxiolytic medication prior to entering the operating room. Surprisingly, 74% (127/171) of the patients reporting little or no anxiety were administered an anxiolytic drug. Interestingly, there was no significant difference in the average anxiety scores of patients who did or did not receive anxiolytic premedication (3.6±2.6 vs. 3.0±2.2, p= 0.11). Conclusions: These data suggest there is poor correlation between the patient’s reported level of pre-operative anxiety and the administration of anxiolytic medication. A more targeted approach to administering anxiolytic premedication based on the patient’s self-reported anxiety level in the pre-operative holding area would lead to more rationale use of anxiolytic medication prior to the patient entering the operating room.