Wellness program for anesthesiology residents: a randomized, controlled trial.

BACKGROUND: Multiple reports illustrate the deleterious effects of stress on physicians' mental and physical health, as well as on patient care. This study evaluates the effects of a wellness program on anesthesiology residents' well-being. METHODS: Sixty residents were randomly assigned to one of three groups: (1) wellness intervention group, (2) no-treatment control with release time, and (3) no-treatment control with routine duties. Coping, stressors, social support, psychological symptoms, and alcohol and tobacco use were measured using a pre-test-post-test design. RESULTS: Residents in the wellness program reported significantly fewer stressors in their role as parent, increased social support at work, greater problem-solving coping, and less anxiety as compared with one or both of the control groups. Findings related to reducing avoidance coping and alcohol consumption also were suggestive of positive intervention effects. CONCLUSIONS: An intervention to increase the use of active coping and social support, to reduce reliance on avoidance coping, and to decrease work and family stressors had an overall pattern of beneficial effects on residents' well-being. The importance of offering such programs during residency training, ways to strengthen intervention effectiveness, and areas for future research are discussed.

Analysing a family-centred preoperative intervention programme: a dismantling approach.

BACKGROUND: The goal of this project was to identify key effective components of ADVANCE, a family-centred preoperative intervention programme, through the use of a dismantling approach. ADVANCE was previously demonstrated to be more effective than parental presence and just as effective as midazolam in reducing children's preoperative anxiety. The total programme, however, may be difficult to implement in hospitals across the country. METHODS: Subjects in this follow-up dismantling report were 96 children aged 2-10 who were part of the original study and who underwent anaesthesia and surgery. Baseline characteristics, parental adherence to the components of ADVANCE, and child and parent anxiety were assessed. RESULTS: We found that greater parental adherence to the ADVANCE intervention was associated with lower child anxiety before surgery. The two components of ADVANCE that emerged as having a significant impact on children's anxiety were practising with the anaesthesia mask at home and parental planning and use of distraction in the preoperative holding area. In fact, not only did children experience significantly less preoperative anxiety when their parents were adherent to mask practise and use of distraction, their anxiety tended to remain stable and relatively low throughout the preoperative period. CONCLUSIONS: Shaping and exposure (i.e. practise with the anaesthesia mask) and parental use of distraction in the surgical setting are two beneficial components that could be included in preoperative preparation programmes that will be designed in the future.

Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients.

BACKGROUND: How phenylephrine and ephedrine treatments affect global and regional haemodynamics is of major clinical relevance. Cerebral tissue oxygen saturation (Sct(O2) )-guided management may improve postoperative outcome. The physiological variables responsible for Sct(O2) changes induced by phenylephrine and ephedrine bolus treatment in anaesthetized patients need to be defined. METHODS: A randomized two-treatment cross-over trial was conducted: one bolus dose of phenylephrine (100-200 µg) and one bolus dose of ephedrine (5-20 mg) were given to 29 ASA I-III patients anaesthetized with propofol and remifentanil. , mean arterial pressure (MAP), cardiac output (CO), and other physiological variables were recorded before and after treatments. The associations of changes were analysed using linear-mixed models. RESULTS: The CO decreased significantly after phenylephrine treatment [▵CO = -2.1 (1.4) litre min(-1), P<0.001], but was preserved after ephedrine treatment [▵CO = 0.5 (1.4) litre min(-1), P>0.05]. The was significantly decreased after phenylephrine treatment [▵ = -3.2 (3.0)%, P<0.01] but preserved after ephedrine treatment [▵ = 0.04 (1.9)%, P>0.05]. CO was identified to have the most significant association with (P<0.001). After taking CO into consideration, the other physiological variables, including MAP, were not significantly associated with (P>0.05). CONCLUSIONS: Associated with changes in CO, decreased after phenylephrine treatment, but remained unchanged after ephedrine treatment. The significant correlation between CO and implies a cause-effect relationship between global and regional haemodynamics.

Leptin and the perioperative neuroendocrinological stress response.

The human response to surgical stress is characterized by massive release of neuroendocrine hormones, provoking catabolism, thermogenesis, and hyperglycemia. Considering the possible adverse outcomes of excessive stress hormones, understanding various components of the stress response may improve management of postoperative morbidity. Leptin, initially described as an adipocyte-derived signaling factor, may also play an important role in regulating the hypothalamo-pituitary-adrenocortical axis. In phase I, plasma leptin and cortisol were measured in women before, during, and after total abdominal hysterectomy. The anesthetic technique was strictly controlled, balanced anesthesia. In phase II, plasma leptin and cortisol levels were measured in cardiac surgery patients. These subjects were anesthetized with a high dose opioid technique that blunts the intraoperative surgical stress response. In phase I, mean leptin levels did not change over the week before surgery, had a maximal decrease to 49% of baseline 2 h after surgery, and increased to just above baseline 24 h postoperatively. Cortisol was 176% of the baseline just before surgery, peaked at 2 h after surgery (383%), and remained elevated 24 h (200%) and 48 h (165%) after surgery. During the first 2 h of surgery, the decrease in leptin parallels the increase in cortisol. In phase II, high dose fentanyl limited both the cortisol increase and the leptin decrease; thus, the ratio of cortisol increase to leptin decrease was similar for the cardiac patients and the hysterectomy patients. These data indicate that leptin has a role in the surgically induced acute stress response in humans. Early in surgery the decrease in leptin parallels the increase in cortisol. This suggests a possible relationship between the neurobiology of these two systems, which could have important implications for regulation of the neuroendocrine response to surgical stress.

Preoperative anxiety in children. Predictors and outcomes.

OBJECTIVE: To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery. DESIGN: A prospective, longitudinal study. SETTING: A university children's hospital. PARTICIPANTS: One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery. MAIN OUTCOME MEASURES: In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year). RESULTS: A multiple regression model (R2 = 0.58, F = 6.4, P = .007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R2 = 0.42, F = 8.6, P = .001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems. CONCLUSIONS: Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority.

Preoperative anxiety and postoperative pain in women undergoing hysterectomy. A repeated-measures design.

OBJECTIVES: To determine whether psychological variables such as preoperative anxiety can serve as predictors for the postoperative pain response. METHODS: The study sample included women who underwent elective abdominal hysterectomy (n=53). Two weeks prior to surgery, characteristics such as trait anxiety, coping style, and perceived stress were evaluated. Throughout the perioperative period, state anxiety, pain, as well as analgesic consumption were assessed at multiple time points. The anesthetic and surgical management were carefully controlled for and postoperative pain management was standardized. RESULTS: Path analysis demonstrated that there are both direct and indirect effects of preoperative state anxiety on postoperative pain. Preoperative state anxiety is a significant positive predictor of the immediate postoperative pain (beta=0.30), which, in turn, is a positive predictor of pain on the wards (beta=0.54). Pain on the ward, in turn, is predictive for pain at home (beta=0.30). CONCLUSION: The results of this study indicate that preoperative anxiety may have a critical role in the chain-of-events that controls the postoperative pain response.

Parental presence during induction of anesthesia: the surgeon's perspective.

Parental presence during induction of anesthesia (PPIA) remains controversial and little is known about surgeons' attitudes toward this clinical practice. A questionnaire was mailed to all the United States (US) members of the Surgical Section of the American Academy of Pediatrics and all members of the British Association of Paediatric Surgeons. Questions were asked about attitudes toward PPIA in the operating room and the prevalence of such practice. A total of 275 subjects, constituting 72.4% of the compared groups, responded after three mailings. Sixty percent of the US respondents and 95% of the Great Britain (GB) respondents said they disagree with the statement "parents should never be present during induction of anesthesia". Ninety-two percent of the GB respondents and 69% of the US respondents thought PPIA decreases anxiety (p = 0.001) and increases the cooperation of the child (86% GB, versus 53% US, p = 0.001). Most US respondents (72%) reported that PPIA occurs in less than 25% of their cases, but most GB respondents (80%) reported PPIA in more than 75% of their cases (p = 0.001). These differences in prevalence persisted after logistic-regression models were used to adjust for potential confounding demographic variables. We conclude that the attitudes and practice toward PPIA held by surgeons from the US and GB differ significantly. While a large percentage of the US sample agree that there are benefits in PPIA, only a minority report the routine use of PPIA in contrast to most respondents from GB who report PPIA as routine in their hospital.

Establishment of a pediatric surgery center: increasing anesthetic efficiency.

STUDY OBJECTIVE: To examine whether the establishment of dedicated pediatric operating rooms (ORs) staffed exclusively by pediatric anesthesiologists has had a significant impact on anesthetic efficiency during surgery. STUDY DESIGN: Before and after design. SETTING: General and pediatric operating rooms at Yale-New Haven Hospital. MEASUREMENTS AND MAIN RESULTS: Using Operating Room Information System data (1991 to 1997), we examined whether the anesthesia-controlled time, the time it takes for induction and emergence of anesthesia of a selected surgical procedure (tonsillectomy and adenoidectomy), was affected by the change of practice from general to pediatric ORs. The average length of anesthesia induction decreased by 30% (p = 0.0007). Similarly, the average length of emergence from anesthesia decreased by 42% (p = 0.01) and anesthesia-controlled time decreased by 31% (p = 0.0008). Of particular importance is the decrease by 75% in the anesthesia-controlled time range (maximum-minimum). CONCLUSIONS: The establishment of dedicated pediatric ORs resulted in significantly shorter anesthesia induction and emergence times. Furthermore, the decreased variability of anesthesia-controlled time may allow for better scheduling of surgical cases and for better surgeon and patient satisfaction.

An alternative method to alleviate postoperative nausea and vomiting in children.

STUDY OBJECTIVE: To evaluate whether isopropyl alcohol vapor is an effective treatment for postoperative nausea and vomiting. DESIGN: Double-blind, randomized, controlled study. SETTING: Pediatric surgery center. PATIENTS: 91 ASA physical status I and II children age 6-16 years, scheduled to undergo general anesthesia and elective outpatient surgery. INTERVENTIONS: Subjects were randomized to inhale isopropyl alcohol or saline. The intervention was repeated up to three times. If postoperative nausea or vomiting persisted after three sequences, intravenous ondansetron was administered as rescue therapy. MEASUREMENTS AND MAIN RESULTS: Improvement in nausea was assessed using a visual analog scale, and improvement in vomiting was assessed using categorical analysis. After three treatment sequences, 65% of the children in the treatment group and 26% of the children in the control group had a significant reduction in the severity of either nausea or vomiting (p = 0.03). However, 54% of subjects in the treatment group and 80% of subjects in the control group had recurrent nausea or vomiting within 20 to 60 minutes. CONCLUSIONS: Under the conditions of this study, repetitive inhaled isopropyl alcohol only achieved a transient antiemetic effect in children with established postoperative nausea or vomiting following general anesthesia and surgery.

Management of tracheobronchial and esophageal foreign bodies in children: a survey study.

STUDY OBJECTIVE: To assess the current anesthetic management for aspiration of a foreign body into the airway and esophagus of a young child. DESIGN: Questionnaire study. MEASUREMENTS AND MAIN RESULTS: A questionnaire regarding choice of induction technique in a variety of foreign body clinical scenarios was sent to 1,342 anesthesiologists, all members of the Society for Pediatric Anesthesia. The foreign body, either a coin (penny) or a safety pin (open), was positioned on radiography in a variety of anatomic locations. Depending on the foreign body location, the patient was either asymptomatic or exhibited symptoms. Participants indicated their choice of induction for each situation. Of the 1,342 questionnaires mailed, there were 838 respondents (62.4%). Coins and pins in the gastroesophageal tract were managed mostly by a rapid-sequence induction (p < 0.001). Coins and pins at all levels in the tracheobronchial tree were managed most often by a mask induction with no cricoid pressure (p < 0.001). Although 14.5% of respondents chose awake and sedated technique for a foreign body in the supraglottic area, few chose this technique for a foreign body in other locations. The type of object did not affect the choice of drugs for induction of anesthesia in most anatomic locations. Respondents with limited pediatric anesthesia experience used inhalation induction much less often than did those with more experience. Multiple-logistic regression analysis showed that both number of years in practice and type of practice (university, private, hybrid) were predictors for the induction. CONCLUSIONS: These data indicate that inhalation induction is favored most often for removal of foreign bodies in the airway, while intravenous induction is preferred for removal of foreign bodies in the gastroesophageal tract. In addition, practice type, greater percentage of time spent in pediatric anesthesia, and greater experience are related to a higher likelihood of inhalation induction.

Preoperative preparation in children: a cross-sectional study.

STUDY OBJECTIVE: To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery. DESIGN: Cross-sectional study. SETTING: A children's hospital. PATIENTS: 143 children undergoing outpatient surgery, and their parents. INTERVENTIONS: A behavioral preoperative preparation program. MEASUREMENTS AND RESULTS: Overall anxiety in children and their parents did not differ significantly between the group that received the preoperative program and the group that did not (p = NS). Children older than 6 years were least anxious on separation from their parents if they participated in the preparation program more than 5 to 7 days prior to surgery, moderately anxious if they did not receive preparation, and most anxious if they received the preparation 1 day prior to surgery (P = 0.04). Multivariable regression analysis (for overall model, F = 2.14, p = 0.02) revealed that although the preparation program itself was not a predictor of a child's behavior on separation to the operating room, the interaction between child's age and timing of the program (p = 0.003), and child's previous hospitalization were predictors of children's anxiety response. Similarly, in the preoperative holding area, independent predictors of anxiety included timing of the preparation program, age of child, and the child's baseline temperament characteristics. CONCLUSIONS: The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.

Anesthetic management of children with neuroblastoma.

STUDY OBJECTIVE: To review the 11-year anesthetic experience with neuroblastoma at Children's Hospital Medical Center, Boston, MA. DESIGN: Retrospective study. SETTING: Children's Hospital, Boston, MA. PATIENTS: 59 consecutive children with neuroblastomas who underwent surgical procedures between 1977 and 1989. INTERVENTIONS: Symptoms, physical findings, laboratory data, and results of echocardiographic examination were recorded. Type of chemotherapy and urine catecholamine levels were noted. Intraoperative information was extracted about the surgical procedure, anesthetic technique, blood loss, and intraoperative vital sign changes. Postoperative data were reviewed for complications. MEASUREMENTS AND MAIN RESULTS: 18 patients presented with a posterior mediastinal tumor. Five children presented with stridor, wheezing, pneumonia, and pleural effusion. Two children presented with hypertension. Left ventricular ejection fraction was within normal limits preoperatively in all patients evaluated by echocardiography. Intraoperative hypertension and tachycardia occurred in 3.5% of the children during tumor manipulation. No hypotension was noted following tumor removal. Of the 18 patients presenting with a posterior mediastinal mass, 3 had tracheal deviation caused by the tumor. The intraoperative course and extubation were uneventful in 2 of the patients, and the other patient remained intubated postoperatively. No adverse effect was identified for any particular anesthetic drug or technique used. CONCLUSIONS: Although neuroblastomas may be associated with hypertension upon presentation, intraoperative hypertension is rare. Tracheal compression and deviation were noted in 5.2% of patients with posterior mediastinal masses; however, airway complications did not occur. No specific optimal anesthetic regimen can be recommended.

Effect of peripheral perfusion on accuracy of pulse oximetry in children.

STUDY OBJECTIVE: To examine the effect of perfusion on accuracy of two pulse oximeters in children and to determine thresholds of perfusion below which these pulse oximeters become inaccurate or cease to function. DESIGN: Prospective, observational clinical study. SETTING: Operating room of a large university hospital. PATIENTS: 19 children 10 years of age or less, who were scheduled for general anesthesia with placement of an intraarterial catheter. INTERVENTIONS: A radial artery catheter, laser Doppler probe, skin temperature sensor, and band probes of two oximeters, Ohmeda 3700 (Boulder, CO) and Nellcor N200 (Hayward, CA), were attached to the same hand. Baseline pulse oximeter and Doppler readings were obtained with simultaneous hemoximetry (AVL Model 912 CO-Oxylite, Roswell, GA), skin and esophageal temperatures, total hemoglobin, and transduced arterial pressure. Readings of all parameters (n = 94) were obtained during periods of low perfusion or by occluding the upper arm to 70% to 100% of systolic pressure. MEASUREMENTS AND MAIN RESULTS: Bias (SpO2-SaO2) of each oximeter is compared to each perfusion variable (age, weight, core and skin temperature, hemoglobin concentration, pulse pressure, and percent flow by laser Doppler) to determine effect on accuracy. Data were analyzed using backward multivariate linear regression, Pearson correlation coefficients, and independent paired t-test. p < 0.05 was considered significant. Less than 2% bias is seen with either oximeter (Nellcor 1.55 +/- 2.33, Ohmeda 0.78 +/- 2.25). Independent predictors of bias for each machine include weight (r = -0.376; p < 0.001) and pulse pressure (r = 0.250; p = 0.021) for the Nellcor, and weight (r = -0.390; p < 0.001), percent flow by Doppler (r = 0.220; p = 0.035), and core temperature (r = 0.307; p = 0.003) for the Ohmeda. However, using predetermined thresholds for each variable, only skin temperature below 30 degrees C is identified as a significant predictor of oximeter inaccuracy. CONCLUSIONS: At the parameters explored in this study, the selected seven perfusion variables (age, weight, core and skin temperature, hemoglobin concentration, pulse pressure, and percent flow by laser Doppler) have little effect on accuracy of pulse oximetry in children.

Social adaptability, cognitive abilities, and other predictors for children's reactions to surgery.

STUDY OBJECTIVE: To examine the relationship between social adaptability, cognitive abilities, and other personality characteristics to perioperative anxiety. STUDY DESIGN: Prospective cohort investigation. PATIENTS: 60 children ASA physical status I and II, age 3 to 10 years. SETTING: Tertiary care children's hospital. MEASUREMENTS: Temperament (EASI), cognitive abilities (KABC), and adaptive behavior (Vineland) were evaluated in a group of children undergoing surgery. Parental coping style (MBBS) and parental state (STAI-S) and trait (STAI-T) anxiety were assessed as well. On the day of surgery, anxiety of the child was measured at the preoperative holding area and during induction of anesthesia (m-YPAS). MAIN RESULTS: Univariate correlational analysis demonstrated that young age (r = -0.27), poor social adaptability (Vineland) (r = -0.38), shy and inhibited personality (EASI; temperament) (r = -0.33), higher intelligence (KABC) (r = 0.29), increased parental anxiety (r = 0.44), and parental high-monitoring coping style (r = -0.25) are all associated with higher levels of perioperative anxiety. Stepwise multivariate regression analysis has demonstrated that controlling for the variables above, parental anxiety (p = 0.004), child's social adaptive capabilities (p = 0.04), and child's temperament (sociability) (p = 0.04) are independent predictors for increased perioperative anxiety (R(2) = 0.38, F = 5.5, p = 0.003). CONCLUSIONS: Anesthesiologists need to pay close attention to the families of pediatric surgical children who are socially maladjusted, shy and inhibited, and have anxious parents.

Desire for perioperative information in adult patients: a cross-sectional study.

STUDY OBJECTIVE: To identify which perioperative information outpatients want from their anesthesiologist. DESIGN: Cross-sectional study. SETTING: Outpatient center. PATIENTS: 197 ASA physical status I and II patients undergoing outpatient surgery. INTERVENTIONS: A questionnaire examining for "desire for information". MEASUREMENTS AND MAIN RESULTS: Demographic data including age, ethnicity, gender, socioeconomic status, and history of previous surgery were obtained. Trait, situational anxiety, and coping strategy were assessed using a validated behavioral instrument and a questionnaire adopted from previous studies conducted in Australia, Scotland, and Canada. Each questionnaire contained 14 statements regarding specific perioperative details. An index of the overall patient desire for information (PDI) was calculated for each subject. More than 85% of subjects gave a high priority to being informed for all the 14 items. Scores on the overall index were found to be higher for females than for males (32 +/- 6 vs. 30 +/- 6; p = 0.03), and this finding persisted in a multivariable model that also included coping strategies and anxiety (DF = 1,175, F = 4.6, p = 0.01). Subjects also had higher PDI scores if a first degree relative had a history of previous surgery (33 +/- 5 vs. 31 +/- 6; p = 0.007). On analysis of individual questionnaire items, Latino Americans were significantly less likely than European Americans or African Americans to desire perioperative information (p < 0.05). Similarly, females had a significantly higher desire for information than males. Subjects who were divorced demonstrated a higher desire for information than did single or married subjects. CONCLUSIONS: Ethnicity, gender, coping mechanism, marital status, and a history of previous surgery in a relative have been identified as predictors for the desire for information.

Premedication and parental presence revisited.

Up to 60% of all children undergoing anesthesia and surgery experience significant anxiety and distress during the perioperative period. Currently, both behavioral interventions such as parental presence during induction of anesthesia and pharmacological interventions such as sedative premedication are used to treat this clinical phenomenon. In this review, we examine the effectiveness of these interventions on clinically relevant perioperative outcomes.

Preoperative anxiety and postoperative nausea and vomiting in children: is there an association?

UNLABELLED: We performed a cross-sectional study to explore a potential association between preoperative anxiety and postoperative nausea and vomiting (PONV). The study enrolled 51 unpremedicated children 5-16 yr old undergoing outpatient surgery and standardized general anesthesia. Anxiety of children was assessed in the preoperative holding area and during the induction of anesthesia. The incidence of nausea and vomiting was documented in the postanesthesia care unit (PACU) and 24 h postoperatively (POD#1). In addition to univariate analysis, we used multivariate logistic regression models, wherein the dependent variable was the presence or absence of PONV and the independent variables included potential confounders such as age, sex, and perioperative opioid consumption. Univariate analysis showed that children who experienced nausea (32 +/- 5 vs 31 +/- 4, P = ns) or vomiting (32 +/- 4 vs 32 +/- 5, P = ns) in the PACU did not differ significantly in their anxiety before surgery. A multivariate model, in which the dependent variable was the presence or absence of vomiting at POD#1 and the independent variables included preoperative anxiety, age, sex, and opioid consumption, indicated that preoperative anxiety does not predict the occurrence of nausea and vomiting (P = ns). We conclude that children's anxiety in the preoperative holding area has no predictive value for the occurrence of PONV in the PACU or POD#1. IMPLICATIONS: This study was performed to explore a possible association between children's anxiety before surgery and postoperative nausea and vomiting. We found that controlling for confounding variables, anxiety in the preoperative holding area has no predictive value for the occurrence of postoperative nausea and vomiting.

Preoperative anxiety and intraoperative anesthetic requirements.

UNLABELLED: 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. IMPLICATIONS: 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.