The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

The purpose of the present study was to assess patients' anxiety level and information requirement in the preoperative phase. During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Two hundred patients also completed Spielberger's State-Trait Anxiety Inventory (STAI-State). Patients were able to complete the questionnaire in less than 2 min. On factor analysis, two factors emerged clearly: anxiety and the need for information. The anxiety scale correlated highly (0.74) with the STAI-State. It emerged that 32% of the patients could be considered as "anxiety cases" and over 80% of patients have a positive attitude toward receiving information. Moreover, results demonstrated that 1) women were more anxious that men; 2) patients with a high information requirement also had a high level of anxiety; 3) patients who had never undergone an operation had a higher information requirement than those who had. The APAIS can provide anesthesiologists with a valid, reliable, and easily applicable instrument for assessing the level of patients' preoperative anxiety and the need for information.

Awareness and recall during general anesthesia. Facts and feelings.

BACKGROUND: Experiences of awareness and recall during general anesthesia can be most distressing for patients. To obtain relevant information, the authors systematically interviewed patients in whom awareness during surgery had occurred, and questioned them about their experiences. METHODS: Twenty-six patients, referred by colleagues, described the facts and feelings they had experienced during the period of awareness, and whether these had had any consequences. Available anesthetic records were independently judged by three experienced anesthesiologists for relevant parameters. RESULTS: Auditory perception and the sensation of paralysis were most frequently mentioned, followed by the sensation of pain. Patients' feelings were mostly related to anxiety, panic, powerlessness, and helplessness. Eighteen patients (70%) experienced unpleasant aftereffects, including sleep disturbances, dreams and nightmares, and flashbacks and anxiety during the day. Only nine patients (35%) had informed their anesthesiologists about what had taken place. Twelve anesthetic records were assessed. In three, the occurrence of awareness had been indicated, while, in a fourth, it was noted that an amnesic drug had been given at a moment of increased blood pressure. Experienced anesthesiologists were unable to reliably distinguish awareness cases from matched controls when judging the records. CONCLUSIONS: Details recalled from the period of awareness correspond with data from the literature. The anesthesiologist's role in discussing, and dealing with, traumatic experiences related to anesthesia may be of great importance. The hand-written anesthetic record is of limited value in retrospectively explaining why awareness and recall have occurred.

Recollections of general anaesthesia: a survey of anaesthesiological practice.

In order to identify the factors to which patients attach importance when undergoing general anaesthesia, 678 patients were retrospectively asked about their recollections of previous anaesthetics during routine preoperative screening over a period of 14 months. The most frequently mentioned recollections concerned the post-anaesthetic period, followed by recollections of the induction of anaesthesia. From the post-anaesthetic period, nausea/vomiting and drowsiness were most often cited. The number of anaesthetics previously undergone had no influence on the reports of the two most frequently mentioned complaints. The rate of nausea/vomiting in this series was 21.0%. The number of patients reporting nausea/vomiting following an anaesthetic has not changed over the years. The last 250 patients were asked to assess the quality of their anaesthetics on a 5-point scale. More than a quarter of the patients were not satisfied with the anaesthesia. No correlation was found between the assessment of the anaesthesia and complaints about nausea/vomiting and drowsiness. The possible role of psychological factors in the origin of complaints about anaesthesia is discussed.

A broken epidural catheter. Case report.

A case is reported of a broken epidural catheter. The importance of the flexed position of the patient's back during the removal of the catheter is discussed.