Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors.

BACKGROUND: Preoperative anxiety comprising anesthesia and surgery related anxiety is common and perceived by many patients as the worst aspect of the surgical episode. The aim of this study was to identify independent predictors of these three anxieties dimensions and to quantify the relevance of specific fears particularly associated with anesthesia. METHODS: This study was part of a cross-sectional survey in patients scheduled to undergo elective surgery. Anxiety levels were measured with the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Modified numeric rating scales (mNRS, range 0-10) were used to assess the severity of eight selected specific fears which were predominantly analyzed descriptively. Multivariate stepwise linear regression was applied to determine independent predictors of all three anxiety dimensions (APAIS anxiety subscales). RESULTS: 3087 of the 3200 enrolled patients were analyzed. Mean (SD) total preoperative anxiety (APAIS-A-T, range 4-20) was 9.9 (3.6). High anxiety (APAIS-A-T > 10) was reported by 40.5% of subjects. Mean (SD) levels of concern regarding the eight studied specific fears ranged from 3.9 (3.08) concerning "Anesthesiologist error" to 2.4 (2.29) concerning "Fatigue and drowsiness" with an average of 3.2 (2.84) concerning all specific fears. Ranking of all specific fears according to mean mNRS scores was almost identical in patients with high versus those with low anxiety. Among nine independent predictors of anxiety, only 3 variables (female gender, negative and positive anesthetic experience) independently predicted all three APAIS anxiety subscales. Other variables had a selective impact on one or two APAIS anxiety subscales only. Female gender had the strongest impact on all three APAIS anxiety subscales. Adjusted r2 values of the three models were all below 13%. CONCLUSIONS: The high variability of importance assigned to all specific fears suggests an individualized approach is advisable when support of anxious patients is intended. Considering independent predictors of anxiety to estimate each patient's anxiety level is of limited use given the very low predictive capacity of all three models. The clinical benefit of dividing patients into those with high and low anxiety is questionable. TRIAL REGISTRATION: German Registry of Clinical Trials (DRKS00016725), retrospectively registered.

Coping strategies in anxious surgical patients.

BACKGROUND: Anaesthesia and surgery provoke preoperative anxiety and stress. Patients try to regain control of their emotions by using coping efforts. Coping may be more effective if supported by specific strategies or external utilities. This study is the first to analyse coping strategies in a large population of patients with high preoperative anxiety. METHODS: We assessed preoperative anxiety and coping preferences in a consecutive sample of 3087 surgical patients using validated scales (Amsterdam Preoperative Anxiety and Information Scale/Visual Analogue Scale). In the subsample of patients with high preoperative anxiety, patients' dispositional coping style was determined and patients' coping efforts were studied by having patients rate their agreement with 9 different coping efforts on a four point Likert scale. Statistical analysis included correlational analysis between dispositional coping styles, coping efforts and other variables such as sociodemographic data. Statistical significance was considered for p < 0.05. RESULTS: The final analysis included 1205 patients with high preoperative anxiety. According to the initial self-assessment, about two thirds of the patients believed that information would help them to cope with their anxiety ("monitors"); the remainder declined further education/information and reported self-distraction to be most helpful to cope with anxiety ("blunters"). There was no significant difference between these two groups in anxiety scores. Educational conversation was the coping effort rated highest in monitors whereas calming conversation was the coping effort rated highest in blunters. Coping follows no demographic rules but is influenced by the level of education. Anxiolytic Medication showed no reliable correlation to monitoring and blunting disposition. Both groups showed an exactly identical agreement with this coping effort. Demand for medical anxiolysis, blunting or the desire for more conversation may indicate increased anxiety. The use of the internet was independent of the anxiety level and the demand of information. CONCLUSION: Conversation with medical staff proved to be the most popular coping strategy. Acknowledgment of the division between information-seeking and blunting-like personalities is central to supporting the patient's individual coping efforts. Internet access may be the easiest way to support coping today.

Isolation and chondrogenic differentiation of porcine perichondrial progenitor cells for the purpose of cartilage tissue engineering.

In vivo, cartilage has a limited regenerative capacity. Clinical replacement strategies require a suitable cell source to provide a stable chondrocyte phenotype without hypertrophic cartilage development, while being broadly available, and harboring a high proliferative potential. Thus, the aim of this study was to analyze the proliferation and chondrogenic differentiation capacity of porcine perichondrial progenitor cells (PPC) isolated from auricular (ePPC) and tracheal cartilage (tPPC) as an alternative cell source to mesenchymal stem cells (MSC). The proliferative potential of these cell types was analyzed by means of doubling times. Cell pellets were cultured in chondrogenic differentiation medium for 4 weeks. Potential chondrogenic differentiation was investigated by histology and immunohistology in addition to gene expression analysis of the cartilage markers collagen II, aggrecan, cartilage oligomeric matrix protein (COMP), the precartilage marker collagen I, and the hypertrophic cartilage marker collagen X. PPC showed a proliferative behavior comparable to that of MSC. Chondrogenic stimulation resulted in a higher expression of collagen II, aggrecan, and COMP in ePPC as compared to tPPC and MSC, whereas the expression of collagen I was comparable in all cell types independently of differentiation stimulation. Collagen type X, however, could not be detected. The production of cartilage-like extracellular matrix components in PPC pellets was confirmed by histological and immunohistological stains. Elastin, a component of auricular cartilage, however, was not detected in ePPC-derived pellets. Thus, PPC present a promising cell source for tissue engineering of cartilage. Furthermore, ePPC may be more convenient than tPPC due to their higher chondrogenic potential and better accessibility.