Spinal Anestezi ile Sezaryende Preoperatif Anksiyete’nin Hemodinamik Parametrelere Etkisi

Abstract

Purpose:Our aim of this study is to assess the effect of preoperative anxiety on intraoperative hypotension, postoperative recovery and maternal satisfaction in cesarean section under spinal anaesthesia. Methods:In this study,105 cesarean sections were included between aged of 18-45 and at 34-42 gestational weeks. Two different scales were used for the anxiety evaluation performed 1 hour before the operation, including STAI (I-II) anxiety score and Verbal Analoque scale (VAS). It was evaluated as low, moderate and high anxiety according to the scores obtained: low (20-37), moderate (38-44) and high (45-80) for STAI and low (0-3), moderate (4-6) and high (7-10) for VAS. During the operation, haemodynamic parameters were monitored at 5,10,15,20,30 minutes. In the post-operative first day, STAI-I, VAS, Post-Cesarean Mother Satisfaction Scale (PCMSS) and Post-Cesarean Recovery Scale (PCRS) were also evaluated. Results:In the evaluation of preoperative STAI -I and VAS anxiety scores, it was observed that the majority of cases had moderate anxiety group (61.9%, and 45.7%). There was no significant correlation between preoperative STAI-I, STAI-II, VAS anxiety levels and SSAM, SSDS in our study. There was a negative correlation between postoperative VAS anxiety scores and SSAM but this was not significant. In our study, no significant difference was found in umbilical cord pH values in different anxiety levels. In preoperative high VAS levels, MBP decreased significantly in 30 minutes, and also vasopressor requirement decreased significantly in preoperative low VAS anxiety levels (p<0.05). Conclusion:Anxiety level of the patients should be reduced through non-pharmacological methods in preoperative visits considering the fact that patients are pregnant. Further studies with a larger samples size should be performed to demonstrate clearly the effect of maternal anxiety on the hypotension during spinal anesthesia for cesarean section.

Keywords

• Anestezi
• Spinal
• Hemodinamik ölçümler
• Anksiyete

The Effect of Preoperative Anxiety on Hemodynamic Parameters in Cesarean Section Under Spinal Anesthesia

Abstract

Purpose:Our aim of this study is to assess the effect of preoperative anxiety on intraoperative hypotension, postoperative recovery and maternal satisfaction in cesarean section under spinal anaesthesia. Methods:In this study,105 cesarean sections were included between aged of 18-45 and at 34-42 gestational weeks. Two different scales were used for the anxiety evaluation performed 1 hour before the operation, including STAI (I-II) anxiety score and Verbal Analoque scale (VAS). It was evaluated as low, moderate and high anxiety according to the scores obtained: low (20-37), moderate (38-44) and high (45-80) for STAI and low (0-3), moderate (4-6) and high (7-10) for VAS. During the operation, haemodynamic parameters were monitored at 5,10,15,20,30 minutes. In the post-operative first day, STAI-I, VAS, Post-Cesarean Mother Satisfaction Scale (PCMSS) and Post-Cesarean Recovery Scale (PCRS) were also evaluated. Results:In the evaluation of preoperative STAI -I and VAS anxiety scores, it was observed that the majority of cases had moderate anxiety group (61.9%, and 45.7%). There was no significant correlation between preoperative STAI-I, STAI-II, VAS anxiety levels and SSAM, SSDS in our study. There was a negative correlation between postoperative VAS anxiety scores and SSAM but this was not significant. In our study, no significant difference was found in umbilical cord pH values in different anxiety levels. In preoperative high VAS levels, MBP decreased significantly in 30 minutes, and also vasopressor requirement decreased significantly in preoperative low VAS anxiety levels (p<0.05). Conclusion:Anxiety level of the patients should be reduced through non-pharmacological methods in preoperative visits considering the fact that patients are pregnant. Further studies with a larger samples size should be performed to demonstrate clearly the effect of maternal anxiety on the hypotension during spinal anesthesia for cesarean section.

Keywords

• Anesthesia
• Spinal
• Hemodynamic parameters
• Anxiety

References

1. 1. Caumo W1, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, Bandeira D, Ferreira MB. Risk factors for postoperative anxiety in adults. Anaesthesia. 2001;56(8):720-8.
2. [2] Furber CM, Garrod D, Maloney E, Lovell K, McGowan L. A qualitative study of mild to moderate psychological distress during pregnancy. Int J Nurs Stud. 2009;46(5):669-77.
3. [3] Pampaka D, Papatheodorou SI, AlSeaidan M, Al Wotayan R, Wright RJ, Buring JE, Dockery DW, Christophi CA Depressive symptoms and comorbid problems in pregnancy - results from a population based study. J Psychosom Res. 2018;112:53-58.
4. [4] Ateser RY, Kayacan N. Intrathecal ropivacaine in cesarean delivery. Niger J Clin Pract. 2017;20(10):1322-1327.
5. [5] Salman C, Kayacan N, Ertuğrul F, Bıgat Z, Karslı B.Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia.Braz J Anesthesiol. 2013;63(3):267-72.
6. [6] Huang B, Huang Q, Hai C, Zheng Z, Li Y, Zhang Z Height-based dosing algorithm of bupivacaine in spinal anaesthesia for decreasing maternal hypotension in caesarean section without prophylactic fluid preloading and vasopressors: study protocol for a randomised controlled non-inferiority trial. BMJ Open. 2019;9(5):249.
7. [7] Chappell D, Helf A, Gayer J, Eberhart L, Kranke P. [Antihypotensive drugs in cesarean sections : Treatment of arterial hypotension with ephedrine, phenylephrine and Akrinor® (cafedrine/theodrenaline) during cesarean sections with spinal anesthesia]. Anaesthesist 2019 ;68(4):228-238.
8. [8] Morgan GE, Mikhail MS, Murray MJ with Larson CP.Obstetric Anesthesia , In:Clinical Anesthesiology. 3rd ed. 2002.TheMcGraw-Hill Companies. P:819-848.

9. [9] Hanss R, Bein B, Ledowski T, Lehmkuhl M, Ohnesorge H, Scherkl W, Steinfath M, Scholz J, Tonner PH. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology. 2005;102(6):1086-93.
10. [10] Hanss R, Ohnesorge H, Kaufmann M, Gaupp R, Ledowski T, Steinfath M, Scholz J, Bein B. Changes in heart rate variability may reflect sympatholysis during spinal anaesthesia. Acta Anaesthesiol Scand. 2007;51(10):1297-304.
11. [11] Spielberger CD, Gorsuch RL, Lushene LE. Manual for State-Trait Anxiety Inventory (self evaluation questionnare).Inc; Palo Alto, CA:Consulting Psychologist Press, 1970.
12. [12] Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns. Anesth Analg. 2000;90(3):706-12.
13. [13] Harten JM1, Boyne I, Hannah P, Varveris D, Brown A Morgan PJ1, Halpern S, Lo J. Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section. Anaesthesia. 2005;60(4):348-53.
14. [14] Morgan PJ1, Halpern S, Lo J. The development of a maternal satisfaction scale for caesarean section. Int J Obstet Anesth. 1999;8(3):165-70.
15. [15] Hobson JA, Slade P, Wrench J, Power L. Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section. Int j Obstet Anesth 2006;15:18-23.
16. [16] MacDorman MF1, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35(2):293-307,.
17. [17] Feng XL1, Xu L, Guo Y, Ronsmans C. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ. 2012;90(1):30-9.
18. [18] Gorkem U, Togrul C, Sahiner Y, Yazla E, Gungor T. Preoperative anxiety may increase postcesarean delivery pain and analgesic consumption. Minerva Anestesiol. 2016;82(9):974-80.
19. [19] Manouchehrian N, Bakhshaei MH. Nitrous oxide effect on relieving anxiety and pain in parturients under spinal anesthesia for caesarean section. Anesth Pain Med. 2014;4(2):166.
20. [20] Størksen HT, Garthus-Niegel S, Adams SS, Vangen S, Eberhard-Gran M. Fear of childbirth and elective caesarean section: a population-based study.BMC Pregnancy Childbirth. 2015; 17(15):221.
21. [21] Zhang S, Huang X, Tan H. Prenatal anxiety and cesarean section with non-medical indication. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 ;38(10):1070-4.
22. [22] Hume MA1, Kennedy B, Asbury AJ. Patient knowledge of anaesthesia and peri-operative care. Anaesthesia. 1994;49(8):715-8.
23. [23]Akildiz M, Aksoy Y, Kaydu A, Kaçar CK, Şahin ÖF, Yıldırım ZB. Effect of Anaesthesia Method on Preoperative Anxiety Level in Elective Caesarean Section Surgeries. Turk J Anaesthesiol Reanim. 2017;45(1):36-40.
24. [24] Orbach-Zinger S, Ginosar Y, Elliston J, Fadon C, Abu-Lil M, Raz A, Goshen-Gottstein Y, Eidelman LA. Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery. Br J Anaesth. 2012 ;109(6):943-9.
25. [25] Ramsay MA. A survey of pre-operative fear. Anaesthesia. 1972;27(4):396-402.
26. [26] Kain ZN, Kosarussavadi B, Hernandez-Conte A, Hofstadter MB, Mayes LC. Desire for perioperative information in adult patients: a cross-sectional study. J Clin Anesth. 1997;9(6):467-72.
27. [27] Rouhe H1, Salmela-Aro K, Gissler M, Halmesmäki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG. 2011;118(9):1104-11.
28. [28] Dualé C1, Ouchchane L2, Schoeffler P3; EDONIS Investigating Group, Dubray C. Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up. J Pain. 2014;15(1):1-20.
29. [29] Gillberg C. "Floppy infant syndrome" and maternal diazepam. Lancet. 1977;30;2(8031):244.
30. [30] Haram K. "Floppy infant syndrome" and maternal diazepam. Lancet. 1977;17;2(8038):612-3.
31. [31] Frölich MA1, Burchfield DJ, Euliano TY, Caton D. A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neonatal effects. Can J Anaesth. 2006;53(1):79-85.
32. [32] Senel AC, Mergan F. Premedication with midazolam prior to caesarean section has no neonatal adverse effects. Braz J Anesthesiol. 2014;64(1):16-21.
33. [33] Mokhtar AM, Elsakka AI, Ali HM. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial. Anesth Essays Res. 2016;10(3):631-636.
34. [34] Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J Anesth. 2014;28(2):222-7.
35. [35] Grabow L1, Buse R Preoperative anxiety--anxiety about the operation, anxiety about anesthesia, anxiety about pain?. Psychother Psychosom Med Psychol. 1990 Jul;40(7):255-63.
36. [36] Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84(1):6-10.
37. [37] Dexter F, Aker J, Wright WA. Development of a measure of patient satisfaction with monitored anesthesia care: the Iowa Satisfaction with Anesthesia Scale. Anesthesiology. 1997;87(4):865-73.