Factors Affecting Preoperative Anxiety Level in Patients Undergoing Fiberoptic Bronchoscopy

Öz

Preoperative anxiety is characterized as a condition of stress or restlessness caused by a lack of information regarding the person's situation, which may include illness, hospitalization, anesthesia, or surgery. In our study, we used the State-Trait Anxiety Inventory (STAI-1) questionnaire to measure preoperative anxiety levels in patients undergoing fiberoptic bronchoscopy (FOB) and investigate the association between these levels and clinical and demographic characteristics. The cross-sectional survey sampled 158 individuals who underwent FOB between November 2021 and January 2024. The patient's socio-demographic data, procedure indications, and previous surgical treatments were documented. The STAI-1 questionnaire was administered to participants 15 minutes before the surgery to assess their momentary anxiety levels. There were 51 (32.3%) female patients, with a median age of 58 (20-84) years. The treatment was carried out under conscious sedation in 65 (41.1%) cases, and there was no statistically significant difference in pre-operative anxiety levels between sedation and local anesthesia (p=0.917). While 64 (41.1%) patients were anxious about the procedure, 17 (10.8%) were anxious about the anesthesia. Patients who were anxious about the operation and anesthesia had significantly greater pre-operative anxiety levels (p<0.001, p=0.009). In multivariate analysis, female gender was found to be an independent predictor of pre-operative anxiety levels [OR: 1.99, 95% CI: 1.05-3.94, p=0.04]. This study, which looked at the relationship between preoperative anxiety levels and sociodemographic and clinical characteristics before FOB, found that the female gender has a significant effect on anxiety levels, emphasizing the importance of taking gender differences into account when managing preoperative anxiety.

Anahtar Kelimeler

• Fiberoptic bronchoscopy
• preoperative anxiety
• female gender
• STAI-1

Fiberoptik Bronkoskopi İşlemi Uygulanan Hastalarda Preoperatif Anksiyete Düzeyini Etkileyen Etmenler

Öz

Preoperatif anksiyete, kişinin hastalık, hastanede yatma, anestezi veya cerrahi gibi durumlarla karşı karşıya kalacağına dair bilgi eksikliğinden kaynaklanan bir endişe veya huzursuzluk hali olarak tanımlanmaktadır. Çalışmamızda, fiberoptik bronkoskopi (FOB) yapılan hastalarda preoperatif anksiyete düzeylerini State Trait Anxiety Inventory (STAI-1) anketi ile belirlemek ve bu düzeylerin klinik ve demografik faktörlerle ilişkisini araştırmayı amaçladık. Kasım 2021-Ocak 2024 tarihleri arasında FOB yapılan 158 olgu kesitsel anket çalışmasına dahil edilmiştir. Olguların sosyo-demografik özellikleri, işlem endikasyonları ve önceki cerrahi girişimleri hakkında bilgiler kaydedilmiştir. Bireylerin geçici anksiyete düzeylerini değerlendirmek için STAI-1 anketi, işlemden 15 dakika önce hastalara uygulanmıştır. Hastaların 51’i (%32,3) kadın olup yaş ortanca değeri 58 (20-84) yıl idi. Olguların 65’ine (%41,1) işlem bilinçli sedasyon altında uygulanmış olup işlemin sedasyon altında olması ile lokal anestezi ile uygulanması arasında preoperatif anksiyete düzeylerinin istatistiksel olarak anlamlı bir farklılık göstermediği belirlenmiştir (p=0,917). Olguların 64’ünde (%41,1) işlem ile ilgili endişe mevcut iken 17’sinde (%10,8) anestezi ile ilişkili endişe bulunmaktaydı. İşlem ile ilgili ve anestezi ile ilgili endişe hisseden olguların istatistiksel anlamlı olarak daha yüksek preoperatif anksiyete düzeyi olduğu saptanmıştır (p<0,001, p=0,009). Çok değişkenli analizde kadın cinsiyetin preoperatif anksiyete düzeyini predikte eden bağımsız faktör olduğu belirlenmiştir [OR: 1,99, %95CI: 1,05-3,94, p=0.04]. Fiberoptik bronkoskopi öncesi preoperatif anksiyete düzeylerinin sosyodemografik ve klinik özelliklerle ilişkisini inceleyen bu çalışma, kadın cinsiyetin anksiyete düzeyleri üzerinde önemli bir etkiye sahip olduğunu ortaya koymuş olup preoperatif anksiyetenin yönetiminde cinsiyet farklılıklarının göz önünde bulundurulması gerektiğini vurgulamaktadır.

Anahtar Kelimeler

• Fiberoptik bronkoskopi
• preoperatif anksiyete
• kadın cinsiyet
• STAI-1

Kaynakça

1. 1. Casal RF, Ost DE, Eapen GA. Flexible bronchoscopy. Clinics in Chest Medicine. 2013;34(3):341-52.
2. 2. Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A.Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999;115(5):1437-40.
3. 3. Du Rand I, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline fordiagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013;68(Suppl 1):i1-i44.
4. 4. Tetikkurt C, Yasar I, Tetikkurt S, Yılmaz N, Kara BY, Yavuz R, et al. Role of anxiety on patient intolerance during bronchoscopy. British Journal of Medicine and Medical Research. 2014;4(11):2171-80.
5. 5. Yang M, Lu L-L, Zhao M, Liu J, Li Q-L, Li Q, et al.Associations of anxiety with discomfort and tolerance in Chinese patients undergoing esophagogastroduodenoscopy. PLoS One. 2019;14(2):e0212180.
6. 6. Isik A, Koca SS, Ozturk A, Mermi O. Anxiety and depression in patients with rheumatoid arthritis. Clinical rheumatology. 2007;26:872-8.
7. 7. Zemła A, Nowicka-Sauer K, Jarmoszewicz K, Wera K,Batkiewicz S, Pietrzykowska M. Measures of preoperative anxiety. Anestezjologia Intensywna Terapia. 2019;51(1).
8. 8. Demir A, Akyurt D, Ergün B, Haytural C, Yiğit T, Taşoğlu İ, etal. Kalp cerrahisi geçirecek olgularda anksiyete sağaltımı. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2010;18(3):177-82.

9. 9. Taşdemir A, Erakgün A, Deniz MN, Çertuğ A. PreoperatifBilgilendirme Yapılan Hastalarda Ameliyat Öncesi ve Sonrası Anksiyete Düzeylerinin State-Trait Anxiety Inventory Test ile Karşılaştırılması. Turkish Journal of Anesthesia & Reanimation. 2013;41(2).
10. 10. Jlala H, French J, Foxall G, Hardman J, Bedforth N. Effect ofpreoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. British journal of anaesthesia. 2010;104(3):369-74.
11. 11. Cevik B. The evaluation of anxiety levels and determinant factors in preoperative patients. Int J Med Res Health Sci. 2018;7(1):135-43.
12. 12. Spielberger CD, Gonzalez H, Taylor CJ, Algaze B, Anton WD. Examination stress and test anxiety. Stress and anxiety. 1978;5:167-91.
13. 13. Öner N, LeCompte WA. Durumluluk-süreklilik kaygıenvanteri: el kitabı: Boğaziçi Üniversitesi Eğitim Fakültesi; 1998.
14. 14. Masood Z, Haider J, Jawaid M, Alam SN. Preoperative anxiety in female patients: the issue needs to be addressed. Khyber Medical University Journal. 2009;1(2):38-41.
15. 15. Mitchell M. Influence of gender and anaesthesia type on day surgery anxiety. Journal of advanced nursing. 2012;68(5):1014-25.
16. 16. Khalili N, Karvandian K, Ardebili HE, Eftekhar N, Nabavian O.Predictive factors of preoperative anxiety in the anesthesia clinic: a survey of 231 surgical candidates. Archives of Anesthesia and Critical Care. 2019.
17. 17. Aljohaney AA. Level and predictors of anxiety in patients undergoing diagnostic bronchoscopy. Annals of thoracic medicine. 2019;14(3):198-204.
18. 18. Leal PC, Goes TC, da Silva LCF, Teixeira-Silva F. Trait vs. state anxiety in different threatening situations. Trends inpsychiatry and psychotherapy. 2017;39(3):147-57.
19. 19. Fiksdal A, Hanlin L, Kuras Y, Gianferante D, Chen X, Thoma MV, et al. Associations between symptoms of depression and anxiety and cortisol responses to and recovery from acute stress. Psychoneuroendocrinology. 2019;102:44-52.
20. 20. Merry S, Hetrick S. Prevention of depression and anxiety: is the whole better than the sum of the parts? BMJ Ment Health. 2017;20(1):e1-e.
21. 21. Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General hospital psychiatry.2007;29(2):147-55.
22. 22. Janson C, Björnsson E, Hetta J, Boman G. Anxiety and depression in relation to respiratory symptoms and asthma. American journal of respiratory and critical care medicine. 1994;149(4):930-4.
23. 23. Catastini P, Di Marco S, Furriolo M, Genovese C, Grande A,Iacinti E, et al. The prevalence of anxiety and depression in Italian patients with cystic fibrosis and their caregivers. Pediatric pulmonology. 2016;51(12):1311-9.
24. 24. Garbarino S, Bardwell WA, Guglielmi O, Chiorri C, Bonanni E, Magnavita N. Association of anxiety and depression in obstructive sleep apnea patients: a systematic review and meta-analysis. Behavioral sleep medicine. 2020;18(1):35-57.
25. 25. Ho CS, Tan EL, Ho RC, Chiu MY. Relationship of anxiety and depression with respiratory symptoms: comparison betweendepressed and non-depressed smokers in Singapore. International journal of environmental research and public health. 2019;16(1):163.
26. 26. Hohls JK, König H-H, Quirke E, Hajek A. Association between anxiety, depression and quality of life: study protocol for a systematic review of evidence from longitudinal studies. BMJ open. 2019;9(3):e027218.
27. 27. Aust H, Eberhart L, Sturm T, Schuster M, Nestoriuc Y, Brehm F, et al. A cross-sectional study on preoperative anxiety in adults. Journal of psychosomatic research. 2018;111:133-9.
28. 28. Mavridou P, Dimitriou V, Manataki A, Arnaoutoglou E, Papadopoulos G. Patient’s anxiety and fear of anesthesia: effect of gender, age, education, and previous experience ofanesthesia. A survey of 400 patients. Journal of anesthesia. 2013;27:104-8.
29. 29. Almalki MS, Hakami OAO, Al-Amri AM. Assessment of preoperative anxiety among patients undergoing elective surgery. The Egyptian Journal of Hospital Medicine. 2017;69(4):2329-33.
30. 30. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto C, Bandeira D, et al. Risk factors for preoperative anxiety inadults. Acta Anaesthesiologica Scandinavica. 2001;45(3):298-307.