Stellenwert der medikamentösen Anxiolyse aus Sicht des Patienten vor elektiven Eingriffen in Allgemeinanästhesie bei Erwachsenen
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Philipps-Universität Marburg
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Abstract
Introduction
Both an operation and anesthesia are very stressful for the majority of patients, whereby the preoperative fear has a decisive influence on this and is perceived by many as the most unpleasant aspect of the perioperative phase. Anxiolytic premedication is a routinely prescribed way to counteract this fear. However, the importance of this measure from the patient's point of view, in terms of the basic need and the desired time of intake, has not yet been adequately researched.
Methods
This cross-sectional study included 1,000 adult patients who were scheduled to undergo elective surgery under general anesthesia. The patients had to fill out the questionnaires before the premedication interview. In addition to demographic data, the presence of fear was recorded dichotomously (yes / no). The fear level was determined using a numerical rating scale (NRS 0-10 points) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS, APAIS-A-T 4-20 points). The basic desire for anxiolytic premedication and the preferred time for anxiolytic premedication were descriptively evaluated. The general relationship between the level of anxiety and the need for anxiolytic premedication was examined using cross tables and logistic regression.
Outcomes
During the period of one year, 1082 patients were recruited, 1000 of whom could be included (537 female, 459 male, 4 no gender stated; age M = 57 ± 18). Among these, 493 patients (318 female (64.5%)) reported fear (APAIS-A-T M = 9.2 ± 3.8). Out of these anxiety patients, 228 (46.2%) stated a definite need for anxiolytic premedication, 142 (28.8%) wanted it if necessary, and 114 (23.1%) declined anxiolytic premedication. The patients with a definite anxiolytic drug desire could choose between different times or combinations of these (on the evening before the operation, on the morning of the day of the operation, shortly before they were called to the operating room), with morning use being the most common chosen time (75 (32.9%)).
Within the group of patients with a definite desire for anxiolytic premeditation, two thirds had no need for further support towards their preoperative anxiety.
While the probability of wanting anxiolytic premedication increased significantly with increasing APAIS-A-T (β = 0.227, OR = 1.26 (95% CI = 1.20 - 1.31), even with lowest APAIS-A-T, a need for anxiolytic premedication could not be ruled out, whereas on the other hand even patients with highest APAIS-A-T could be without a desire for anxiolytic premedication.
Conclusion
More than half of women and a good third of men are afraid of an operation under general anesthesia. Three quarters of these patients definitely want anxiolytic premedication or the option to receive it if necessary. This is in contrast to the current clinical practice of cautious administration of preoperative anxiolytics.
If one wants to satisfy all patients with regard to the need for anxiolytic premedication, the quantification of preoperative fear using instruments like the APAIS to collect anxiety score data is not sufficient. Instead, individual inquiries about possible desire for anxiolytic premedication and the preferred time of administration are required.
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Dates
Created: 2022Issued: 2023-03-09Updated: 2023-03-09
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
DDC-Numbers
610
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Kampmann, Stefan: Stellenwert der medikamentösen Anxiolyse aus Sicht des Patienten vor elektiven Eingriffen in Allgemeinanästhesie bei Erwachsenen. : Philipps-Universität Marburg 2023-03-09. DOI: https://doi.org/10.17192/z2023.0133.
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This item has been published with the following license: In Copyright