Patients have misconceptions and high levels of anxiety about general anesthesia

May 20, 2010

Eight-five per cent of patients who took part in a survey shortly after day surgery said that they had been anxious about receiving a general anaesthetic, according to research in the May issue of the Journal of Advanced Nursing.

Seventeen per cent of respondents said they were very or extremely anxious, 22 per cent said they were quite anxious, 46 per cent said they were a little anxious and 15 per cent experienced no anxiety at all.

Key concerns included dying while asleep, not waking up after , waking up during surgery and anxiety while waiting to go into surgery or arriving at the theatre door.

"Our survey underlines the importance of patients receiving planned and timely information about anaesthesia, prior to the day of surgery, in order to limit their anxiety" says Dr Mark Mitchell, senior lecturer in the Faculty of Health and Social Care at the University of Salford, UK.

"This should include information about how anaesthesia is managed, the notion of carefully controlled and supervised anaesthesia and dispelling misconceptions associated with general anaesthesia."

Patients scheduled for elective surgery in three day surgery units in England were invited to take part in the survey and 460 patients - a response rate of 37 per cent - completed the questionnaire within 24 to 48 hours of surgery.

The patients who took part were aged between 18 and 75, with an average age of 46, and 59 per cent were female. The majority had undergone gynaecological, general, orthopaedic, urological and ear, nose and throat surgery.

Patients were asked to indicate their anxiety levels about 24 different issues. This showed that:

  • The top three concerns that made patients very anxious were the thought of not waking up (26 per cent), dying while asleep (25 per cent) and waking up during surgery (20 per cent).
  • When the researchers combined all the patients who were anxious, the top five concerns were: waiting for their turn in theatre (59 per cent), the thought of arriving at the theatre door (56 per cent), dying while asleep or not waking up afterwards (both 48 per cent) and waking up during surgery (46 per cent).
  • Forty-one per cent said that they didn't like the thought of having to put their trust in strangers and 12 per cent felt very anxious about this.
  • Anxiety levels were lowest when it came to interactions with medical staff and the support of a partner or friend. Thirty per cent felt very calm about the anaesthetist explaining the procedure, 28 per cent about the anaesthetist visiting and 17 per cent about the nurse explaining the procedure. Twenty-six per cent felt very calm about having a friend or partner with them during recovery.
"Undergoing day surgery and general anaesthesia is very common" says Dr Mitchell. "The development of less invasive techniques means that the surgical effects on the body are now markedly reduced and, as a direct consequence, the amount of physical nursing care required before and after surgery is also considerable reduced.

"However, while patients need less physical nursing care, our survey shows that more attention needs to be paid to the psychological aspects of their care.

"The formal and timely provision of information about the planned surgery - together with a patient-centred approach to the provision of information, such as pre-assessment clinics - are vital first steps.

"It is clear from our study that many patients do not know how the anaesthesia process works and that this has led to misconceptions about, for example, waking up during surgery. It is vital to tackle these if we are to reduce patient anxiety before day surgery."

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More information: General anaesthesia and day-case patient anxiety. Mitchell et al. 66.5, pp 1059-1071. Journal of Advanced Nursing. (May 2010). DOI: 10.1111/j.1365-2648.2010.05266.x

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