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The Influence of Preoperative Anxiety on Hypotension following Spinal
Abstract Number: S-14
Abstract Type: Original Research
Introduction: We designed a prospective observational study to assess the effect of pre-operative anxiety on hypotension after spinal anaesthesia for caesarean delivery.
Methods: After IRB approval and signed informed consent, 100 healthy term parturients undergoing elective caesarean delivery under spinal anaesthesia were enrolled. Preoperative anxiety was assessed using VAS (0-10) anxiety score; other assessments were State-Trait Anxiety Inventory questionnaire (STAI-s) and salivary amylase. Anxiety data were transformed into low, medium and high anxiety groups (VAS: low 0-3, medium 4-6, high 7-10; STAI-s: low <40, medium 40-55, high >55; log salivary amylase: low <3, medium 3-4, high >4). Spinal anaesthesia was performed using hyperbaric bupivacaine 10mg and fentanyl 20g. All patients received intravenous crystalloid 500mL prehydration and 500mL cohydration. Hypotension was treated by standardized protocol (fluid bolus and ephedrine or phenylephrine depending on maternal heart rate). Systolic blood pressure (SBP) was measured at baseline and every minute after spinal anaesthesia. The effect of low, medium and high anxiety groups on the maximum percentage change in SBP (%ΔSBP) was assessed (one-way ANOVA, Bonferroni's post-hoc test).
Results: 93 patients were included in analysis. Comparing low, medium and high anxiety (VAS) there was a significant effect on %ΔSBP (p=0.004). There was a significant difference between low and high anxiety groups (p=0.003; mean difference -13%; 95% CI -21 to -5) but no significant difference between other groups. Neither State-Trait Anxiety Inventory questionnaire (STAI-s) or salivary amylase correlated with %ΔSBP.
Conclusion: Preoperative anxiety assessed by VAS had a significant effect on hypotension following spinal anaesthesia.