Evaluation of the effect of preoperative anxiety on intraoperative hemodynamic stability and drug consumption in patients who underwent BIS-guided total intravenous anesthesia (TIVA) for neurophysiological monitoring in spine surgery

Abstract

In our study, the aim was to evaluate the effects of preoperative anxiety measured by Spielberger’s State-Trait Anxiety Inventory-State (STAI-S) and State-Trait Inventory-Trait (STAI-T) scores on intraoperative hemodynamic stability, drug consumption and recovery in patients who underwent spinal surgery with neurophysiological monitoring and total intravenous anesthesia with bispectral index (BIS) monitoring, without the use of muscle relaxants. Eighty patients with planned spinal surgery and neurophysiological monitoring were included in this prospective observational study. Anxiety scores were recorded by applying Spielberger’s STAI-T and STAI-S scoring questionnaires to all patients included in the study 1 hour before the operation. Age, gender and American Society of Anesthesiologists (ASA) scores of the patients who were taken to the operating table without premedication were recorded. Before anesthesia induction, standard monitoring including electrocardiography (ECG), noninvasive blood pressure, peripheral oxygen saturation (SpO2), BIS was applied. The correlation between STAI-T and STAI-S scores with demographic characteristics of patients, preoperative, post-induction, 5th minute, 10th minute, 30th minute, 50th minute, 70th minute, 90th minute heart rate (HR), mean arterial pressure (MAP), SpO2, operation time, recovery time, and total amount of propofol and remifentanil used during the operation were evaluated statistically. A significant negative correlation was observed between STAI-S anxiety scoring and age (p < 0.05). A significant positive correlation was found between the total amount of remifentanil and propofol used with the STAI-S score (p < 0.05). Significant positive correlations were observed between the STAI-S score and the HR value preoperatively, and in the 5th, 30th, 50th, 70th, and 90th minutes (p < 0.05). Our study showed that preoperative anxiety increases intraoperative drug consumption and heart rate. It is of great importance to keep the amount of intraoperative medication at optimal levels, to measure preoperative anxiety, and to eliminate it with multimodal treatments, especially for the accurate detection of neurological damage in patients with neurophysiological monitoring.