Comparison Of Preoperative Anxiety In Adult Patients Undergoing Spinal Anesthesia Electively for the Second time Or more versus the ones for the first time: An observational study

All patients who are admitted in our hospital and who fulfill the inclusion criteria will be enrolled for the study. As a part of pre-anesthetic evaluation, all the patients will be visited by the anesthesiologist in their respective ward or in the pre-anesthesia clinic, at least a day before the surgery as per institutional protocol. The process and steps involved in the administration of subarachnoid blockade and surgery will be explained in their comprehensible language for all the patients. A special emphasis will be laid on obtaining the history of previous surgery, anesthesia, no. of days of ICU stay, discharge from recovery room, backache and other pain related to surgery, history of sleep disturbances. Before collection of data all the participants will be explained about the purpose and importance of conducting the study and after receiving the informed consent, the APAIS questionnaire will be handed over to them in a language preferred by the patient. All the participants will be assured regarding maintenance of confidentiality with respect to their Identity. Data collection will be done by the anesthesiologist, a day prior to the surgery in person using Amsterdam Preoperative Anxiety Informaton Scale (APAIS) questionnaire will be issued and scores noted in both groups. All the patients who are admitted in our hospital and who fulfill the inclusion criteria will be enrolled for the study. As a part of pre-anesthetic evaluation, all the patients will be visited by the anesthesiologist in their respective ward or in the pre-anesthesia clinic, at least a day before the surgery as per institutional protocol. The process and steps involved in the administration of subarachnoid blockade and surgery will be explained in their comprehensible language for all the patients. A special emphasis will be laid on obtaining the history of previous surgery, anesthesia, no. of days of ICU stay, discharge from recovery room, backache and other pain related to surgery, history of sleep disturbances. Before collection of data all the participants will be explained about the purpose and importance of conducting the study and after receiving the informed consent, the APAIS questionnaire will be handed over to them in a language preferred by the patient. All the participants will be assured regarding maintenance of confidentiality with respect to their Identity. Data collection will be done by the anesthesiologist, a day prior to the surgery in person using Amsterdam Preoperative Anxiety Informaton Scale (APAIS) questionnaire (annexure 1). The questionnaire comprises of 6 questions, out of which first 2 questions gauge the anesthesia related anxiety, questions 5 and 6 gauge the surgery related anxiety, question 1,2,4 and 5 gauge the combined anxiety with surgery and anesthesia and lastly questions 3 and 6 throws light on the area of patient’s desire to know more about the procedure. Each of these questions will be given a response on a likert scale from score 1 to 5, which is described as "not at all" to " extremely" respectively. Any patient who has a score of over 11 will be prescribed tab Alprazolam 0.25mg on the night before surgery. On the day of surgery, as per hospital protocol, peripheral intravenous cannula will be secured and intravenous crystalloid infusion will be initiated. Following the premedication with proton pump inhibitor and antiemetic, patient will be wheeled in to the operation theatre. ASA standard monitoring will be done after positioning the patient supine on the operating table. The baseline clinical parameters viz., heart rate, blood pressure, respiratory rate and oxygen saturation will be recorded and documented in the clinical proforma. Under strict asepsis, in the sitting position, lumbar puncture will be performed with a 25 gauge Quincke Bob needle, following local infiltration of L3-L4 or L4-L5 intervertebral space with 2 ml of 2% lignocaine . After confirming the free flow of CSF, 12mg-15mg of 0.5% H- bupivacaine will be injected intrathecally. In less than 30 seconds, patient will be made to lie supine and will be tested for motor blockade and level of sensory blockade by standard clinical tests. Simultaneously the vital parameters will be recorded every 5 minutes in all patients.All the patients who are admitted in our hospital and who fulfill the inclusion criteria will be enrolled for the study. As a part of pre-anesthetic evaluation, all the patients will be visited by the anesthesiologist in their respective ward or in the pre-anesthesia clinic, at least a day before the surgery as per institutional protocol. The process and steps involved in the administration of subarachnoid blockade and surgery will be explained in their comprehensible language for all the patients. A special emphasis will be laid on obtaining the history of previous surgery, anesthesia, no. of days of ICU stay, discharge from recovery room, backache and other pain related to surgery, history of sleep disturbances. Before collection of data all the participants will be explained about the purpose and importance of conducting the study and after receiving the informed consent, the APAIS questionnaire will be handed over to them in a language preferred by the patient. All the participants will be assured regarding maintenance of confidentiality with respect to their Identity. Data collection will be done by the anesthesiologist, a day prior to the surgery in person using Amsterdam Preoperative Anxiety Informaton Scale (APAIS) questionnaire (annexure 1). The questionnaire comprises of 6 questions, out of which first 2 questions gauge the anesthesia related anxiety, questions 5 and 6 gauge the surgery related anxiety, question 1,2,4 and 5 gauge the combined anxiety with surgery and anesthesia and lastly questions 3 and 6 throws light on the area of patient’s desire to know more about the procedure. Each of these questions will be given a response on a likert scale from score 1 to 5, which is described as "not at all" to " extremely" respectively. Any patient who has a score of over 11 will be prescribed tab Alprazolam 0.25mg on the night before surgery. On the day of surgery, as per hospital protocol, peripheral intravenous cannula will be secured and intravenous crystalloid infusion will be initiated. Following the premedication with proton pump inhibitor and antiemetic, patient will be wheeled in to the operation theatre. ASA standard monitoring will be done after positioning the patient supine on the operating table. The baseline clinical parameters viz., heart rate, blood pressure, respiratory rate and oxygen saturation will be recorded and documented in the clinical proforma. Under strict asepsis, in the sitting position, lumbar puncture will be performed with a 25 gauge Quincke Bob needle, following local infiltration of L3-L4 or L4-L5 intervertebral space with 2 ml of 2% lignocaine . After confirming the free flow of CSF, 12mg-15mg of 0.5% H- bupivacaine will be injected intrathecally. In less than 30 seconds, patient will be made to lie supine and will be tested for motor blockade and level of sensory blockade by standard clinical tests. Simultaneously the vital parameters will be recorded every 5 minutes in all patients.