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Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Evidence-based Practice and Quality Improvement

Impact of the preoperative anaesthesia clinic meeting on patient's preference for spinal versus general anaesthesia for lower limb joint arthroplasty

1AP5-1

Murdoch, J. A.C.; Raghavan, G.; Phelan, R.; Shyam, V.

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European Journal of Anaesthesiology: June 2011 - Volume 28 - Issue - p 17
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Background and Goal of Study: Patients can have preconceived opinions or fears regarding spinal anaesthesia. (1) The presurgical meeting with an anesthesiologist offers a chance to provide information for an informed anaesthetic choice and to allay anxieties. We hypothesized that meeting with the anesthesiologist would alter patients' anaesthesia preference in favour of spinal anaesthesia and reduce anxiety levels.

Materials and Methods: Following Research Ethics Board approval and informed consent, 62 patients undergoing elective hip or knee arthroplasty were recruited from the preoperative assessment clinic. In this prospective study, a questionnaire was administered before and immediately after the meeting with an anaesthesiologist, who had no knowledge of the study questions. The primary outcome was preference for general versus spinal anaesthesia while the secondary outcome was anxiety, measured using a modified Amsterdam Preoperative Anxiety and Information Scale (APAIS). Other secondary outcomes included reasons for change of anaesthetic preference and concerns for side effects. Chi square test and Fisher's exact test were used to analyze changes in anaesthetic preference and concerns for side effects; paired t tests were used to compare anxiety levels (p< 0.05).

Results and Discussion: 62 patients, (35 female, 27 male, mean age 67+/SD 10) were recruited over a six week period. We observed a significant decrease in patients preferring general (48% to 18%, p< 0.01) and a significant increase in patients preferring spinal (39% to 74%, p< 0.01) anaesthesia before versus following the meeting with the anaesthesiologist.

The most frequent reason quoted for this change was “being more knowledgeable” with “safety” ranked second. Of those reporting the greatest concern for having spinal anaesthesia, the commonest reason (72%) was that of “hearing intraoperative sound”. Regarding side effects, the most frequent concerns were “nerve damage” and “paralysis”. All concerns regarding side effects and all anxiety measures were significantly reduced post meeting except anxiety directly associated with the anaesthetic. This was likely attributable to patient's anxiety scores for the anaesthetic already being low prior to the meeting.

Conclusions The anaesthetic preoperative interview significantly influences patients' choice in favour of spinal anaesthesia for major lower limb arthroplasty and reduces anxiety.

References:

(1)Sosis et al. J Clin Anesth 7(5):389-94, 1995.
    © 2011 European Society of Anaesthesiology