Assessment Of Preoperative Anxiety In Breast Cancer Patients:Contributing Factors And Hemodynamics

Objective1.To clarify the related factors of preoperative anxiety in patients with breast cancer,to provide clinical basis for preventing or reducing the occurrence of preoperative anxiety in patients with breast cancer.2.To observe and compare the influence of preoperative anxiety on hemodynamics in anesthetic management in patients with breast cancer,and to supplement the new research results for the adverse effect of preoperative anxiety on anesthetic management.Methods1.The study obtained the informed consent of all patients and passed the ethics review of the Ethics Committee of Cancer Hospital of Tianjin Medical University.From September 2018 to November 2018,75 patients undergoing radical mastectomy were selected from Cancer Hospital of Tianjin Medical University.They were classified as ASA Ⅰ/Ⅱ,NYHA Ⅰ/Ⅱ and BMI18-24kg/㎡.2.On the afternoon of the day before operation,the researchers visited the patients before operation and recorded their age,history of general anesthesia,length of stay in hospital,basic heart rate and blood pressure.State Anxiety Inventory(SAI),which is included in State-trait Anxiety Inventory(STAI),and The Amsterdam preoperative Anxiety and Information Scale(APAIS)designed for the purpose of the study was used to assess the preoperative anxiety status of patients.According to the State Anxiety Inventory(SAI),the patients were divided into two groups: high anxiety group(SAI > 45)and low anxiety group(SAI≤46).Analysis factors related to preoperative anxiety of breast cancer patients.3.The heart rate and blood pressure of the patients in both groups were observed and recorded at the time of placement of laryngeal mask after induction of general anesthesia and 30 minutes after operation,and the heart rate and blood pressure were measured at the time of removal of the laryngeal mask.The effects of preoperative anxiety on hemodynamics in anesthetic management were analyzed and compared.Result1.75 breast cancer patients agreed to participate in the survey and completed all questionnaires.75 valid questionnaires were collected for statistical analysis,and the effective questionnaire completion rate was 100%.There were 16 patients(21%)in preoperative high anxiety group and 59 patients(79%)in preoperative low anxiety group.2.Age,previous history of general anesthesia and length of hospitalization were related factors of preoperative anxiety in patients with breast cancer.75 patients were divided into two groups: age 60 and below and over 60 years old.The patients under60 years old were more likely to be anxious than those over 60 years old,the difference was statistically significant,and there was a negative correlation between age and SAI score.Patients with no previous history of general anesthesia were more likely to have anxiety than those with previous history of general anesthesia,and patients who had been hospitalized for more than one day before operation were more likely to have anxiety before operation than those had been hospitalized for less than one day before operation.3.Breast cancer patients have different levels of anxiety about surgery and anesthesia.The anxiety degree of the young patients on anesthesia,operation itself and the need for anesthesia,especially the information related to the operation were higher than those of the older patients.For all patients,the concern about the operation itself and the need for surgical information were higher than those of anesthesia,the difference being statistically significant.4.The effect of different degree of preoperative anxiety on hemodynamics in anesthesia management was different.There was no statistical difference between the preoperative hemodynamic baseline values of the high-anxiety group and the low-anxiety group.The systolic blood pressure of the high-anxiety group was higher than that of the low-anxiety group when the laryngeal mask is placed.The systolic and the heart rate of the patients with high-anxiety group were significantly higher than those of the low-anxiety group when the laryngeal mask is removed.In the low-anxiety group,10 patients(17%)had high blood pressure during the operation,8(50%)had high blood pressure during the operation in the low-anxiety group,and the incidence of hypertension in the high-anxiety group was higher than that of thelow-anxiety group.Conclusion1.The related factors of preoperative anxiety in breast cancer patients were age,history of prior general anesthesia,length of hospital stay.The preoperative anxiety was more likely to occur in younger patients than in old-age patients,and the degree of preoperative anxiety was gradually reduced with age.Patients with a prior history of general anesthesia were more prone to preoperative anxiety than those with a history of general anesthesia.Patients with more than one day of preoperative hospital stay were more likely to have preoperative anxiety than those in the day of the hospital stay.In addition,the patient’s concern over the operation-related information before the operation of the breast cancer patients is more than that of the anesthesia.2.Preoperative anxiety in patients with breast cancer has different effects on hemodynamics in anesthetic management.The systolic blood pressure(SBP)and heart rate(HR)of the patients with high anxiety were higher than those of the patients with low anxiety when the laryngeal mask was inserted after induction of general anesthesia,and the systolic blood pressure and heart rate of the patients with high anxiety were higher than those of the patients with low anxiety.In addition,patients with high anxiety before operation are more likely to have hypertension in anesthesia management than patients with lower anxiety.