Anxiety is a common emotion that many people experience at some point in their lives. It’s characterized by feelings of fear, worry, unease, and apprehension. Anxiety disorders affect over 40 million adults in the United States each year.
It’s normal to feel anxious before undergoing anesthesia and surgery. Anesthesia involves being put in an unconscious state so you don’t feel pain during surgery. The thought of being unaware and having your life in someone else’s hands can definitely cause anxiety.
However, there are concerns that anxiety could actually interfere with anesthesia and how it works in the body. Let’s explore whether pre-surgery anxiety can “mess with” anesthesia and what you can do to minimize anxiety before a procedure.
Can anxiety affect how anesthesia works?
Research shows that anxiety may influence the effects of anesthesia in a few key ways:
- Increased anesthetic requirements. Anxiety is believed to increase the amount of anesthetic drugs needed to reach the desired level of sedation and pain control during surgery. One study found over 30% higher anesthetic requirements in anxious versus non-anxious surgical patients.
- Higher pain perception. Anxious patients may perceive more pain after surgery, even when given the same anesthetic doses as more relaxed patients. Stress hormones and inflammation linked to anxiety may alter pain signaling pathways in the brain and spinal cord.
- More anesthesia awareness. There are very rare cases where patients recall events or sensations that occurred while under general anesthesia. Anxiety may slightly increase this risk, perhaps because more anesthetic is needed to induce full unconsciousness.
- Worse post-surgery recovery. Anxiety before surgery has been associated with more postoperative pain, slower wound healing, longer hospital stays, and decreased quality of life during recovery. Mechanisms are unclear but may involve subtle effects on the stress response system.
Overall, these findings suggest that high anxiety going into surgery may potentially interfere with how anesthesia works during and after procedures. However, large well-controlled studies are still needed for definitive conclusions.
Why might anxiety influence anesthesia?
Researchers propose a few ways anxiety could theoretically impact the effects of anesthesia:
- Stress hormone effects. Anxious patients have higher levels of cortisol and epinephrine (adrenaline). These stress hormones can quicken metabolism of anesthetic drugs, leading to lower sedation.
- Inflammation. Anxiety may trigger low-grade inflammation through immune system activation. This can alter pain perception and healing after surgery.
- Brain chemistry changes. Chronic anxiety may remodel neural pathways involved in arousal, anxiety, and sensations of pain. This could subtly affect anesthesia requirements and pain levels.
- Psychological factors. Expectations, hypervigilance, and decreased ability to relax could indirectly contribute to worse experiences with anesthesia in anxious individuals.
However, much more research is needed to confirm these proposed mechanisms linking anxiety to anesthesia outcomes.
Risk factors for pre-surgery anxiety
Any surgery comes with a normal level of anxiety, but certain factors may predispose patients to greater anxiety levels before anesthesia and procedures:
- Existing diagnosed anxiety disorder
- First time undergoing anesthesia
- Fear of needles, doctors, hospitals, surgery, pain, losing control
- Negative past experiences with anesthesia
- Prior awareness under anesthesia
- High levels of pre-operative pain or opioid use
- Catastrophic thinking patterns
- Lack of support system
- Younger age groups like children and adolescents
Patients with these types of vulnerabilities may benefit from taking steps to lower pre-surgery anxiety when possible.
Pre-surgery anxiety assessment
If your doctor knows you tend to feel very anxious before medical procedures requiring anesthesia, they may have you complete a short anxiety screening questionnaire. Two common ones are:
- Beck Anxiety Inventory (BAI): 21-item self-report scale rating anxiety symptoms over the past month.
- State-Trait Anxiety Inventory (STAI): 40-item scale discriminating between temporary “state” anxiety and longstanding “trait” anxiety.
High scores indicate clinically significant anxiety levels that could potentially impact anesthesia response. Your anesthesiologist can then tailor a personalized anxiety reduction plan for you before surgery.
Tips to minimize pre-surgery anxiety
If you tend to feel very anxious before undergoing anesthesia, there are many effective ways to minimize worry and ease your mind before procedures:
- Ask your anesthesiologist questions and learn about what to expect.
- Avoid catastrophizing and tell yourself it will go smoothly.
- Practice relaxation techniques like deep breathing, meditation, or mindfulness.
- Distract yourself with positive activities you enjoy.
- Get support from loved ones.
- Make sure you are well-rested and nourished before surgery.
- Consider anti-anxiety medications if anxiety is very severe.
Cognitive behavioral therapy is also helpful for chronic and excessive anxiety interfering with medical procedures. Don’t be afraid to speak up so your care team can help get anxiety under control.
Medications to reduce pre-surgery anxiety
If self-help measures don’t fully control anxiety before surgery, your anesthesiologist may recommend an anti-anxiety medication. Common options include:
|How It Works
|Benzodiazepines (lorazepam, alprazolam)
|Sedative effects through GABA receptor activation in the brain. Used for short-term relief.
|Lowers blood pressure and stress response. May be given as a pill or patch.
|Originally an antiseizure drug but also helps reduce anxiety symptoms.
|Beta blocker that controls rapid heart rate and physical anxiety symptoms.
These are given before surgery and are short-acting so they won’t interfere with anesthesia. They can help mute the extreme anxiety some people experience pre-operatively.
Anesthesia techniques for anxious patients
In addition to anti-anxiety medications, your anesthesiologist has many techniques they can use during the procedure to facilitate adequate sedation if they know you tend to be anxious:
- Higher doses of intravenous anesthesia induction drugs
- Deeper levels of gas anesthetic concentration
- Additional sedative medications like benzodiazepines
- Multi-modal analgesia for optimal pain control
- Local anesthetic nerve blocks near the surgical site
- EEG monitoring of anesthetic brain effects
- Bispectral (BIS) monitoring of anesthetic depth
These tailored approaches help overcome any potential resistance anxiety may create in response to anesthesia. Pre-operative communication about your anxiety can allow anesthesiologists to set up an optimal anesthesia plan.
Possible risks of untreated pre-surgery anxiety
While more research is still needed, possible consequences of leaving severe anxiety untreated before surgery may include:
- Need for more anesthesia medication
- Increased risk of intraoperative awareness
- More postoperative pain
- Slower recovery
- Longer hospital stay
- Higher risk of complications
- Worse overall surgical experience
That’s why it’s important to discuss managing anxiety long before any elective surgery when possible. This gives time to bring anxiety down to more optimal levels beforehand.
Seeking help for anxiety before surgery
If you have a diagnosed anxiety disorder or find you become extremely anxious before any medical procedures, it’s important to get help. Your primary doctor or anesthesiologist can refer you to resources like:
- Mental health therapist
- Anxiety support groups
- Mindfulness training
- Stress management classes
You don’t have to just put up with debilitating anxiety around anesthesia and surgery. A variety of effective solutions exist, so don’t hesitate to ask your physicians for guidance finding anxiety relief.
- Anxiety before surgery is common but may potentially impact how anesthesia works in some patients.
- Proposed effects include higher anesthetic requirements, greater pain, and slower recovery.
- Risk factors for high pre-surgery anxiety include past negative experiences, anxiety disorders, fear of medical procedures, and insufficient support.
- Relaxation strategies, anti-anxiety medications, tailored anesthesia plans, and therapy can help minimize anxiety.
- Communication with your anesthesiologist is key for best anesthesia experience if you are very anxious.
The bottom line
Anxiety is never helpful before undergoing anesthesia and surgery. While more research is warranted, extreme anxiety potentially could interfere with anesthesia effects. Speaking up about anxiety concerns well in advance allows your medical team to take steps for best outcomes. Don’t hesitate to utilize anti-anxiety medications and therapies so anxiety is well-controlled before any elective procedures requiring anesthesia.