The effect of pre-procedure anxiety on sedative requirements for sedation during upper gastrointestinal endoscopy

Three hundred patients between the ages of 18-70 yr, ASA physical status I and II, scheduled to undergo planed upper gastro intestinal endoscopy, were studied. Fasting periods were in accordance with ASA guidelines. All patients were prepared to upper gastro intestinal endoscopy as a standard protocol. Baseline anxiety levels were measured before the procedure while patients waited in the reception area. Each patient was asked to complete Spielberger’s State-Trait Anxiety Inventory (STAI) form X. The STAI measures both state and trait anxiety. STAI-X is subdivided into two different scales, STAI-X1 and -X2, used to evaluate state anxiety and trait anxiety, respectively. The STAI-X1 (State Anxiety) contains 20 items based on a 4-point Likert scale and ask the respondent how they feel “right now”. The total score may range from 20 to 80, with higher scores representing more severe anxiety. The STAI has no established categories, but a cutoff score of 40 has been used to identify patients with high/very high anxiety. The validity and reliability of the Turkish versions of these instruments have been validated . Immediately after the admission into the reception area, the patients were asked to fill out the STAI-X1 questionnaire. Data were collected by an anaesthetist who was blind to sedation procedures. A 20-gauge IV catheter was inserted in the right forearm before the patient arrived in the operating room. 0.9% saline infusion was used to keep the IV line open. BIS monitoring (BIS Monitor, Aspect 2000TM XP, USA) was applied to all patients in addition to routine monitoring (consisting of a pulse oximeter, 3-lead ECG and a non-invasive blood pressure cuff). After baseline measurements (haemodynamic profiles and BIS values) were obtained, the patient was placed in the left lateral position. Supplemental oxygen (4 l.min-1) was administered through a nasal canula.One milligram of midazolam were administered intravenously. Next, an initial intravenous dose of propofol (0.3–0.5 mg/kg of body weight) was administered, followed by repeated 10–20 mg doses so as to achieve BIS values 65-85 or the patient expressed discomfort. All drugs were administered until completion of endoscopy. Other medications, including analgesics, were not used in the present study. All sedation procedures were practised by an anaesthetist who was blind to pre-procedure anxiety scores.If there were any symptoms of respiratory depression or airway obstruction, a simple jaw thrust or chin lift maneuvers was performed. All endoscopies, also blinded to the anxiety scores, were performed by one of three endoscopists, each of whom had performed more than 300 endoscopies before participating in the study. Endoscopist satisfaction were evaluated immediately after procedure by using a 10-cm visual analog scale. Patient satisfaction was measured using a 10-cm visual analog scale when the patients with a modified Aldrete score higher than or equal to 9. Doses of propofol, total procedure time, satisfaction of patients and endoscopists and BIS values (Basal,after initial dose of propofol, at the second minute of the procedure, at the end of procedure) were recorded. Complications associated with the procedure (Abdominal distension, abdominal pain, nausea and vomiting) were also analyzed. We also recorded any complications associated with sedation (i.e. oxygen saturation < 90 %, blood pressure < 90/50 mm Hg, heart rate < 50 bpm).