Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Br J Anaesth. 2012 Jan;108(1):119-25. doi: 10.1093/bja/aer305. Epub 2011 Nov 13.
Psychological factors are thought to drive inter-patient variations in anaesthetic and analgesic requirements. This cross-sectional study investigated whether preoperative psychological factors can predict anaesthetic requirements and postoperative pain.
Before total thyroidectomy, 100 consecutive women completed the Spielberger's State-Trait Anxiety Inventory (STAI) and the pain sensitivity questionnaire (PSQ). Target-controlled propofol was administered for induction of anaesthesia, and sevoflurane-oxygen-air was given to maintain equal depths of anaesthesia, as determined by bispectral index (BIS) monitoring.
Patients with higher anxiety scores (state and trait) required greater amounts of propofol to reach light (BIS=85) and moderate (BIS=75) levels of sedation, but only trait anxiety was significantly associated with propofol requirements in reaching a deep level of sedation (BIS=65). The MAC-hour of sevoflurane was significantly correlated only with PSQ scores. The postoperative pain intensity was significantly correlated with both STAI and PSQ.
Preoperative anxiety and pain sensitivity are independent predictors of propofol and sevoflurane requirements in general anaesthesia. Anaesthetic and analgesic doses could be modified based on the patient's preoperative anxiety and pain sensitivity.
心理因素被认为是导致患者间麻醉和镇痛需求差异的原因。本横断面研究旨在探讨术前心理因素是否可预测麻醉需求和术后疼痛。
在甲状腺全切术前行，100 例连续女性患者完成了状态特质焦虑量表（STAI）和疼痛敏感问卷（PSQ）。采用靶控输注丙泊酚诱导麻醉，并用七氟醚-氧-空气维持麻醉深度，以脑电双频指数（BIS）监测。
焦虑评分较高（状态和特质）的患者需要更多的丙泊酚才能达到轻度（BIS=85）和中度（BIS=75）镇静水平，但只有特质焦虑与丙泊酚达到深度镇静水平（BIS=65）时的需要量显著相关。七氟醚的 MAC 小时数仅与 PSQ 评分显著相关。术后疼痛强度与 STAI 和 PSQ 均显著相关。
术前焦虑和疼痛敏感性是全身麻醉中丙泊酚和七氟醚需求的独立预测因素。可以根据患者术前的焦虑和疼痛敏感性来调整麻醉和镇痛剂量。
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