Preoperative anxiety and implications on postoperative recovery: what can we do to change our history.

Preoperative anxiety can influence the intensity of postoperative pain and anesthesia and analgesia requirement. In certain types of surgery, anxiety may even increase postoperative morbidity and mortality. The goal of this narrative review is to remind anesthesiologists that anxiety measurement using specific tools can be done in clinical practice, to present the implications of preoperative anxiety on postoperative patient recovery, and to acknowledge the importance of a dedicated anesthesia plan in the management of anxious adult patients. Preoperative assessment performed several weeks before surgery in an outpatient clinic is a reasonable option to give information about surgery, anesthesia and postoperative pain. This is the time to assess patient preoperative anxiety by using VAS-A. If high anxiety level is detected early, the patient can be referred to a psychologist for preoperative preparation. This is consistent with the guidelines for enhanced recovery after surgeries, which underline the importance of patient-doctor discussion about hospitalization and perioperative care. Patients with preoperative anxiety could benefit from multimodal analgesia, including non-pharmacological methods, such as cognitive therapy and music therapy and relaxation. The authors' opinion is that greater education about preoperative anxiety consequences in the surgical community is needed. A systemized approach and guidelines about the management of preoperative anxiety should be followed.