BACKGROUND: Preoperative anxiety has been identified as a health concern in perioperative care because prior research has shown that most patients undergoing surgery would experience some degree of anxiety. OBJECTIVE: To evaluate preoperative anxiety and anesthesia-related fears adult patients undergoing surgery under anesthesia. METHOD: A cross-sectional study was conducted among 392 surgical patients who underwent under anesthesia. Preoperative anxiety was assessed by using STAIS. Binary regression was used to find out the factors affecting preoperative anxiety. SPSS 27 was used for analysis. A -value of < 0.05 was considered statistically significant. RESULTS: Prevalence of a preoperative high STAI (State and Trait Anxiety Inventory Scale) (52.6%), fear of death (40.5%), fear of unable to recover (54.8%), fear of intraoperative pain (53.8%), and fear of awareness (40.8%) are statistically significant anesthesia-related causes for preoperative anxiety. CONCLUSION: The prevalence of anxiety was considered to be high. Fear of death, fear of being unable to recover, fear of intraoperative pain, and fear of awareness are statistically significant anesthesia-related causes of preoperative anxiety. No prior exposure of anesthesia and surgery, female gender, emergency procedure, and pre-existing chronic diseases are significantly associated risk factors for preoperative anxiety.