Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.
Anxiety related to surgery is a common phenomenon. Between roughly a quarter and four-fifths of patients admitted for surgery report meaningful preoperative distress, and reported rates in the ambulatory setting range even more broadly across studies (Stamenkovic et al., 2018; Wang et al., 2022). Anxious patients tend to require higher doses of induction and maintenance anesthetics, report more severe postoperative pain, require more analgesia, and in some surgical populations show worse wound healing, longer hospital stays, and even increased cardiovascular morbidity and mortality (Stamenkovic et al., 2018; Wilson et al., 2015). Because these downstream effects are modifiable, screening for and treating anxiety associated with surgery deserves systematic attention, and clinicians should utilize a variety of pharmacological and non-pharmacological treatment strategies.
Mitigation begins with recognizing who is most vulnerable. Female sex is the most reproducible risk factor across studies, and younger age, a history of cancer, prior psychiatric illness, smoking, and poor sleep are all associated with elevated anxiety levels (Wilson et al., 2015; Stamenkovic et al., 2018). Notably, patients undergoing procedures under regional or local anesthesia present a distinct anxiety profile: rather than being primarily concerned with the surgery itself, apprehension is typically generated by anxiety about being awake, feeling the surgeon’s touch, or hearing conversations in the operating room. This anxiety, along with patients receiving inadequate anesthetic information, independently predicts higher day-of-surgery anxiety (Mitchell, 2008). Several validated instruments exist for formal assessment, including the lengthier State-Trait Anxiety Inventory, the brief Amsterdam Preoperative Anxiety and Information Scale, and single-item tools such as the Visual Analogue Scale for Anxiety, which many clinicians favor for its speed and ease of use in busy preoperative clinics (Stamenkovic et al., 2018; Wilson et al., 2015).
Pharmacological management is a particularly beneficial tool for patients with higher levels of anxiety related to surgery. It typically takes the form of benzodiazepines such as midazolam or alprazolam, though these carry risks of sedation, respiratory depression, and psychomotor impairment and are unsuitable for patients with histories of substance use (Wilson et al., 2015). Gabapentinoids, clonidine, and, in some trials, mirtazapine or melatonin have shown anxiolytic benefit with fewer sedative side effects, although evidence for pregabalin and lorazepam has been inconsistent, and current Enhanced Recovery After Surgery guidance discourages routine sedative premedication (Stamenkovic et al., 2018; Wilson et al., 2015).
Non-pharmacological interventions have consequently gained traction as first-line or adjunctive strategies for treating surgical anxiety. Structured preoperative education and clear communication from surgeons, anesthesiologists, and nurses consistently reduce anxiety, particularly when delivered one to two weeks before surgery rather than the night before (Stamenkovic et al., 2018; Wilson et al., 2015). Cognitive behavioral therapy, music, guided imagery and relaxation, massage, hypnosis, and aromatherapy each have supporting evidence, though effect sizes vary and access to trained practitioners for CBT or hypnosis can be limited outside specialized centers (Wang et al., 2022). For patients undergoing conscious surgery under regional or local anesthesia, simple measures such as explaining anesthetic duration, maintaining verbal contact intraoperatively, and offering touch or hand-holding meaningfully reduce apprehension (Mitchell, 2008).
No single approach suits every patient. Because pharmacological and non-pharmacological methods for management of anxiety associated with surgery differ in cost, availability, side-effect profile, and patient acceptability, an individualized, often multimodal strategy is ideal (Stamenkovic et al., 2018; Wang et al., 2022).
References
- Mitchell, M. (2008). Conscious surgery: influence of the environment on patient anxiety. Journal of Advanced Nursing, 64(3), 261–271. https://doi.org/10.1111/j.1365-2648.2008.04769.x
- Stamenkovic, D. M., Rancic, N. K., Latas, M. B., Neskovic, V., Rondovic, G. M., Wu, J. D., & Cattano, D. (2018). Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiologica, 84(11), 1307–1317. https://doi.org/10.23736/S0375-9393.18.12520-X
- Wang, R., Huang, X., Wang, Y., & Akbari, M. (2022). Non-pharmacologic approaches in preoperative anxiety, a comprehensive review. Frontiers in Public Health, 10, 854673. https://doi.org/10.3389/fpubh.2022.854673
- Wilson, C. J., Mitchelson, A. J., Tzeng, T. H., El-Othmani, M. M., Saleh, J., Vasdev, S., LaMontagne, H. J., & Saleh, K. J. (2015). Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes. The American Journal of Surgery. https://doi.org/10.1016/j.amjsurg.2015.03.023