Relationship between patients’ pre-operative anxiety level and administration of anxiolytic premedication

Document Type

Article

Publication Date

3-3-2026

Abstract

Objective: To evaluate the relationship between the patient’s reported level of preoperative anxiety, the anaesthesiologist’s assessment of the patient’s anxiety level and the administration of anxiolytic premedication prior to entering the operating room. Methods: Patient pre-operative anxiety levels were assessed using a simple visual analogue scale (0 = no anxiety to 10 = severe anxiety) in the pre-operative holding area. The anaesthesiologist independently visually assessed the patient’s level of anxiety on a similar zero to ten anxiety rating scale at the time of their pre-operative interview. Immediately after completing their pre-operative evaluation, the anaesthesiologist decided whether to order the administration of an anxiolytic medication prior to the patient entering the operating room. Results: Based on the anxiety score reported by 293 patients on the numeric analogue scale, 171 patients (58%) reported no-to-low levels of anxiety (scores ≤3) and 122 (42%) reported moderate-to-high levels of anxiety (scores ≥4). Based on the observational assessment by the anaesthesiologists, 205 (70%) of the patients were assigned an anxiety score of 3 or less and 88 (30%) were assigned an anxiety score of 4 or more. Overall, 188 out of the 293 patients (64%) received parenteral anxiolytic premedication. However, only 61 of 122 (50%) patients reporting moderate-to-high levels of anxiety received an anxiolytic medication prior to entering the operating room. Surprisingly, 127 of 171 (74%) patients reporting little or no anxiety were administered an anxiolytic drug. Interestingly, there was no significant difference in the average anxiety scores of patients who received anxiolytic premedication and those who did not. Conclusions: These data suggest that anaesthesia providers’ observation of the patient did not accurately assess the patient’s level of acute anxiety and the need for anxiolytic premedication. This results in both undertreatment of anxious patients and overtreatment of patients with low levels of anxiety. Perioperative nurses are uniquely positioned to improve the appropriate use and administration of anxiolytic drugs in the pre-operative holding area by incorporating a pre-operative assessment of the patient’s acute anxiety as part of their routine perioperative nursing assessment. This nurse-centric approach could also facilitate the communication of objective data regarding the patient’s reported anxiety level to the anaesthesia team, enabling them to improve their decision-making process regarding the use of premedication in the preoperative period.

Publication Title

Journal of Perioperative Nursing

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