The patient holds their eyes wide open, transfixed with fear as the anesthesiologist swiftly motions a face mask forward (see figure). Numbly watching, the patient has a vivid recollection of the doctor mentioning “gas mixture” and “sevoflurane” from 2 days before. “This is it, it’s happening,” ruminates the patient, anxiously preparing as the mask inches closer. Two more doctors loom over, gently whispering to the patient “count down from 10,” in hopes of distracting the patient as the gases take their effect. It is clear that the act of administering inhalational anesthesia is striking fear and anxiety in the patient. As the countdown continues, the uncertainty with going under begins to plague the patient’s mind with fear-ridden thoughts: “What if I’m not fully asleep during the operation? What if I don’t wake up after?” But, amid the turmoil, the eyes will eventually close and the patient will drift into unconsciousness as the anesthesiologist assumes responsibility over the care of the patient.

This multimedia art piece captures the sentiment of fear among patients toward general anesthesia. The thoughts of going under send shivers down the spines of many people. To some, the thought of undergoing general anesthesia is a more terrifying ordeal than the surgery itself; others may so much as cancel their operation.1  While anxiety may be a common experience among patients, it does not come without risks and complications.

As our anxious patient now lies anesthetized in the operation theater, higher anesthetic doses may be required to maintain an acceptable level of sedation for the procedure to go smoothly. Even after the patient opens their eyes in the recovery room, a wave of postoperative psychologic distress may overwhelm them—remnants of their initial fear. Not to mention, greater analgesia use may be needed to subdue the physical pain paralyzing their body as the effects of the general anesthesia wear off.2,3 

Given the negative consequences of patient anxiety, it begs the question: How do anesthesiologists help anxious patients going into surgery? The preoperative role of an anesthesiologist becomes increasingly important here. Apart from thoroughly examining the patient and their history to develop a safe anesthetic plan, anesthesiologists also establish a trusting physician–patient relationship through a preanesthesia interview.2,4  In a series of questions addressing general anxiety to specific anesthesia-related worries, a patient may transition from being anxious to completely confident before operation. In fact, many patients report reduced fear of anesthesia as well as increased reassurance and satisfaction after preanesthesia interviews—illustrating the power of communication.2 

In retrospect, perhaps our patient (see figure) simply needed reassurance going into their operation. Conceivably, having concerns addressed may have been enough for the patient to go from being anxiety stricken to peacefully counting down as the inhaled gas drifts them into slumber.

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