Journal of Anesthesia

, Volume 33, Issue 2, pp 250–256 | Cite as

A survey of anesthetic preference and preoperative anxiety in hip and knee arthroplasty patients: the utility of the outpatient preoperative anesthesia appointment

  • Gita RaghavanEmail author
  • Vidur Shyam
  • John A. C. Murdoch
Original Article



The general public’s perceptions of anesthesia and the risks associated with it may be skewed. The outpatient preoperative appointment with an anesthesiologist allows for patient education regarding different anesthetic options and counseling regarding anxiety related to anesthesia and surgery. This study investigates whether the preoperative appointment for hip and knee arthroplasty alters patient preference for general or spinal anesthesia and reduces patient anxiety.


Sixty-two patients undergoing hip or knee arthroplasty were administered two verbal questionnaires at the preoperative clinic. The first questionnaire was completed prior to meeting the anesthesiologist and addressed patient anesthetic preferences, previous anesthetic experiences, and perioperative anxiety and need for information using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The second questionnaire was completed immediately following the appointment and addressed the patient’s anesthetic preference, reasons for any preference changes, and anxiety levels and need for information using the APAIS. The clinic anesthesiologist was blinded to the nature of the study.


Following the clinic appointment, a significant decrease in patients wanting general anesthesia (from 48 to 18%, P < 0.001) and a significant increase in patients wanting spinal anesthesia (from 39 to 76%, 95%, P < 0.01) was noted. A significant decrease in overall anxiety and anxiety related to the patients’ upcoming surgeries and need for information was also noted.


The preoperative anesthesia meeting serves an important role in educating patients regarding anesthesia, and can influence patients’ choice of anesthetic while also reducing overall patient anxiety.


Regional anesthesia Preoperative anxiety 



We would like to thank Joelle B. Thorpe, PhD for her editorial advice and for her help in preparing this manuscript for publication. We would also like to thank Rachel Phelan, MSc for her assistance with statistical analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

540_2018_2608_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 KB)
540_2018_2608_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 KB)


  1. 1.
    Matthey PW, Finegan BA, Finucane BT. The public’s fears about and perceptions of regional anesthesia. Reg Anesth Pain Med. 2004;29:96–101.CrossRefGoogle Scholar
  2. 2.
    Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, Murad MH, Mantilla CB. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016;116:163–76.CrossRefGoogle Scholar
  3. 3.
    Jankowski CJ, Hebl JR, Stuart MJ, Rock MG, Pagnano MW, Beighly CM, Schroeder DR, Horlocker TT. A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2003;97:1003–9.CrossRefGoogle Scholar
  4. 4.
    Maurer SG, Chen AL, Hiebert R, Pereira GC, Di Cesare PE. Comparison of outcomes of using spinal versus general anesthesia in total hip arthroplasty. Am J Orthop. 2007;36(7):E101–6.Google Scholar
  5. 5.
    Memtsoudis SG, Sun X, Chiu YL, Stundner O, Liu SS, Banerjee S, Mazumdar M, Sharrock NE. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118:1046–58.CrossRefGoogle Scholar
  6. 6.
    Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J Anesth. 2014;28:222–7.CrossRefGoogle Scholar
  7. 7.
    Moerman N, van Dam FSAM, Muller MJ, Oosting H. The Amsterdam preoperative anxiety and information scale (APAIS). Anesth Analg. 1996;82:445–51.Google Scholar
  8. 8.
    Sosis MB, Parnass SM, McCarthy RJ, Braverman B, Watson G, Halter T. Spinal phobia: survey results of patient attitudes and preferences regarding anesthesia. J Clin Anesth. 1995;7:389–93.CrossRefGoogle Scholar
  9. 9.
    Shevde K, Panagopoulos G. A survey of 800 patients’ knowledge, attitudes, and concerns regarding anesthesia. Anesth Analg. 1991;73:190–8.CrossRefGoogle Scholar
  10. 10.
    Lam E, Lee M, Brull R, Wong DT. Effect of anesthesia consultation on patients’ preoperative concerns. Can J Anesth. 2007;54:853–4.CrossRefGoogle Scholar
  11. 11.
    Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial blocks: the 3rd National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102(2):179–90.CrossRefGoogle Scholar
  12. 12.
    Boker A, Brownell L. Donen N. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Can J Anesth. 2002;49:792–8.CrossRefGoogle Scholar
  13. 13.
    Calvin RL, Lane PL. Perioperative uncertainty and state anxiety of orthopaedic surgical patients. Orthop Nurse. 1999;18:61–6.Google Scholar
  14. 14.
    Groves ND, Humphreys HW, Williams AJ, Jones A. Effect of informational internet web pages on patients’ decision-making: randomised controlled trial regarding choice of spinal or general anesthesia for orthopaedic surgery. Anaesthesia. 2010;65:277–82.CrossRefGoogle Scholar
  15. 15.
    Matthey P, Finucane BT, Finegan BA. The attitude of the general public towards pre-operative assessment and risks associated with general anesthesia. Can J Anaesth. 2001;48:333–9.CrossRefGoogle Scholar
  16. 16.
    Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, Chan VWS. A survey of orthopedic surgeons’ attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004;98:1486–90.CrossRefGoogle Scholar
  17. 17.
    Nelson FV, Zimmerman L, Barnason S, Nieveen J, Schmaderer M. The relationship and influence of anxiety on postoperative pain in the coronary artery bypass graft patient. J Pain Symptom Manag. 1998;15:102–9.CrossRefGoogle Scholar
  18. 18.
    Kunihiro M, Somura H, Matsumoto M, Sakabe T. Changes in psychological features in patients for anesthesia and operation during perioperative period. Masui. 1998;47:1085–9 (in Japanese with English abstract).Google Scholar
  19. 19.
    Fitzgerald BM, Elder J. Will a 1-page informational handout decrease patients’ most common fears of anesthesia and surgery? J Surg Educ. 2008;65:359–63.CrossRefGoogle Scholar
  20. 20.
    Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. Br J Anaesth. 2010;104(3):369–74.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  • Gita Raghavan
    • 1
    • 2
    Email author
  • Vidur Shyam
    • 1
  • John A. C. Murdoch
    • 1
  1. 1.Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences CentreQueen’s UniversityKingstonCanada
  2. 2.Department of AnesthesiaMount Sinai HospitalTorontoCanada

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