Effect Of Anesthesia Outpatient Education On Pre-Operative Anxiety Of Pregnant Women Undergoing Cesarean Section

Objective: The incidence rate of antenatal anxiety among pregnant women in China is as high as 8% to 68%,among which the incidence rate of antenatal anxiety is higher for cesarean section women due to the need for medical operations such as surgery and anesthesia.As an important link of preoperative visits and education,the anesthesia clinic can provide preoperative consultation and humanistic care for pregnant women,and help alleviate their adverse preoperative emotions.The purpose of this study was to explore the impact of anesthesia outpatient education on anxiety before cesarean section in pregnant women.Method: This is a single center case control study.From June 1,2021 to August30,2021,women with ASA(American Society of Anesthesiologists)II～III who were scheduled for elective cesarean section under spinal anesthesia were assessed for eligible.State Anxiety Scale(SAI)were used to assess the anxiety state of women undergoing elective cesarean section on the day before surgery.This study explored the relationship between anesthesia outpatient education and moderate to severe preoperative anxiety through binary logistic regression analysis.The primary outcome of the study was moderate to severe anxiety in the pregnant women before surgery,while the secondary outcome was the fear of anesthesia and perioperative pain in the pregnant women before surgery.In addition,this study conducted a stratification analysis of pregnant women with different levels of prenatal depression based on the Edinburgh Postnatal Depression Scale(EPDS)score.SAI score served as the outcome variable,a multivariate linear regression analysis was conducted for sensitivity analysis.Results: A total of 226 pregnant women participated in the study.Among them,83(36.7%)parturients experienced moderate to severe preoperative anxiety before delivery,with a mean SAI score of 45.4 ± 5.3(mean ± standard deviation).Preoperative education at anesthesia outpatient was associated with lower risk of moderate to severe preoperative anxiety(OR = 0.23,95% CI: 0.10,0.52,P < 0.001).The results of a stratification analysis of depression among all pregnant women based on the EPDS score showed that the above associations were statistically significant in pregnant women with lower levels of depression(EPDS score < 10)and higher levels of depression(EPDS score≥10).In addition,the sensitivity analysis results suggest that receiving anesthesia outpatient education is associated with lower preoperative SAI scores(β =-4.18,95% CI:-6.32,-2.05,P < 0.001).Anesthesia outpatient education is associated with less fear of anesthesia(OR = 0.32,95% CI: 0.14,0.74;P = 0.01)and less fear of postoperative pain(OR = 0.53,95% CI: 0.26,1.10;P = 0.01).Conclusion: Preoperative anesthesia outpatient education is associated with a lower risk of moderate to severe preoperative anxiety,and a lower risk of preoperative fear of anesthesia or pain for parturients who were scheduled for cesarean section.Among parturients with lower and higher levels of depression,preoperative anesthesia outpatient education is associated with a lower risk of moderate to severe preoperative anxiety.