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Usefulness of pre-anesthetic consultation to reduce the degree of anxiety in patients scheduled for surgical intervention
Utilidad de la consulta preanestésica para disminuir el grado de ansiedad en pacientes programados para intervención quirúrgica
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"apellidos" => "Peral" "email" => array:1 [ 0 => "davidperalsanchez@yahoo.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hospital Universitario de La Plana, Vila-real, Castellón, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Provincial de Castellón, Castellón, España, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad Jaime I, Castellón, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la consulta preanestésica para disminuir el grado de ansiedad en pacientes programados para intervención quirúrgica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1277 "Ancho" => 2124 "Tamanyo" => 71791 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Level of anxiety of patients before and after the pre-anaesthesia evaluation. The columns show the total number of patients with each anxiety level. STAI 1 *: before the evaluation; STAI 2 **: after evaluation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anxiety is a subjective pathological state characterized by excessive and persistent worry that the patient finds hard to control and that has a significant impact on their lifestyle.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This disorder can be aggravated by different situations that involve physical or mental aggression.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Specifically, preoperative anxiety is defined as a state of dissatisfaction or discomfort secondary to surgery, hospitalization and anaesthesia. It is a common phenomenon, with an incidence that can range from 30% to 90% of cases.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Its intensity can vary from nervousness to a panic attack.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have shown that this type of anxiety can appear several weeks before the intervention itself, and that anxious patients make slower progress (greater need for sedatives, poorer compliance with preoperative and fasting rules, greater consumption of analgesics, and slow surgical wound healing).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The most frequent sources of anxiety in patients before a surgical intervention are the fear of pain, fear of death, fear of the outcome of the intervention and of anaesthesia, among others, although these fears are modulated by the patient’s personality, their previous experience, and their baseline trait anxiety.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The level of anxiety is usually assessed subjectively by the anaesthesiologist in the pre-anaesthesia consultation, although ideally it should also be measured objectively using specific clinical tests, for example, the Depression, Anxiety and Stress Scale, the Visual Analogue Anxiety Scale, the Taylor Anxiety Scale, or the Amsterdam Information and Preoperative Anxiety Scale. However, the pressures of work and the number of questions included in these tests make their administration impractical. One of the most widely used tests in clinical practice is the State-Trait Anxiety Inventory (STAI).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Although this questionnaire is also lengthy, a shorted version has been developed.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Various strategies have been used to reduce patient anxiety, obtain their cooperation, and increase their satisfaction, such as music therapy,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> hypnosis<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and, of course, the administration of anxiolytic drugs.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> We, like other authors, believe that listening to the patient and giving them all the information they need will reduce their anxiety,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and that this reduced level of anxiety can be determined by administering an anxiety assessment test and measuring biological variables such as heart rate and blood pressure. For this reason, we performed this study to test our hypothesis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">After obtaining approval from the Ethics Committee, we performed a single-centre, observational, prospective study to assess the variation in the level of preoperative anxiety after the pre-anaesthesia visit, and to determine whether these changes could also be quantified physiologically by measuring heart rate and blood pressure. We also evaluated the possible relationship between the level of anxiety and different demographic and surgical variables.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was performed out in the consultation room of the Anaesthesia Service of the Provincial Hospital of Castellón (Spain). Patients of legal age, ASA I-III, scheduled for non-oncological surgery, with or without a history of previous surgeries, with no language or comprehension barrier, who gave their informed consent to participate were included in the study. Patients who did not give their consent, who presented cognitive deficits, language barriers, or a previous diagnosis of anxiety, depression or other psychiatric disorders, as well as arterial hypertension or cardiac arrhythmia, were excluded.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Non-probability convenience sampling was used to select consecutive patients seen in the consultation who fulfilled the inclusion criteria. The sample size was calculated on the basis of the incidence of anxiety reported in previous studies, assuming a power of 90% and an alpha error of 0.05. A total of 90 patients were finally included.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the first stage, after obtaining the patient's consent, one of the researchers collected sociodemographic data (age, sex, level of education), biological data (heart rate and blood pressure), and level of anxiety according to the abbreviated STAI scale. Scores on this scale range from 0 to 18 points, with a score of 6 points or less indicating mild anxiety, a score of between 7 and 12 points moderate anxiety, and a score of more than 12 points indicating severe anxiety (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">In a second stage, another anaesthesiologist who was blinded to the observed anxiety levels performed the pre-anaesthesia visit according to their usual practice. During this consultation, they described the procedure to the patient and answered their questions about the surgery and anaesthesia. The patient was then scheduled for either outpatient or inpatient surgery, and was asked whether he or she preferred general or regional anaesthesia.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the last stage of the study, and after receiving this information, the patient was seen again by the first investigator, who collected the initial variables again.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using IBM SPSS Statistics for Windows v24. Demographic and clinical variables were analysed descriptively, using mean and standard deviation for normally distributed variables and median and interquartile range for those with non-normal distribution. The Wilcoxon test was used to evaluate biological variables and the level of anxiety before and after the consultation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patient demographics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was 62.5 years, most patients were female (58%), classified with ASA-II physical status. Most of the patients had been educated up to the secondary level, and most underwent outpatient procedures. When asked about their anaesthesia preference, most patients chose regional anaesthesia (peripheral blocks or spinal anaesthesia) over general anaesthesia.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Both biological variables (blood pressure and heart rate) and the degree of anxiety according to the abbreviated STAI were evaluated before and after the patient had received information on their specific procedure from an independent anaesthesiologist.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The level of anxiety is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. Patients that scored more than 6 on the scale were considered anxious. Baseline anxiety among patients was 5 points on the STAI (IQR 3–9), with 64.4% exhibiting mild anxiety (≤6 points), 27.8% moderate anxiety (7–12 points), and 7.9% severe anxiety (> 12 points). Therefore, the prevalence of pre-surgical anxiety before the anaesthesia consultation was 35.7%.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After the pre-anaesthesia consultation, the mean anxiety level fell to 4 points on the STAI (IQR 2–6.25), with 75.6% of patients exhibiting mild anxiety, 22.2% moderate anxiety, and 2.2% severe anxiety. In other words, the prevalence of pre-surgical anxiety after the consultation fell to 24.4% - a difference that was statistically significant (p = 0.005).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Univariate logistic regression was performed to determine whether some of the sociodemographic variables could be considered predictors of anxiety; however, none were found to correlate significantly with a particular level of anxiety.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The decrease in the STAI score was not influenced by the sociodemographic variables considered (sex, ASA, outpatient vs. inpatient procedure, anaesthesia technique or level of education).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The results show that the higher the initial score on the abbreviated STAI, the greater the subsequent reduction in anxiety levels (p = 0.009).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Changes in the biological variables measured at the 2 study time points are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The differences observed in these variables before and after the consultation were not statistically significant.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The results obtained in our study appear to support our hypothesis and emphasize the importance of using the pre-anaesthesia consultation not only to detect potential surgical or anaesthesia-related risks, but also to reduce anxiety and facilitate the entire perioperative process by providing patients with the correct information.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of anxiety in our sample (almost 36%) can be considered similar to that reported in other studies carried out in European populations with similar characteristics.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The sociocultural factors specific to each region are undoubtedly highly relevant when evaluating this problem. A situation that for us may be considered normal, in other cultures can be transformed into a real health problem.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Detecting, preventing and treating patient anxiety should be a fundamental part of perioperative care; however, given the number of different factors involved, this condition can sometimes be overlooked.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Nevertheless, its importance is beyond question, since evidence has shown preoperative anxiety to be a predictor of worse intraoperative evolution. This may be due to poor compliance with preoperative indications, a greater need for sedative drugs, opioid consumption and, in general, a longer hospital stay, with the corresponding increase in costs.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Despite its small sample size, the predictors of anxiety identified in our study differ from those observed in other similar investigations.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,17</span></a> For example, in our sample female sex was not a risk factor for anxiety. This discrepancy may be explained by the mean age of our sample (which in itself was not a risk factor) and the likelihood of our patients presenting a history of prior surgeries (note, however, that the ASA class was not a risk factor).</p><p id="par0125" class="elsevierStylePara elsevierViewall">Neither were we able to identify a correlation between the patient’s level of education and their risk of anxiety. In fact, it has been suggested that both a high and low cultural level can promote anxiety - in the first case, because the patients are more aware of the possible risks of the procedure, and in the second, because they are unable to rationalize this fear. However, patients at both ends of this scale can tackle their fears either by being more receptive and understanding the information given, or by choosing the ignore the risks and downplay their importance.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">One of the factors of most concern to patients is the surgical regimen (outpatient or inpatient). On the one hand, many patients prefer to be admitted to hospital because they feel safer in the knowledge that they will receive qualified care should they need it. However, other patients are reluctant to stay in hospital, and clearly benefit from family contact and a known and controlled environment, such as their home. Our data did not show a clear correlation between patient anxiety and surgical regimen.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The fear of anaesthesia and losing control of the situation is one of the factors that favour the appearance of anxiety, and one of the best known by clinicians. However, it is unclear whether the patient’s level of fear varies according to the type of anaesthesia administered.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> According to our data, this factor was not associated with a greater level of anxiety.</p><p id="par0140" class="elsevierStylePara elsevierViewall">We believe it is important to have access to a reliable method for evaluating the patient’s level of anxiety and the extent to which it diminishes over time as a result of the preventive and therapeutic strategies implemented. Clinical judgement based on observation and experience is the most widely used method; however, it is a subjective and highly variable approach. The use of more objective, reproducible methods, such as specific anxiety assessment scales, could improve our evaluation of this problem and show the effectiveness of the correctives strategies used.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Another approach involves the biological variables measured on a daily basis in pre-anaesthesia consultations. Collecting these variables does not alter in any way the consultation procedure, and complements the information obtained from the other assessment tools. The most common variable used is heart rate and blood pressure, although other indirect measures of anxiety can also be taken, such as increased oxygen consumption, pupil dilation, increased sweating, and even biochemical changes and clotting disturbances.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The findings of our study show that the patient’s level of anxiety diminishes after the pre-anaesthesia consultation. We believe, like other authors, that establishing a good rapport and a relationship of trust with the patient can help reduce anxiety. However, because of time limits and the pressures of work, the pre-anaesthesia consultation is usually limited to collecting clinical information related to the surgery, without paying due attention to other aspects such as anxiety. Other non-pharmacological methods have been used with variable success in the literature, such as music therapy<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> or explaining procedures using audiovisual or multimedia material.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However, we believe that these merely complement, but never replace, the clinical interview in which the anaesthesiologist answers each patient’s questions on an individual basis with clear, easily understood information. In our study, the pre-anaesthesia interview was always performed by the same clinician using a standardised clinical assessment based on the recommendations of scientific societies, and we expect that the results obtained in other hospitals will be very similar to ours.</p><p id="par0150" class="elsevierStylePara elsevierViewall">We therefore consider that the correct conduct of the pre-anaesthesia interview - a simple intervention with no side effects or additional costs - has important clinical benefits. All that is needed is a little extra time during the consultation, although given the pressures of modern healthcare, finding this time may prove difficult.</p><p id="par0155" class="elsevierStylePara elsevierViewall">This study has several limitations. The sample size is too small to draw firm conclusions, although we do not believe that increasing it would have disproved our hypothesis. Being a single-centre study, its internal validity is high, but extending the study to other hospitals would give our conclusions more consistency. We decided to exclude patients with prevalent diseases, such as anxiety or arterial hypertension, so that the patient’s background treatment would not be a potential source of interference in the measurement tools used. Furthermore, ignoring whether the patient had a history of previous surgeries could have introduced significant bias. The timing of the clinical interview is also an important factor - and performing the interview a week before surgery is not the same and performing it one month prior. In addition, the study focuses on evaluating anxiety before and after the pre-anaesthesia consultation. It would have been interesting to correlate that level of anxiety with the anxiety exhibited on the day of surgery. Ideally, therefore, the pre-anaesthesia consultation should be conducted as close as possible to the date of surgery, although this is not always possible.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion, we emphasize the importance of a good clinical interview and of reserving enough time to properly attend to our patients. Hospital managers need to understand that these measures do not increase health spending but improve the quality of care.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1432404" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1307559" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1432405" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1307558" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-16" "fechaAceptado" => "2020-08-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1307559" "palabras" => array:5 [ 0 => "Anxiety" 1 => "Preanesthetic visit" 2 => "Interview" 3 => "Information" 4 => "Anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1307558" "palabras" => array:5 [ 0 => "Ansiedad" 1 => "Consulta preanestésica" 2 => "Entrevista" 3 => "Información" 4 => "Anestesia." ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Preoperative anxiety can alter perioperative evolution, increasing the need for sedatives and analgesics. Information received during the pre-anesthesia consultation could reduce the level of anxiety. The objective of this study was to determine whether preoperative anxiety levels decrease after the pre-anesthesia consultation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observational, unicentric, prospective study. Sociodemographic and clinical data were recorded. Heart rate, blood pressure and anxiety levels were measured before and after the pre-anesthesia consultation using the abbreviated State-Trait Anxiety Inventory (STAI). Results were analyzed using Wilcoxon test and univariate logistic regression.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">90 patients were included, with a median age of 62 years; 58% were females, 79% had completed primary-secondary studies, 72% were selected for ambulatory surgery and 72% preferred regional anesthesia. The prevalence of anxiety was 35.6% (STAI score 5, IQR 3–9); after the anesthesia consultation the score was reduced to 4 (IQR 2–6), P=.005. There was no significative decrease in hemodynamic values, and no significant relationship between anxiety and sociodemographic or clinical variables.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The pre-anesthesia consultation reduces anxiety levels in surgical patients. This emphasizes the importance of the pre-anesthesia consultation in identifying and managing anxiety.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La ansiedad preoperatoria puede alterar la evolución perioperatoria aumentando la necesidad de sedantes y analgésicos. La información recibida en la consulta de anestesia podría reducir el nivel de ansiedad. Nuestro objetivo fue comprobar la reducción del nivel de ansiedad tras la consulta preanestésica.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, unicéntrico y prospectivo. Se registraron datos sociodemográficos y clínicos. La frecuencia cardiaca, tensión arterial y la ansiedad mediante la escala <span class="elsevierStyleItalic">State-Trait Anxiety Inventory</span> (STAI) <span class="elsevierStyleItalic">abreviada</span> se midieron antes y después de la entrevista anestésica. Los resultados fueron analizados mediante el test de Wilcoxon y regresiones univariables. Un valor de p menor o igual a 0.05 fue considerado significativo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 90 pacientes, con edad media de 62 años, 58% mujeres, 79% con estudios primarios o secundarios, 72% programados para cirugía ambulatoria, y un 72% prefería anestesia regional. La prevalencia de la ansiedad fue del 35,6% (puntuación en escala STAI de 5, (RIC 3-9), que se redujo tras la consulta a 4 (RIC 2-6); p = 0,005. No hubo descenso significativo de los valores hemodinámicos ni relación entre el nivel de ansiedad y las variables sociodemográficas y clínicas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La información administrada en la entrevista anestésica logró reducir los niveles de ansiedad. Este hecho enfatiza la importancia de la consulta preanestésica en lo que a identificación y manejo de la ansiedad se refiere.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Porcar E, Peral D. Utilidad de la consulta preanestésica para disminuir el grado de ansiedad en pacientes programados para intervención quirúrgica. Rev Esp Anestesiol Reanim. 2020;67:545–550.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1644 "Ancho" => 2200 "Tamanyo" => 245848 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Source: Perpiñá Galvañ.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1277 "Ancho" => 2124 "Tamanyo" => 71791 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Level of anxiety of patients before and after the pre-anaesthesia evaluation. The columns show the total number of patients with each anxiety level. STAI 1 *: before the evaluation; STAI 2 **: after evaluation.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ASA: American Society of Anesthesiologists; IQR: interquartile range.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age, mean (IQR) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">62.5 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">(50.45−75.25) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(57.78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(42.22) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Level of education, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(37.78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secondary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(41.11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>University \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(21.11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ASA, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(11.11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(74.44) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(14.44) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Surgical regimen, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outpatient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(72.22) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inpatient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(27.88) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Anaesthesia preference, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(26.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(72.22) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2462900.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical-demographic data.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">HR: heart rate; 95% CI: 95% confidence interval; IQR: interquartile range; DBP: diastolic blood pressure; SAD: systolic blood pressure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before the consultation</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">After the consultation</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IQR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IQR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67−84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.9−79.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64−80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.4−75.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120−140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128.4−134.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120−135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124.5−129.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70−75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.9−73.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.5−72.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.1−71.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2462901.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Heart rate and blood pressure values before and after the pre-anaesthesia consultation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. 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