The Anxious Airway: Correlation Between Preoperative Anxiety Scores and Hemodynamic Instability During Endotracheal Intubation

Background: Laryngoscopy and endotracheal intubation elicit a reflex sympathetic response mediated by glossopharyngeal and vagus nerve afferents, resulting in transient hypertension and tachycardia. While preoperative anxiety elevates baseline catecholamines, whether anxiety intensity reliably predicts the magnitude of hemodynamic instability during airway manipulation remains unclear.

Objectives: This prospective observational study assessed the relationship between preoperative anxiety scores and hemodynamic responses during the induction of general anesthesia and endotracheal intubation.

Methods: One hundred adults (ASA physical status I–III) were consecutively enrolled and underwent elective surgery under general anesthesia. Preoperative anxiety was assessed using the Hamilton Anxiety Rating Scale (HAM-A). Patients were categorized as having mild (<17), mild-to-moderate (18–24), or moderate-to-severe (25–30) anxiety. Hemodynamic parameters—heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)—were recorded at baseline, post-sedation, 1 minute post-intubation, and 3 minutes post-intubation. Pearson’s correlation and multivariable linear regression analyses were performed.

Results: Patients with moderate-to-severe anxiety exhibited significantly greater increases in HR and MAP compared with those with mild anxiety. Pearson’s correlation demonstrated strong positive associations between HAM-A scores and peak hemodynamic changes (HR: r = 0.736; MAP: r = 0.745; p < 0.001). Multivariable regression analysis showed that each 1-point increase in HAM-A score independently predicted a 0.98 mmHg rise in MAP (p < 0.001), after adjustment for age and sex.

Conclusion: Preoperative anxiety, as measured by HAM-A, is a significant independent predictor of hemodynamic instability during endotracheal intubation. Routine anxiety assessment may help identify patients at risk for exaggerated pressor responses