Prediction of Pre-operative Anxiety by Heart Variability and Pupillometry
Prediction of Pre-operative Anxiety by Heart Variability and Pupillometry
The purpose of this study is to determine whether heart rate variability levels and
 pupillometric measures are effective objective predictors of anxiety among patients before
 surgery.
The prevalence of preoperative anxiety in adults is estimated between 60 and 80% and prevents
 a good integration of the information delivered, while seeking more attention from
 caregivers. In addition, anxious patients require the administration of higher doses of
 hypnotics at anesthetic induction. The pain expressed in the postoperative period is
 proportional to preoperative anxiety, with a slower recovery kinetics responsible for
 prolonged stay in the recovery room. Finally, the incidence of chronic pain is correlated
 with the intensity of preoperative anxiety.

 While the recommendations of the European Anesthesia Society (ESA) emphasize the importance
 of managing preoperative anxiety, this dimension is often overlooked and existing methods of
 assessment are time consuming and sometime inaccurate.

 Objective screening with dynamic monitoring of the level of anxiety in real time is the
 necessary step to ensure accurate detection and personalized management of the emotional
 state of patients before performing an invasive procedure.

 Anxiety is an emotional state reflecting an imbalance of cortico-frontal regulation on the
 limbic system. The interaction between these two neuronal systems is expressed in particular
 by the intensity of the vagal tone and the autonomic nervous system. Exploring the balance
 between sympathetic and parasympathetic systems is a promising avenue of exploration for
 identifying, predicting, and treating anxiety.

 Two reliable and easy-to-use devices analyzing the expression of the autonomic nervous system
 validated in the analysis of nociception in the awake patient or under general anesthesia are
 marketed:

 A. Analgesia Nociception Index (ANI) (MDoloris Medical Systems) analyzing oscillatory changes
 in heart rate as a function of respiratory time, namely the heart rate variability (HRV) B.
 Algiscan (IDMed) analyzing pupil responsiveness to nociception

 The use of these devices in conscious pre-operative patients could allow a reliable and
 objective detection of anxiety while following its kinetic evolution over time. The purpose
 of this project is to evaluate the validity of these two devices in the context of
 preoperative anxiety. After receiving clear information and giving their written agreement,
 patients will be included in the study by the anesthetist physician. During the anesthesia
 consultation, the included patients will be subjected to a self-assessment Hospital Anxiety
 Depression Scale (HADS) questionnaire of level of anxiety.
Inclusion Criteria:

 -Day case surgical patients

 Exclusion Criteria:

 -  <18yo

 -  psychiatric disorders

 -  participating refusal