Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Vitalis Mung'ayi

Second Supervisor/Advisor

Dr. Rajpreet Bal

Third Supervisor/Advisor

Dr. David Odaba


Anaesthesiology (East Africa)


Background: Preoperative anxiety is a common occurrence in patients presenting for surgery with a reported incidence of up to 80%. Higher incidences have been reported in the female population and in the obstetric population compared to general surgical patients. Increased preoperative anxiety has been associated with increased anaesthetic requirements, a more turbulent immediate postoperative course, poor patient satisfaction, protracted hospital stays, and poorer surgical outcomes. Provision of information relating to surgery and anaesthesia to patients has been proven to have benefit in allaying anxiety. However, the best format of information dissemination remains unknown and especially so targeting a specific patient population.

Objective: The primary objective was to determine the effect of video information in addition to the pre-anaesthetic review on the mean preoperative STAI-S score in adult patients presenting for elective caesarean section under spinal anaesthesia at AKUHN. Secondary objectives were to determine the prevalence of preoperative anxiety in the obstetric population presenting for elective caesarean section at AKUHN as well as to determine the effect of age, level of education, parity and exposure to previous anaesthetic on preoperative anxiety.

Study design: A randomized control trial.

Study setting: Aga Khan University Hospital- Nairobi, Anaesthesia clinic.

Study population: Adult patients presenting for elective caesarean section.

Sample size: A target sample size of 36 patients,18 patients per arm, calculated to detect an 8.85 points difference in mean STAI-S scores from baseline between the two arms.

Randomization: Computer-generated random numbers in sealed envelopes.

Inclusion criteria: Adult patients booked for elective caesarean section reviewed in the clinic who had consented for spinal anesthesia.

Exclusion criteria: Previous spinal anaesthetic, unable to read or write, poor eyesight, non- English speaking, high risk pregnancies, use of psychotropics, history of psychiatric illness.

Data collection: Demographic data were collected using a data collection tool, and cumulative STAI S and T scores were recorded from filled questionnaires as per the accompanying manual.

Data analysis: Continuous data were described in terms of means with standard deviation, and percentages as appropriate. Comparison of means was done using Student’s t and paired sample t tests. Fisher’s exact test was used to investigate the association of the independent factors and the anxiety scores.

Results: 37 patients were randomized in this study. The mean STAI-T score in the sampled population was 45.64 (SD 5.625). The mean baseline STAI-S score was 46.32 (SD 4.911). There was no statistically significant difference in change in STAI score between the video and control arms (p>0.005). There was no significant association between STAI scores and the age, level of education, parity, or previous anaesthetic history of the participants.

Conclusion: There was no benefit demonstrated from the use of an information video about spinal anaesthesia on anxiety levels in obstetric patients presenting for a first time spinal.