Enfermera

Severe Needle Phobia in the Perianesthesia
Setting
Olumuyiwa A. Bamgbade, MBBS, MSc, FRCA

Needle phobia is a peculiar type of specific phobia, with unique
clinical features, that may be encountered in some surgical patients.
It may present a serious acute problem to the perianesthesia care
team and requires careful psychological and/or pharmacological
management. This article provides aclinical report and detailed
discussion of severe needle phobia in the perianesthesia setting.
Keywords: continuing education, needle phobia, patient management, perioperative care, case report.
© 2007 by American Society of PeriAnesthesia Nurses.
Objectives—After completion of this continuing education offering, the participant will be able to
(1) describe the problem of needle phobia in theperianesthesia period, (2) describe the pathophysiology of needle phobia, and (3) discuss the clinical features and appropriate management of needle
phobia by perianesthesia personnel.
PHOBIAS ARE UNUSUAL anxiety states with
abnormally intense and unreasonable fears. This
group of medical conditions affects a significant
proportion of the population, and many surgical patients have severesituational phobias that
may affect their hospital care.1,2 Needle phobia
affects an estimated 4% of the general population.1 Most affected surgical patients do not
receive preoperative counseling or desensitization therapy and their phobia usually presents
as an acute problem to the perianesthesia team
on the day of surgery. This is a clinical report
and detailed discussion of two cases ofsevere
needle phobia in the perianesthesia setting.

Olumuyiwa A Bamgbade, MBBS, MSc, FRCA, is a Consultant Anesthetist, Department of Anesthesia, Central Manchester University Hospital, Manchester, UK.
Address correspondence to Olumuyiwa A Bamgbade, MBBS,
MSc, FRCA, Department of Anesthesia, Central Manchester University Hospital, Oxford Road, Manchester M13 9WL, United
Kingdom; e-mail address:mubitim@yahoo.co.uk.
© 2007 by American Society of PeriAnesthesia Nurses.
1089-9472/07/2205-0004$35.00/0
doi:10.1016/j.jopan.2007.07.002

322

Case Report
Patient A was a 27-year-old man, American Society of Anesthesiologists (ASA) Physical Status
Classification 1, with a body mass index (BMI)
of 26 kg/m2, who presented for arthroscopic
surgical repair of the right knee as anoutpatient. Preoperatively on the day of surgery, he
was very agitated and irritable. Further questioning revealed a significant past medical history of needle phobia, with associated syncope
on three occasions. He was worried that he may
have a panic or syncopal attack because of his
phobia. Therefore, he was premedicated with
oral midazolam 20 mg and reassured that he
would not feel any needle painthroughout his
perianesthesia period. Eutectic mixture of local
anesthetics (EMLA) cream was also applied to
the back of his hands. He was counseled, with
the help of his wife, for about 40 minutes. He
consented to facemask induction of anesthesia,
which he had successfully undergone in the
past.
Journal of PeriAnesthesia Nursing, Vol 22, No 5 (October), 2007: pp 322-329

PERIANESTHESIANEEDLE PHOBIA

He arrived in the operating room very calm, but
suddenly started screaming and developed simple partial seizures after seeing a syringe being
unwrapped. The seizures lasted about two minutes and consisted of progressive automatic
jerky movements of both upper and lower
limbs. There was no alteration in his level of
consciousness. Postictal vital signs and neurologicalexamination were normal. Anesthesia
was induced smoothly with sevoflurane, after
which intravenous cannulation was performed.
Anesthesia was maintained with sevoflurane
and nitrous oxide via a laryngeal mask airway.
Surgery and anesthesia were uneventful. However, he had a repeat episode of similar simple partial seizures on seeing a syringe in the
recovery room. He was generally and neurologically...