Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study

Moritz, Nicole Morem Pilau; Moritz, José Eduardo; Parma, Gabriel Oscar Cremona; Dexter, Franklin; Traebert, Jefferson

doi:10.1016/j.bjane.2023.11.001

Nicole Morem Pilau Moritz ^** Corresponding author. E-mail: nika_mp@yahoo.com.br (N.M. Moritz).

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Palhoça, SC, Brazil

Hospital Universitário da Universidade Federal de Santa Catarina, Departamento de Anestesia, Florianópolis, SC, Brazil

https://orcid.org/0000-0002-6642-4637

José Eduardo Moritz

Ultralitho Centro Médico, Florianópolis, SC, Brazil

https://orcid.org/0000-0003-2621-1773

Gabriel Oscar Cremona Parma

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Palhoça, SC, Brazil

Franklin Dexter

University of Iowa, Department of Anesthesia, Iowa City, United States of America

https://orcid.org/0000-0001-5897-2484

Jefferson Traebert

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Palhoça, SC, Brazil

https://orcid.org/0000-0002-7389-985X

* Corresponding author. E-mail: nika_mp@yahoo.com.br (N.M. Moritz).

Conflicts of interest

The Iowa Satisfaction with Anesthesia Scale is copyright Franklin Dexter and the University of Iowa Research Foundation. Dr. Dexter receives no funds personally other than his salary and allowable expense reimbursements from the University of Iowa and has tenure with no incentive program. He and his family have no financial holdings in any company related to his work, other than indirectly through mutual funds for retirement. Income from the Division of Management Consulting work including use of the Iowa Satisfaction with Anesthesia Scale is used to fund Division research. A list of all the Division’s consults is available in Dr. Dexter’s posted curriculum vitae at https://FranklinDexter.net/Contact_Info.htm.

Figures (2)
Tables (4)

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Figure 2
The scree plot displays the eigenvalues generated by the parallel analysis method in the exploratory factor analysis. This method, considered more accurate than others, compared the eigenvalues from the pilot sample (data) with those generated from a random sample of the same size (simulations). The goal is to identify the point at which the observed eigenvalues significantly deviate from the mean eigenvalues of random data. Only eigenvalues greater than those generated in the random sample were retained, indicating the extraction of three factors.

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Figure 3
These two plots illustrate the temporal stability of ISAS-Br (n = 25). (3A) ICC is shown in a scatter plot with retest and test scores. Most data points are close to the identity line, randomly scattered around it. This suggests that the test and retest measurements have good correlation. (3B) Bland-Altman plot displaying the relationship between the test vs retest bias (y axis: difference between values from test and retest for each individual) and the theoretical real value (x axis: mean value from test and retest for each individual). The points clustered around the bias line (mean difference = 0.25, p = 0.054), within the limits of agreement (-0.97 to 1.48), indicate that the test and retest measurements have good agreement and consistency. Both plots show that there is no significant systematic bias between them since there is low vertical dispersion and no apparent patterns.

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Figure 1
Final version of ISAS-Br.

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Table 1
Description of the cross-cultural adaptation study sample of the ISAS-Br (n = 127).

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Table 2
Proportion of responses for each item of the ISAS-Br (n = 127).

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Table 3
Factor loadings from the exploratory factor analysis of ISAS-Br after extraction using the maximum likelihood method with varimax rotation and composite reliability indices for each factor.

Characteristics	n	(%)
Age
18‒59 years	99	78
> 60 years	28	22
Gender
Female	56	44
Male	71	56
Skin color (n = 124)
White	103	83
Non-white	21	17
Education^a a Over four years of study.
Incomplete elementary/middle education	27	21
Complete elementary/middle education or higher	100	79
ASA physical status (n = 125)
I	51	41
II	72	58
III	2	2
Surgical specialties
Dermatology	17	13
General surgery	19	15
Gynecology	5	4
Ophthalmology	6	5
Plastic surgery	23	18
Urology	57	45
Healthcare system
Public	64	50
Private	63	50
History of previous anesthesia
No	18	14
Yes	109	86
Sedative medication
Alfentanil, midazolam, ketamine	1	1
Fentanyl, midazolam	6	5
Fentanyl, midazolam, clonidine	1	1
Fentanyl, midazolam, dexmedetomidine	1	1
Midazolam, sufentanil	1	1
Propofol	18	14
Propofol, alfentanil	5	4
Propofol, alfentanil, midazolam	1	1
Propofol, dexmedetomidine	13	10
Propofol, dexmedetomidine, ketamine	1	1
Propofol, fentanyl	40	31
Propofol, fentanyl, ketamine	1	1
Propofol, fentanyl, dexmedetomidine	10	8
Propofol, fentanyl, midazolam	23	18
Propofol, midazolam	1	1
Propofol, midazolam, dexmedetomidine	1	1
Propofol, midazolam, dexmedetomidine, ketamine	1	1
Propofol, midazolam, sufentanil	2	2

	Agree very much n (%)	Agree moderately n (%)	Agree slightly n (%)	Disagree slightly n (%)	Disagree moderately n (%)	Disagree very much n (%)	Means subscore
1. I threw up or felt like throwing*	4 (3.1)	0 (0)	1 (0.8)	1 (0.8)	2 (1.6)	119 (93.7)	2.83
3. I itched*	6 (4.7)	0 (0)	6 (4.7)	2 (1.6)	-	113 (89.0)	2.50
5. I felt pain*	4 (3.1)	4 (3.1)	7 (5.5)	1 (0.8)	3 (2.4)	108 (85.1)	2.39
7. I was too cold or hot*	13 (10.2)	8 (6.3)	17 (13.4)	1 (0.8)	4 (3.1)	84 (66.2)	1.4
9. I felt pain during surgery*	5 (3.9)	‒	6 (4.7)	‒	1 (0.8)	115 (90.6)	2.57
11. I hurt*	4 (3.1)	‒	1 (0.8)	1 (0.8)	2 (1.6)	119 (93.7)	2.75

	Disagree very muchage n (%)	Disagree moderately n (%)	Disagree slightly n (%)	Agree slightly n (%)	Agree moderately n (%)	Agree very much n (%)	Means subscore
2. I would want to have the same anesthetic again	4 (3.1)	-	3 (2.4)	5 (3.9)	3 (2.4)	112 (88.2)	2.61
4. I felt relaxed	2 (1.6)	2 (1.6)	3 (2.4)	1 (0.8)	3 (2.4)	116 (91.2)	2.69
6. I felt safe	1 (0.8)	‒	‒	3 (2.4)	5 (3.9)	118 (92.9)	2.87
8. I was satisfied with my anesthetic care	2 (1.6)	‒	1 (0.8)	‒	1 (0.8)	123 (96.8)	2.87
10. I felt good	1 (0.8)	‒	‒	1 (0.8)	3 (2.4)	122 (96.0)	2.75

	Factor			Singularity
	1 Emotional well-being factors	2 Physical comfort	3 Anxiety/ Fear relief	Singularity
Item 10	0.95			0.09
Item 6	0.83			0.31
Item 8	0.74			0.29
Item 5		0.75		0.43
Item 9		0.69		0.47
Item 11		0.45		0.80
Item 1		0.33		0.87
Item 3		0.16		0.97
Item 7		0.14		0.97
Item 4			0.61	0.61
Item 2			0.43	0.81
Composite reliability	0.874	0.580	0.428

[1] * Corresponding author. E-mail: nika_mp@yahoo.com.br (N.M. Moritz).

Brasil

Brasil

Abstract

Background:

Methods:

Results:

Conclusion: