Kindly give the answer which seems to describe your present feelings best

1 = not at all 2 = somewhat 3 = moderately so 4 = very much so 5 = completely

1. I was worried about anesthesia

1…2…3…4…5

2. I wanted to be informed as much as possible about anesthesia

1…2…3…4…5

3. I was worried about the success of the surgical procedure

1…2…3…4…5

4. I am worried about the recipient's risk of anesthesia-related mortality

1…2…3…4…5

5. I wanted to be informed as much as possible about the surgical procedure

1…2…3…4…5

6. I feel secure

1…2…3…4…5

7. I am in sense of regret

1…2…3…4…5

8. I was worried about my future

1…2…3…4…5

9. I feel relaxed

1…2…3…4…5

10. Do you have?

Pain (0-100):

Nausea and vomiting: