The Multiple Affect Adjective Check List (MAACL) can be used to evaluate the level of anxiety expressed by a patient prior to surgery. This can help identify those patient's who may require additional reassurance or other interventions to reduce anxiety.


NOTE: The instrument can be used at the time of scheduling surgery, since anxiety at that time correlates with anxiety on the day of surgery.


Instructions: The patient is asked to indicate which words apply to how they feel about anesthesia and surgery.



(1) anxious words (11)

(2) calm words (10)


Anxious words:

(1) afraid

(2) fearful

(3) desperate

(4) frightened

(5) terrified

(6) upset

(7) nervous

(8) panicky

(9) shaky

(10) tense

(11) worrying


Calm words

(1) calm

(2) cheerful

(3) contented

(4) loving

(5) happy

(6) joyful

(7) pleasant

(8) thoughtful

(9) steady

(10) secure








number of anxious words =

= SUM(number of anxious words indicated)


number of calm words =

= SUM(number of calm words indicated)


total score =

= (number of anxious words) + (10 – (number of calm words))



• minimum score: 0

• maximum score: 21

• The higher the score, the more marked the anxiety.


Other risk factors to elicit at the time of surgery scheduling that can help identify patients who may require additional interventions to reduce anxiety:

(1) no previous experience with anesthesia

(2) previous bad experience with anesthesia

(3) obviously anxious patients


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