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Use and scoring of the Iowa Satisfaction with Anesthesia Scale

To the Editor

I thoroughly enjoyed Said et al.’s paper (Said et al. 2016), but was concerned with the use of the Iowa Satisfaction with Anesthesia Scale (ISAS) (Dexter et al. 1997; Dexter and Candiotti 2011).

The ISAS is scored from − 3 to + 3 and the mean taken (Dexter et al. 1997; Dexter and Candiotti 2011). The authors report (page 269, column 1) using 1 to 6 (Said et al. 2016). The maximum mean of the 11 items would then be a score of 6. However, the authors’ Figure 3 on page 271 shows scores with a median of 9 in each of the two groups.

Quoting from the titles of both References Dexter et al. 1997 and Dexter and Candiotti 2011, the ISAS measures “patient satisfaction with monitored anesthesia care.” From (accessed May 17, 2016), “the instrument” (Dexter et al. 1997; Dexter and Candiotti 2011) “should not be used for … regional anesthesia”. “For measuring patient satisfaction with regional anesthesia, click here. For satisfaction with the perioperative period including regional anesthesia, click here.” The “click here” PubMed hyperlinks are for References Maurice-Szamburski et al. 2013 and Mui et al. 2011, respectively. The ISAS likely is invalid for measuring patient satisfaction for the authors’ (Said et al. 2016) epidural anesthesia group.

The authors’ text on page 270, column 1, refers to the mean differing (“the mean ISAS score was significantly higher (P = 0.018) in group [epidural] compared with group [local anesthesia]”) (Said et al. 2016). An unpaired t test for comparing means would be an appropriate analysis for the ISAS (Dexter and Candiotti 2011). Yet the authors’ methods (page 269, column 1) refer to “Wilcoxon ranked test,” which would not compare means.

The authors’ sample size (N = 31 and 32 in each group) was approximately half the N = 70 we calculated for each group to achieve an 80% statistical power to detect a moderate effect size (Dexter et al. 1997).

The ISAS is copyrighted by Franklin Dexter and the University of Iowa Research Foundation. This is stated in each table of the original paper and throughout the second paper (Dexter et al. 1997; Dexter and Candiotti 2011). Web search with Google or Bing (both performed May 17, 2016) using “Iowa Satisfaction with Anesthesia Scale” (with quotation marks) returned the authorization form for use as their first and second entries, respectively; Bing provides the original paper (Dexter et al. 1997) as the first entry. This is in part to assure the best possible use of the scale and help investigators with the analysis.



Iowa Satisfaction with Anesthesia Scale, from the first sentence


  • Dexter F, Aker J, Wright WA (1997) Development of a measure of patient satisfaction with monitored anesthesia care: the Iowa Satisfaction with Anesthesia Scale. Anesthesiology 87:865–873

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  • Dexter F, Candiotti KA (2011) Multicenter assessment of the Iowa Satisfaction with Anesthesia Scale, an instrument that measures patient satisfaction with monitored anesthesia care. Anesth Analg 113:364–368

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  • Maurice-Szamburski A, Bruder N, Loundou A, Capdevila X, Auquier P (2013) Development and validation of a perioperative satisfaction questionnaire in regional anesthesia. Anesthesiology 118:78–87

    Article  Google Scholar 

  • Mui WC, Chang CM, Cheng KF, Lee TY, Ng KO, Tsao KR et al (2011) Development and validation of the questionnaire of satisfaction with perioperative anesthetic care for general and regional anesthesia in Taiwanese patients. Anesthesiology 114:1064–1075

    Article  Google Scholar 

  • Said AM, El-Serwi HB, Fahmy FM (2016) Percutaneous vertebroplasty under epidural anesthesia: comparative study versus local anesthesia. Ains Shams J Anaesthesiol 9:267–273

    Article  Google Scholar 

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FD contributed to the concepts, design, definition of intellectual content, literature search, manuscript preparation, and manuscript editing and is the guarantor. The author read and approved the final manuscript.

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Correspondence to Franklin Dexter.

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The Iowa Satisfaction with Anesthesia Scale is copyrighted by 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. Dr. Dexter 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’s consulting work, including uses of the Iowa Satisfaction with Anesthesia Scale, is used to fund Division research.

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Dexter, F. Use and scoring of the Iowa Satisfaction with Anesthesia Scale. Ain-Shams J Anesthesiol 10, 7 (2018).

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