During Pete Wilson's last broadcast on KGO-AM, he spoke openly of his apprehension over his hip replacement surgery, scheduled the following morning.

Even though 13 years earlier he went through the same procedure for the other hip, the left, he was unaccountably distressed in contemplating the procedure.

"I am nearly driving myself nuts with anxiety this time, and I don't know why," Wilson told listeners on July 18. "Mortality is now an actual thought on occasion, never mind that they do 200,000 replacement surgeries a year in this country alone and there are very few disasters. But adrenaline is playing havoc with my system."

Within hours of signing off from his popular afternoon talk show, Wilson's anxiety escalated. That night he was admitted to Stanford Hospital's emergency department for anxiety attacks, confirmed Chapin Day, spokesman for the Wilson family.

"He was anxious, so they put him in there," Day said. "His wife (Sandra) was with him the whole night. Day said Wilson was monitored in the ER and an electrocardiogram revealed no unusual heart rate patterns, such as an arrhythmia.

The next morning Wilson's surgery began at 11 a.m. after he was placed under general anesthesia, Day said. Within about 30 minutes Wilson suffered a massive heart attack.

According to a statement from Stanford, a heart transplant surgeon, cardiac anesthesiologists and cardiologists "worked unceasingly together for several hours to restore his heart function."

Wilson was placed on life-support equipment and transferred to the intensive care unit. But these efforts failed to revive him, and on Friday at 9:20 p.m. Wilson died.

For many listeners and colleagues recalling Wilson's apprehension, his sense of foreboding and anxiety over the surgery now reflects a tragic tinge of deja vu.

Anxiety in advance of surgery is nearly universal among patients, said every medical expert interviewed for this article. But it runs the spectrum from mild worry to dread. Severe anxiety and thoughts of death are reasons to consider postponing a procedure, according to one set of surgical guidelines.

"If the patient has a fear of dying during surgery, the concern should be expressed and the surgeon notified. In some cases, the procedure may be postponed until the patient feels more secure," the guidelines state, at http://www.surgeryencyclopedia.com.

In addition to generating extremely uncomfortable emotions, severe anxiety also releases a cascade of stress hormones, including adrenaline, cortisol and norepinephrine, all of which affect the cardiovascular system, among numerous other effects.

Day, the Wilson family spokesman, said he believed the ER admission "may have been an abundance of caution." He added that Wilson was unlikely ever to face the surgery without high anxiety.

"Knowing Peter as I did, I would say he was never going to be comfortable with the surgery," Day said. "He was nervous about flu shots."

Still, Dr. Loren Johnson, former president of the California chapter of the American College of Emergency Physicians, said it's highly unusual to admit surgical patients to an ER the evening before surgery.

"It's uncommon," Johnson said.

Typically, a person admitted to the ER for severe anxiety, which may include symptoms like shortness of breath, rapid heartbeat and a sense of doom, is monitored for cardiac problems, as the symptoms for both anxiety attacks and a cardiac event may be similar.

"They were (likely) being extra cautious, to make sure there wasn't a cardiac arrhythmia or some other event," Johnson said.

Day said he didn't know what symptoms of anxiety Wilson had before his ER admission at Stanford. Wilson also had anxiety attacks previously. About two years earlier Wilson suffered one on the air and was taken to an emergency room, where tests ruled out heart disease as the cause of his symptoms, Day said.

Jonnie Banks, a Stanford Hospital spokeswoman, said the hospital would not release information related to Wilson's ER admission.

Johnson also cautioned that drawing any link between Wilson's anxiety attacks and his heart attack during surgery "was making too much" of the issue.

"I don't think that would change a surgical outcome," he said.

But medical experts at the UCSF/Osher Center for Integrative Medicine viewed the nexus between the two events differently.

"Oh, boy," said Teresa Corrigan, R.N., who teaches the center's "Prepare for Surgery" class, when she learned that Wilson was admitted to the ER the night before surgery for anxiety attacks.

"If you have such an anxiety attack that you end up in the emergency room, it might have warranted a little more intervention or possibly postponing the surgery a couple of days to understand the anxiety before operating," Corrigan said. "Unless it's an emergency, you need to feel informed and ready."

Corrigan said she doesn't believe that a patient should endure a "white-knuckled" fear of surgery.

"It doesn't have to be, and shouldn't be, a terrifying experience," she said.

At the Osher Center class on preparing for surgery, participants learn about clinically validated techniques for lowering anxiety and improving surgical outcomes.

Some of the counseling simply focuses on teaching people to relax and breathe deeply, Corrigan said.

Other effective methods for significantly reducing preoperative anxiety, Corrigan said, include massage, acupuncture, guided imagery and biofeedback.

With guided imagery, which one insurer found resulted in significant cost savings due to shortened hospital stays, patients focus on positive outcomes.

Biofeedback entails paying close attention to one's own body through the use of monitors while practicing relaxation techniques, Corrigan said.

"If you do, say, slow breathing, you can see immediately what an effect it has," she said. "So for many people who think this stuff is kind of woo-woo, they see within five breaths that they have reduced body temperature and blood pressure.

"It gives people hope to see what an effect they can actually have on their own body," she continued. "That they have a lot of control and options."

Other simple techniques include listening to soothing music through headsets before surgery, she added.

"I think they should go much further," said Corrigan, of programs to reduce presurgical anxiety. "Our dream is everyone who goes to surgery would go to a class like this, just like childbirth classes."