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Identifying and assessing anxiety in pre-operative patients
Abstract
Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient’s level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.
... It is a rational and normal reaction to actual and potentially dangerous circumstances as a result of sympathetic, parasympathetic, and endocrine activation; however, excessive and prolonged worry leads to serious, life-threatening complications and increases post-operative morbidity and mortality [2]. Preoperative anxiety is a common reaction in patients admitted to surgery and is caused by "unknown, unsuccessful recovery and surgical failure, anesthesia-related fear, personal identity loss, fear of postoperative pain, a sense of loss of control, and a fear of death" [3,4]. ...
... The questionnaire contains five sections: socio-demographic characteristics, health status, and clinical characteristics, possible reason for anxiety, and social support assessed by the OSLO social support scale that consists of 3 items with a sum score ranging from 3 to 14 with three categories: poor (3)(4)(5)(6)(7)(8), moderate (9)(10)(11), and strong (12)(13)(14) social support [40]. ...
... Monthly income: categorized as above the international poverty line (US$ Social support is classified by sum score as poor (3)(4)(5)(6)(7)(8), moderate (9)(10)(11), and strong (12)(13)(14) social support [40]. ...
Background
Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area.
Objective
To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022.
Methods and Materials
An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05.
Results
The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4–61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety.
Conclusion
Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.
... The implications of these factors may result in decreased quality of life among patients with breast cancer [11]. A large number of patients undergoing breast cancer surgery have high levels of anxiety such as increased tension, nervousness, apprehension and aggression including other forms of distress before surgery [12,13]. Studies have given the various reasons for the cause of presurgical anxiety including pain, anaesthesia, unsuccessful surgery, loss of individual identity, recuperation around unknown people, loss of control, failed recovery and death [13]. ...
... A large number of patients undergoing breast cancer surgery have high levels of anxiety such as increased tension, nervousness, apprehension and aggression including other forms of distress before surgery [12,13]. Studies have given the various reasons for the cause of presurgical anxiety including pain, anaesthesia, unsuccessful surgery, loss of individual identity, recuperation around unknown people, loss of control, failed recovery and death [13]. ...
... It is not surprising that majority of the participants indicated they were anxious about the surgery because a number of studies have pointed to that fact. Pritchard [13] stated that just the mere information that an individual is to be scheduled for surgery can lead to increased anxiety in many patients. Body image issues, financial, stigmatization and change of roles were among the factors that affected anxiety and depression among participants. ...
Background
Cancer is a major threat to public health globally and in Ghana. Breast cancer is a serious health problem among women which affects the daily functioning of the individual and their psychological health.
Aim
The study examined the influence of spirituality and health beliefs on anxiety and depression among preoperative breast cancer patients in Ghana.
Methodology
This is a qualitative study involving 54 preoperative breast cancer patients selected from 3 referral hospitals in Accra namely: 37 Military hospital, Korle Bu Teaching Hospital, and the Sweden Ghana Medical Centre all in Ghana. The study collected data via one-on-one in-depth interviews (IDI) and Focus group discussion (FGD).
Result
Qualitative thematic analysis techniques were employed to analyse data and the results revealed spirituality and health beliefs influenced patients’ perception and health-seeking, while spirituality in particular helped patients cope with the disease. The results also showed that participants’ levels of anxiety increased due mainly to surgery which is the most common mode of breast cancer treatment.
Discussion
This study generates knowledge about the relations between spirituality, health beliefs and psychological wellbeing among breast cancer patients in Ghana. The study implies that spirituality and health beliefs of the cancer experience have implications for psychological wellbeing.
... A patient may also experience peripheral vasoconstriction which makes it difficult for the hospital staff to obtain blood. (21) Anxiety may cause also behavioral and cognitive changes that result in increased tension, apprehension, nervousness, and aggression. (21) Some patients may become so apprehensive that they cannot understand or follow simple instructions. ...
... (21) Anxiety may cause also behavioral and cognitive changes that result in increased tension, apprehension, nervousness, and aggression. (21) Some patients may become so apprehensive that they cannot understand or follow simple instructions. Some may be so aggressive and demanding that they require constant attention of the nursing staff. ...
... Each questionnaire statement was given a weight (Yes or No) to estimate the significance of the statement as follows: (1: Yes, 0: No), these weights are reflected in the levels of death anxiet and, for interpretation of the arithmetic means, the degree of presence of those levels were judged according to the following scale:(1-16) degree is a weak level of death anxiety, (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) degree is a moderate level of death anxiety, and (34-50) degree there is a highly level of death anxiety. ...
Surgery is sometimes a necessary and inevitable solution because it is the only resort for healing, and surgical intervention is a routine matter for the medical staff, but it may be a terrifying specter for the patient, especially the one who undergoes it for the first time as a result of the physiological and biological imbalances that occur to the patient and as a result of the damage caused by it. This study aimed at measuring the death anxiety among patients who are about to undergo surgery. This is a descriptive study with (62) patients were admitted in the Surgical Department at Al-Gamhoria Teaching Hospital and May Hospital in Aden Governorate, who were targeted with a self-administered questionnaire applied for this purpose in the period from 22/06/2021 until 21/09/2021. Each questionnaire statement was given a weight (1: Yes, or 0: No) to estimate the significance of the statement, these weights are reflected in the levels of death anxiety, and for interpretation of the arithmetic means, the degree of presence of those levels were judged according to the following scale: (1- 16) degree is a weak level of death anxiety, (17- 33) degree is a moderate level of death anxiety, and (34- 50) degree there is a highly level of death anxiety. Around two thirds of the patients reported a moderate level of preoperative death anxiety. Death anxiety was reported more high by female patients, and those in the age group 60 and more, amongst illiterate and primary education patients, and with patients of gynecologic and orthopedic surgeries. In this study, the preoperative death anxiety was high among female patients, in the age group 60 and more, amongst illiterate and primary education patients, and with patients of gynecologic and orthopedic surgeries. The current study recommended that patients need to be assessed regularly for anxiety during the preoperative visit and appropriate anxiety reduction methods should be introduced through mental and psyche health professionals.
... Preoperative anxiety among patients is common (Caumo et al., 2001;Pritchard, 2009b), and an increased level of preoperative anxiety is associated with impaired recovery, a longer hospital stay, and increased levels of postoperative infections (Levandovski et al., 2008). Factors that can affect the patients experience of anxiety include losing control (Arakelian et al., 2018;Pritchard, 2009a;Susleck et al., 2007), an unknown environment Pritchard, 2009a), and a lack of information about what´s going to happen (Pritchard, 2009a). ...
... Preoperative anxiety among patients is common (Caumo et al., 2001;Pritchard, 2009b), and an increased level of preoperative anxiety is associated with impaired recovery, a longer hospital stay, and increased levels of postoperative infections (Levandovski et al., 2008). Factors that can affect the patients experience of anxiety include losing control (Arakelian et al., 2018;Pritchard, 2009a;Susleck et al., 2007), an unknown environment Pritchard, 2009a), and a lack of information about what´s going to happen (Pritchard, 2009a). ...
... Preoperative anxiety among patients is common (Caumo et al., 2001;Pritchard, 2009b), and an increased level of preoperative anxiety is associated with impaired recovery, a longer hospital stay, and increased levels of postoperative infections (Levandovski et al., 2008). Factors that can affect the patients experience of anxiety include losing control (Arakelian et al., 2018;Pritchard, 2009a;Susleck et al., 2007), an unknown environment Pritchard, 2009a), and a lack of information about what´s going to happen (Pritchard, 2009a). ...
Purpose: The aim was to describe patients’ lived experience of warmth and coldness in connection with surgery.
Methods: A reflective lifeworld research (RLR) approach founded on phenomenology and the methodological principles of openness, flexibility, and bridling were used. The data consisted of 16 in-depth interviews with patients from four hospitals in Sweden.
Results: Warmth and coldness in connection with surgery means an expectation to maintain one´s daily life temperature comfort. When patients’ needs of temperature comfort is fulfilled it give a sense of well-being and calmness. Despite the body is covered there are feelings of vulnerability. When patients have the ability to change their own temperature comfort, they feel independent.
Conclusion: The individual feeling of temperature comfort could be affected or changed to discomfort during the perioperative context, and an intervention is required to avoid suffering due to the care. An ability to independently influence one´s own temperature comfort can strengthen the patient, whereas the opposite entails suffering in silence. The phenomenon is also related to feelings of confidence about receiving the best care as well as being exposed and vulnerable. When the patient´s need of comfortable temperature is met then feelings of security and sense of well-being emerged.
... Modern elective surgery has resulted in an overall reduction in the time spent in hospital, which has given anaesthetists less time to accurately assess and alleviate preoperative anxiety [4][5][6]. A thorough preoperative assessment requires 27 minutes, however usually only 5-15 minutes is available, meaning that patients' concerns can go unaddressed [5]. ...
... However, for consent to be valid, the individual must receive the relevant information about the nature and the purpose of the procedure [7]. Additionally, information provision has traditionally served as an antidote for preoperative anxiety, which evidence shows can be an effective strategy [6]. Yet, there is also evidence that shows information can trigger preoperative anxiety [8]. ...
... Pritchard [6] saw the dilemma that healthcare professionals face with increasing demands and reduced time to determine the psychological wellbeing of patients. Currently, there are no guidelines that address this issue and healthcare professionals are required to use their clinical judgement to determine how anxious their patient is and what intervention is required to alleviate their anxiety. ...
... In a parallel process, which occurs in the hypothalamusadrenal (adrenal) axis, cortisol is released. The emotional response to stress can also be described as emotional states related to psychological concern such as: anxiety, restlessness and the occurrence of some neurological problems (21)(22)(23)(24). Stress also occurs abundantly in the work environment, which is referred to as occupational stress. ...
... This can help reduce stress, especially when listening to music for a short time or with other people (58,59). In this situation, experts think that the reason for this is to make people feel happier and healthier emotionally (7,60) and to make people feel more connected to each other (17,24,29,61). Therefore, the results of this study are similar to the other studies about using music for a short time. ...
Background: The aim of this study was to investigate if listening to music can help reduce stress for women who work in an electric car parts factory in Mashhad. Methods: Out of 200 people in this study, 32 were chosen at random and split into two groups: one for the experiment and one for comparison. To gather information, we used a job stress questionnaire and a music therapy plan that consisted of 30 sessions, which lasted for one month. In this study, we played the music that the participants liked 4 times during each session. Each time, we played the music for 15 minutes, while they were taking a break or before they started working. Results: There were 16 participants in the group we tested. The people in the control group followed their normal way of doing things and did not use this procedure. The research found that music intervention helps decrease the occupational stress in women more than the traditional work schedule method. The effect size of the music intervention was 0.809, which means it had approximately an 81% impact on reducing stress. Conclusion: The results of the pre-tests and post-tests indicated that the stress levels of women in the experiment group decreased significantly after listening to music. Based on these findings, it can be concluded that listening to music while taking breaks at work helps to lower job stress.
... Many studies suggested that factors of pre-operative anxiety depend on age, sex, marital status, educational level, uncertainty of the precise day of operation, the pre-operative patient anxiety caused by many fears which include; fear of unknown, fear of medication, concern about pain, loss of control, and fear of death (3) . The extent of anxiety levels differs from person to person, it varies over time; different patients respond perioperative period in different ways, some of them experienced it as a stressful event; they were concerned about their distress or concerned about the achievement of the operation (4) . ...
... The anxious patient response differently to anesthesia and analgesia when compared with non-anxious patient; patient who experience high level of anxiety requires more anesthetic to achieve sedation and needs to increased doses of analgesia to relief pain. Research studies suggested that pre-operative anxiety increased post-operative pain, fatigue, nausea, delay recovery period and depression (3) . Provide patients with appropriate information during the period prior to anesthesia will decreases patient's anxiety. ...
Background: Surgery was suggested as a major life change that negatively affects the patient’s recovery and post-operative pain.Objectives: The study aims to assess the preoperative anxiety levels among surgical patients, to determine the fears related to surgery and to find out the relationships between some variables; age, sex, marital status, educational level and experience of previous surgery and level of anxiety.Methodology: a cross-sectional study was conducted on patients undergoing surgery under a general anesthesia in general surgery unit of Baghdad Teaching Hospital from 1st August 2018 to 30th May 2019.Results: the current study indicated that all patients 80 (100%) were experience a preoperative anxiety in different levels; 36.2% of them had a high level of anxiety, 32.5% had a moderate level of anxiety and (31.2%) had a low level of anxiety. The main source of patients’ fears was; fear of death (51.2%), post-operative wound pain (48.8%), and fear of post-operative nausea and vomiting (47.5%) There was a significant relationship between age and level of anxiety. No difference in level of anxiety in respect to gender and previous surgery.
... These include tachycardia, hypertension, sweating, elevated body temperature, apprehension, increased mental tension and aggression. 6,7 Pre-operative anxiety has unfavourable effects on induction and maintenance of anesthesia. Anxious patients require larger doses of anesthetic drugs and may have autonomic fluctuations as well. ...
... 5 The patients start to have anxiety as soon as the surgery is planned, and it increases to a maximum on admission to hospital. 6 Anxiety causes unnecessary fear, irritability and autonomic fluctuations in admitted patients. These unpleasant symptoms may compel them to refuse the planned surgeries. ...
Background Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60–92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country. Methods This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability convenience sampling was adopted and a total of 205 cases were included. The researchers themselves collected the data on the day before surgery using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately. Results The prevalence of pre-operative anxiety was 25.85%. The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272–4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107–5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety compared to those from a joint family and those having past history of surgery respectively. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265–0.985, p = 0.045). Conclusions One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.
... These include tachycardia, hypertension, sweating, elevated body temperature, apprehension, increased mental tension and aggression. 6,7 Pre-operative anxiety has unfavourable effects on induction and maintenance of anesthesia. Anxious patients require larger doses of anesthetic drugs and may have autonomic fluctuations as well. ...
... 5 The patients start to have anxiety as soon as the surgery is planned, and it increases to a maximum on admission to hospital. 6 Anxiety causes unnecessary fear, irritability and autonomic fluctuations in admitted patients. These unpleasant symptoms may compel them to refuse the planned surgeries. ...
Background: Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60–92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country.
Methods: This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability consecutive sampling was adopted. The researchers themselves collected the data using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately.
Results: The prevalence of pre-operative anxiety was 53 (25.85%). The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272–4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107–5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265–0.985, p = 0.045).
Conclusions: One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.
... On his part, Smith (2008) conceptualized anxiety as a feeling of dread-fear without specific object that is detected when people manifest unease, exhibit worrying looks, anxiousness, fidgeting, high rate of heart palpitation, and muscle tension. Anxiety, therefore, is an involuntary and emotional reaction to the threat of the unknown such as, surgical failure, loss of personal identity, loss of control, possible death, strange environment, and life threatening episodes (Pritchard, 2009;Brown, Mason, Spokane et al., 2009). ...
... The literature, however, outlined ways of handling or curing pre-surgical anxiety as preoperative patient counselling or tours, accurate and thorough information about the operation, relaxation therapy, cognitive behavioural therapy, acupressure, auricular acupuncture, permitting family members to be present before the operation (Obidigbo, Obi-Nwosu & Nweke, 2023). Administration of anti-anxiety medication such as benzodiazepines or melatonin, play Music; improved nurse-patient relationships, and preoperative visit from the anaesthesiologist are also important and useful (Pritchard, 2009;Agarwai et al., 2009). Obidigbo (2018Obidigbo ( , 2019Obidigbo ( , 2022 had outline the benefit of counselling and other clinical interventions in the management of surgical anxiety. ...
... Anxiety can present itself in many forms -psychological symptoms like fear and excessive worry or physical symptoms such as increased heart rate high blood pressure and nausea 1 . A recent study also found that the nearly one third (32.4%) of adult patients undergoing elective surgery experienced pre-operative anxiety 2 . ...
... Anxiety Disorders are defined as anxiety symptoms that are persistent, illogical, excessive, and/or severe; occur in the absence of stressful events or stimuli; or interfere with daily activities [1]. Preoperative anxiety is a common reaction experienced by patients who are admitted to a hospital for surgery [2]. It is an emotional state of anxiety, uneasiness, and worry about hazardous occurrences that is accompanied by restlessness, weariness, attention issues, and muscular tension, as well as a physiological state of awareness [3], [4]. ...
Preoperative, anxiety, APAIS, prevalence, Iraq. Although surgical procedures have improved, preoperative anxiety remains a concern in preoperative treatment and visit which is recognized as a common reaction among patients awaiting surgery. To assess the prevalence and determinants of preoperative anxiety among adult surgical patients using APAIS questionnaire. A cross sectional study that included 400 adult healthy respondents who were attended the selected clinics for any complain and selected randomly to participate in this study. Two different types of questionnaires had been applied to all attendants to collect needed information. The first questionnaire included questions to gather information on certain socio-demographic variables and the second questionnaire applied was the validated Amsterdam Preoperative Anxiety and Information Scale (APAIS). Preoperative anxiety was detected in 31.5%; while 61% had intermediate level of information. Four factors were found to be significant independent risk factors for greater likelihood of preoperative anxiety. These factors were young age (OR= 6.54), female gender (OR= 10.43), higher education (OR= 14.53), and negative history of previous surgery (OR= 2.76). Prevalence of preoperative anxiety was not high in this study. Factors that increase this prevalence were younger age, female gender, higher educational level, and lack of previous surgical experience. This work is licensed under a Creative Commons Attribution Non-Commercial 4.0 International License.
... While music reduces negative emotions (anxiety, life anxiety, restlessness or anger, etc.) (Akin & Iskender, 2011;Cohen et al., 1983;Pittman & Kridli, 2011;Pritchard, 2009), it may increase positive emotions such as happiness (Jäncke, 2008;Juslin & Västfjäll, 2008). Listening to music has been strongly associated with reduced cortisol levels, lower heart rate and mean arterial pressure reduction, (Burrai et al., 2016;Koelsch et al., 2016;Kreutz et al., 2012; and reduced physical arousal. ...
Many studies have been conducted on child development and education from past to present. The child has an important place in the survival of societies, in improving the quality of life and in laying the foundations of the future. Investing in children who will create the future is the most reliable investment for society. Therefore, it is important to support the development and education of the child. The topics in this book, which emerged as a reflection of the innovations and thoughts in the field of child development and education, will gain practical meaning with the interests and wishes of the readers.
In order for them to become responsible, healthy individuals of the future, it is necessary to follow the development and education of children in well- equipped environments and by well-equipped people, and to work in cooperation with families and educational institutions. In order to recognize children developmentally, to support their healthy development in all developmental areas, and to provide them with appropriate learning experiences, it is necessary to have the competence to put the principles of child development and education into practice.
It is expected that this book will contribute to the field in terms of drawing attention to new trends in child development and education in the 21st century and looking at child development and education from different perspectives.
The book includes 9 chapters on children, “child development and child education”. We wish to contribute to all concerned whose target audience is children.
... In accordance with anxiety found in the different patient populations described above, the incidence and degree of preoperative anxiety also varies [69]. Preoperative anxiety begins from treatment planning and gradually increases until it reaches its peak when entering the operating room [70]. ...
Research has shown that personality is associated with anxiety levels in the general population. However, little is known about the relationship between personality and preoperative anxiety and the subsequent health outcomes in patients undergoing surgery. Therefore, this review aimed to identify studies that explored the relationship between personality traits and preoperative anxiety, as well as their association with postoperative outcomes. Existing literature shows that anxiety may play an intermediary role in the relationship between personality and postoperative outcomes. Severe anxiety may partially explain the adverse effects of certain personality traits, such as neuroticism, on postoperative outcomes. However, the relationship between personality traits, preoperative anxiety, and postoperative outcomes remains unclear. Interventions such as clinical evaluation, preoperative counseling, and management strategies can be of great value in identifying and resolving patients’ anxiety and negative emotions to improve postoperative outcomes.
... The lowest score is six, and the highest score is 30. In addition, after the APAIS questionnaire, patients were presented with nine statements indicating the estimated reason for their anxiety about anesthesia [13]. They were asked to choose the statements that fit them. ...
Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.
... Предоперационная тревога начинается, как только планируется процедура, и достигает пика в день операции [17]; это дополнительно подтверждается соответствующими физическими изменениями [18,19], такими как повышение уровня гормонов и высвобождение белка в острой фазе, эпизоды тахикардии, гипертония, повышение температуры тела, дисбаланс жидкости и электролитов, снижение иммунных реакций и более длительное заживление ран, что может повлиять на исход операции, послеоперационное восстановление [20] и привести к увеличению дозировки анестетиков и седативных средств, вводимых в день операции [11,21], с последующим повышенным риском побочных эффектов и взаимодействий. Пациенты с тревогой, как правило, дольше остаются в больнице, меньше получают послеоперационное удовлетворение и менее склонны к реабилитации и трудотерапии [22]. ...
Aim. To assess the extent to which cognitive and emotional disorders in patients undergoing spinal cord surgery affect the quality of rehabilitation and, based on the data obtained, to suggest optimization of rehabilitation measures.
Materials and methods. The study included 60 patients (30 men and 30 women) whose condition required spinal cord surgery. All patients underwent assessment of somatic and neurological status, as well as quantitative neuropsychological testing. The influence of cognitive and emotional disorders before and after surgery on the severity of pain syndrome and movement disorders was assessed. When included in the study, patients were randomized into the main (30 people) and control (30 people) group. The patients of the main group received cognitive-motor training, which was carried out using the methodological manual Cognitive Training for Patients with Moderate Cognitive Impairment, developed by the staff of the Department of Nervous Diseases and Neurosurgery of the Sechenov First Moscow State Medical University (Sechenov University). Cognitive, emotional, motor disorders, severity of pain syndrome, as well as the quality of life and adherence of patients to cognitive-motor training were assessed 3 and 6 months after the surgical intervention.The severity of cognitive and emotional disorders in patients of the main and control groups did not differ before the operation.
Results. After the operation, the severity of cognitive impairments was significantly higher in patients of the control group (p=0.03). Patients in the control group were significantly worse than patients in the main group in performing memory tasks (p=0.00), they also had a significantly lower rate of mental processes (p=0.00). These differences persisted 3 months after surgery (p=0.00). A week after the surgical intervention, the severity of anxiety and depression was significantly higher in patients in the control group (p=0.01). The positive effect of the operation in the form of pain reduction was achieved in all patients, but in the control group there was an increase in the severity of the pain syndrome after six months of observation compared with that after three months. An increase in the severity of the pain syndrome was associated with an increase in depression, anxiety, and cognitive impairment. The analysis showed that patients of the main group with high adherence to cognitive training showed significantly greater positive dynamics both in terms of cognitive functions and in terms of anxiety and depression (p0.05). A survey of patients after inclusion in the study with the provision of prospective recommendations for clinical care showed the following: 58 patients (96.7% of patients) noted that the proposed recommendations for clinical care, from their point of view, would significantly improve their postoperative prognosis. Important points that should be reflected in the clinical guidelines for the management of patients with spinal cord surgery, from the point of view of patients, were: discussion with the doctor of the picture of their illness, duration of hospitalization, expected outcome, prognosis (60 patients, 100%), medical education rehabilitation skills (51 patients, 85% of patients), communicating with patients who have already undergone a similar operation earlier in this surgical department (49 patients, 81.7%), ensuring continuity and discussing the entire rehabilitation route before surgery (60 patients, 100%).
Conclusion. Cognitive and emotionally disorders determine the quality of life and rehabilitation of patients who have undergone surgery on the spinal cord. Our results allow us to recommend the inclusion of cognitive-motor training in the rehabilitation program for patients after spinal neurosurgical operations.
... Hence, they are not considered separately. In addition, pre-operative anxiety in general is well documented in the literature [6,7] and the review team felt that it may be difficult to isolate any deleterious mental health effects from surgical delay specifically as opposed to pre-operative anxiety more generally. ...
The COVID-19 pandemic has resulted in significant delays to non-urgent elective surgery. Decision making regarding prioritisation for surgery is currently informed primarily by clinical urgency. The ways in which decision making should also consider potential social and economic harm arising from surgical delay are currently unclear. This scoping review aimed to identify evidence related to (i) the nature and prevalence of social and economic harm experienced by patients associated with delayed surgery, and (ii) any patient assessment tools that could measure the extent of, or predict, such social and economic harm. A rapid scoping review was undertaken following JBI methodological guidance. The following databases were searched in October 2020: AMED; BNI; CINAHL; EMBASE; EMCARE; HMIC; Medline; PsychINFO, Cochrane, and the JBI. A total of 21 publications were included. The findings were categorised into five themes: (i) employment, (ii) social function and leisure, (iii) finances, (iv) patients’ experiences of waiting, and (v) assessment tools that could inform decision making. The findings suggest that, for some patients, waiting for surgery can include significant social, economic, and emotional hardship. Few validated assessment tools exist. There is an urgent need for more research on patients’ experiences of surgical delay in order to inform a more holistic process of prioritising people on surgical waiting lists in the COVID-19 pandemic recovery stages.
... This in turn results in increased physiological arousal, such as heart rate (HR), blood pressure, and cardiac output (Bally et al., 2003;Pfaff et al., 2007). Stress-related emotional states can be defined in terms of subjective worry, nervousness, and restlessness (Cohen et al., 1983;Pritchard, 2009;Akin and Iskender, 2011;Pittman and Kridli, 2011), and have many similarities with "state anxiety" as an outcome. Accordingly, many researchers describe state anxiety as an emotional response to an individual's perception of a stressful experience (e.g., Hook et al., 2008;Koelsch et al., 2011). ...
Stress has a major negative impact on the development of psychopathology and contributes to the onset of adverse physical conditions. Timely recognition and monitoring of stress-related problems are therefore important, especially in client populations that are more vulnerable to stress, such as people with mild intellectual disabilities (MID). Recent research on the use of physiological measures to assess stress levels emphasize that, in addition to these measures, self-report instruments are necessary to gain insight into the individual perception and impact of stress on daily life. However, there is no current overview of self-report stress measures that focus on the experience of stress in the present moment or in daily life. To provide an overview of the existing self-report stress measures for clinicians and researchers, a scoping review was conducted. In addition, to advise clinical professionals on the use of self-report measures of stress for people with MID, the results of an expert consultation were used to refine the preliminary findings. A systematic scoping literature search resulted in a total of 13 self-reported stress measures that met the final inclusion criteria, of which three were developed specifically for assessing stress in adults with MID (GAS-ID, LI, and SAS-ID). For each included self-report stress measure, the psychometric quality, assessment procedure, and suitability for adults with MID were reported. These were supplemented by the findings from the expert consultation. Implications for clinical practice on the use of self-report stress measures, particularly for people with MID, are discussed. Recommendations for future research and development are given.
... [11] Sixty percent to 80% of surgical patients can suffer from preoperative anxiety. [16] High level of preoperative anxiety can harm the anesthetic [17][18][19] and surgical care, [20,21] and can thereby extend the outpatients' length of stay. ...
Despite the benefits related to ambulatory surgery such as cost reduction due to lack of accommodation and patient satisfaction due to early home return, it may not lead to these expected benefits. Indeed, this kind of practice can increase responsibility for the person being treated and his or her relatives. It is therefore essential to inform them as well as possible to obtain their adherence to the proposed care protocol. Nevertheless, patients’ failures to comply with preoperative instructions or the non-attendance of the patient may result in late cancellation of the scheduled surgery. In order to reduce this kind of dysfunction, the Assistance Publique-Hôpitaux de Paris (APHP) uses a reminder system by Short Message Service (SMS).
This study is a descriptive cross-sectional multicenter study that focuses on outpatients’ lived experiences of their preoperative preparation and information. It aims to collect patients’ perceptions of their ability to follow preoperative instructions received by SMS the day before an operation performed for ambulatory surgery, according to their level of health literacy (HL) and preoperative anxiety. Indeed, poor communication between patients and doctors can contribute to preoperative anxiety, while low health literacy (LHL) can lead to poor understanding of preoperative preparation instructions. Therefore, it seems important to take these 2 criteria into account in this study. This research is designed to interview outpatients undergoing ambulatory surgery in the establishments of APHP. A self-questionnaire will be used for this purpose. The choice of this institution is justified by its decision to use in all care units the reminder of preoperative instructions by SMS.
The main outcome is the perception of outpatients with LHL skills regarding preoperative information provided by doctors.
French ethics review committee (Comité d’Ethique de la Recherche) of the University of Paris has approved the study protocol (IRB 00012020-14). Results from this study will be disseminated through oral communications and a scientific article in an international peer-reviewed journal.
This protocol is registered on researchregistry.com (researchregistry5834). This version number is 1.1 Protocol dated July 22, 2020.
... They might even affect patients' responses to anaesthetic and analgesia intraoperatively. Patients' discharge from hospital might be delayed due to increased pain and delayed wound healing caused by anxiety (Pritchard, 2009). Up to 75% of patients undergoing surgery are reported to suffer from surgery-related anxiety (Kühlmann et al., 2018;Montin et al., 2008). ...
Aims:
To explore the effectiveness of a new perioperative practice model on anxiety and health-related quality of life in patients undergoing total hip arthroplasty and total knee arthroplasty under spinal anaesthesia.
Design:
A randomized clinical trial.
Methods:
Control group participants (N = 222) received standard perioperative care, meaning they were cared for by various nurses during their perioperative process without postoperative visits. Intervention group participants (N = 231) were assigned one named anaesthesia nurse during their entire perioperative process who visited them postoperatively. Both groups responded to two self-reported questionnaires: the generic 15D health-related quality of life instrument and the State-Trait Anxiety Inventory (STAI) measuring anxiety two to three weeks pre-operatively and three months postoperatively.
Results:
There were no statistically significant differences between the groups at baseline or at follow-up in health-related quality of life or anxiety.
... Music listening is strongly associated with stress reduction by the decrease of physiological arousal as indicated by reduced cortisol levels, lowered heart rate, and decreases in mean arterial pressure (e.g., Burrai et al., 2016;Koelsch et al., 2016;Kreutz et al., 2012;Linnemann et al., 2015). Music can also reduce negative emotions and feelings, such as subjective worry, state anxiety, restlessness or nervousness (Akin & Iskender, 2011;Cohen et al., 1983;Pittman & Kridli, 2011;Pritchard, 2009), and increase positive emotions and feelings, such as happiness (Jäncke, 2008;. This is in line with studies showing that music modulates activity in brain structures, such as the amygdala and the mesolimbic reward brain system, which are known to be involved in emotional and motivational processes (Blood & Zatorre, 2001;Koelsch, 2015;Koelsch et al., 2016Koelsch et al., , 2016Levitin, 2009;Moore, 2013;Salimpoor et al., 2013;Zatorre, 2015). ...
Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.
... Physiological repliescomprise tachycardia, hypertension, high temperature, sweating, vomiting and a sensitive to touch, smell and hearing. Physiological replies comprise alters in behavior like enlarged tension, apprehension, anxiety and anger (Pritchard, 2009). The purpose of current study was to investigate the preoperative anxiety level among patients undergoing elective general surgery in district head quarter hospital Timergara. ...
Anxiety is an emotive state considered by anxiety and fear subsequent from the expectation of a threatening occurrence. The occurrence of preoperative anxiety levels from 11% to 80% in mature patients and also differs among various surgical categories. The purpose of current study was to investigate the preoperative anxiety level among patients undergoing elective general surgery in district Head Quarter Hospital (DHQ) Timergara. In the present study total of 103 patients were selected, among these 56(54.4%) were arranged between 20-35 years of age, while 47 (45.6%) were arranged 36-50 years of age. Sex wise distribution was 50(48.5%) in male, while 53(51.5%) in female respectively. On the basis of marital status total of 68(66.0%) patients were married, while 35(34.0%) were unmarried. Preoperative anxiety may cause to numerous complications such as autonomic variations, late jaw relaxation and coughing during entrance of anesthesia.
... The causes of preoperative anxiety are multifactorial and have individually varying influences on the perioperative outcome [1]. Cognitive and behavioural changes, physiological reactions, different requirements for anaesthetic drugs and perception of pain, mood swings, woundhealing problems, and alteration of the immune system have been reported [2]. A generalised anxiety disorder was also significantly associated with major adverse cardiovascular and cerebrovascular events in patients undergoing coronary artery bypass graft surgery [3]. ...
Introduction
Premedication of surgical patients with benzodiazepines has become questionable regarding risk-benefit ratio and lack of evidence. Though preoperative benzodiazepines might alleviate preoperative anxiety, a higher risk for adverse events is described, particularly for elderly patients (≥ 65 years). Several German hospitals already withhold benzodiazepine premedication from elderly patients, though evidence for this approach is lacking.
The patient-centred outcome known as global postoperative patient satisfaction is recognised as a substantial quality indicator of anaesthesia care incorporated by the American Society of Anesthesiologists. Therefore, we aim to assess whether the postoperative patient satisfaction after premedication with placebo compared to the preoperative administration of 3.75 mg midazolam in elderly patients differs.
Methods
This study is a multicentre, randomised, placebo-controlled, double-blinded, two-arm parallel, interventional trial, conducted in nine German hospitals. In total 614 patients (≥ 65–80 years of age) undergoing elective surgery with general anaesthesia will be randomised to receive either 3.75 mg midazolam or placebo.
Discussion
This is, to the best of our knowledge, the first study analysing patient satisfaction after premedication with midazolam in elderly patients. In conclusion, this study will provide high-quality data for the decision-making process regarding premedication in elderly surgical patients.
Trial registration
ClinicalTrials.gov, NCT03052660. Registered on 14 February 2017. EudraCT 2016-004555-79.
... Physiological repliescomprise tachycardia, hypertension, high temperature, sweating, vomiting and a sensitive to touch, smell and hearing. Physiological replies comprise alters in behavior like enlarged tension, apprehension, anxiety and anger (Pritchard, 2009). The purpose of current study was to investigate the preoperative anxiety level among patients undergoing elective general surgery in district head quarter hospital Timergara. ...
Anxiety is an emotive state considered by anxiety and fear subsequent from the expectation of a threatening occurrence. The occurrence of preoperative anxiety levels from 11% to 80% in mature patients and also differs among various surgical categories. The purpose of current study was to investigate the preoperative anxiety level among patients undergoing elective general surgery in district Head Quarter Hospital (DHQ) Timergara. In the present study total of 103 patients were selected, among these 56(54.4%) were arranged between 20-35 years of age, while 47 (45.6%) were arranged 36-50 years of age. Sex wise distribution was 50(48.5%) in male, while 53(51.5%) in female respectively. On the basis of marital status total of 68(66.0%) patients were married, while 35(34.0%) were unmarried. Preoperative anxiety may cause to numerous complications such as autonomic variations, late jaw relaxation and coughing during entrance of anesthesia.
Background: Control of preoperative anxiety especially before cesarean section, is one of the most important goals of nursing care around the world. Aim of study : To determine the effect of acupressure on preoperative cesarean section anxiety. Methods: Forty primiparae undergoing elective cesarean section surgery, were selected from El Galaa Teaching hospital, Cairo, Egypt , their age ranged from 20-35 years, and BMI was less than 30 kg/m2. They were divided randomly into two groups equal in number, (group A) Study group, consisted of twenty women who received acupressure in two points (HE7 and Yintang) for 5 minutes each 30 minutes before surgery and (group B) control group, consisted of twenty women who received acupressure in two ineffective points (sham points) for 5 minutes each , 30 minutes before surgery. All women on both groups (A &B) were assessed pre and post treatment through assessing their vital signs: heart rate, and blood pressure to indicate the state of a patient's essential body functions Also, the State-Trait Anxiety Inventory (questionnaire) for measuring the circumstantial or temporary arousal of anxiety. Results : There was no statistical significant difference in heart rate between the pretreatment values compared to post treatment values in both groups (A&B) and there was no significant difference between both groups (A&B) when comparing heart rate post treatment values , while for systolic and diastolic blood pressure in group (A) there was a statistical significant decrease in post treatment values compared with pretreatment values, while there was no statistical significant difference between the pretreatment and post treatment values in group (B).When comparing the post treatment values of systolic and diastolic blood pressure of both groups there was a statistical significant decrease for favor of group (A) when compared to group (B), and for the Stait trait anxiety inventory questionnaire there was a statistical significant decrease between the pretreatment values compared to the post treatment values in both groups .When comparing the post treatment values of both groups there was a statistical significant decrease for favor of group (A) than group (B). Conclusion: Application of acupressure is effective in decreasing preoperative cesarean section anxiety.
Objectives
Surgical anxiety has emerged as a major limitation of implant surgery impeding its emergence as a leading choice of rehabilitation. It also triggers a series of physiological, emotional, and cognitive responses which adversely affects treatment outcomes and postoperative management. Hence, this study was designed specifically to address anxiety in patients undergoing dental implant surgeries.
Materials and Methods
This study included 54 partially edentulous patients requiring single-implant rehabilitation. The patients were randomly assigned to the test group (Alprazolam group) and control group (Placebo group). Twenty-seven patients (test group) received Alprazolam 0.5 mg as a preemptive anxiolytic and 27 patients (control group) received a multivitamin tablet as placebo 1 h before implant surgery. Heart rate, blood pressure and respiratory rate of patients were measured to access the activation of sympathetic nervous system.
Results
Oral administration of Alprazolam 1 h before the procedure showed significant reduction in preoperative anxiety in patients undergoing surgical placement of dental implants.
Conclusion
Anxiolytic effect of Alprazolam mediated by binding to the alpha 1 subunit of GABA A receptor enhances the inhibitory effect on the nervous system. Preoperative administration of alprazolam 0.5 mg h prior, conceivably be standardized for management of surgical anxiety.
This study aimed to explore whether differences exist in anesthesia care providers’ use of intraoperative medication between African American and non-Hispanic White patients in adult surgical patients who underwent noncardiothoracic nonobstetric surgeries with general anesthesia. A retrospective observational cohort study used electronic health records between January 1, 2018 and August 31, 2019 at a large academic health system in the southeastern United States. To evaluate the isolated impact of race on intraoperative medication use, inverse probability of treatment weighting using the propensity scores was used to balance the covariates between African American and non-Hispanic White patients. Regression analyses were then performed to evaluate the impact of race on the total dose of opioid analgesia administered, and the use of midazolam, sugammadex, antihypotensive drugs, and antihypertensive drugs. Of the 31,790 patients included in the sample, 58.9% were non-Hispanic Whites and 13.6% were African American patients. After adjusting for significant covariates, African American patients were more likely to receive midazolam premedication ( p < .0001; adjusted odds ratio [aOR] = 1.17, 99.9% CI [1.06, 1.30]), and antihypertensive drugs ( p = .0002; aOR = 1.15, 99.9% CI [1.02, 1.30]), and less likely to receive antihypotensive drugs ( p < .0001; aOR = 0.85, 99.9% CI [0.76, 0.95]) than non-Hispanic White patients. However, we did not find significant differences in the total dose of opioid analgesia administered, or sugammadex. This study identified differences in intraoperative anesthesia care delivery between African American and non-Hispanic White patients; however, future research is needed to understand mechanisms that contribute to these differences and whether these differences are associated with patient outcomes.
Background and Aims
Preoperational anxiety affects the outcome of anesthesia and surgery. Benzodiazepines impair psychomotor performance and cause excessive sedation. L-theanine is a unique amino acid found in green tea. It prevents stress, produces anxiolysis, modulates alpha activity, and provides beneficial effects on mental state, including sleep quality. Gamma-aminobutyric acid (GABA) is a non-proteinogenic amino acid and a phytochemical that is the main inhibitory neurotransmitter in the mammalian brain. It is beneficial in anxiety and stress regulation. Hence, alternative premedicants such as L-theanine and GABA will have a widespread appeal and are safer. The primary objective was to study and compare the effects of L-theanine and GABA on preoperative anxiety, sedation, and cognition in patients posted for major elective surgeries. The secondary objective was to study adverse reactions.
Material and Methods
A total of 168 patients aged between 18 and 55 years, belonging to the American Society of Anesthesiologists physical status class I and II, and satisfying all inclusion criteria were randomly divided into three groups that received either oral L-theanine, oral GABA, or oral alprazolam 0.25 mg. The anxiety score, sedation score, and psychomotor and cognitive performance scores were noted 60 minutes before and after the administration of the drugs.
Results
Alprazolam produced more sedation than GABA and L-theanine ( P = 0.0001). Psychomotor and cognitive functions improved with L-theanine and GABA ( P = 0.0001) and decreased with alprazolam ( P = 0.0001).
Conclusion
GABA and L-theanine result in effective preoperative anxiolysis with minimal sedation and improvement of cognitive skills.
Visitors to emergency department waiting areas often experience high anxiety, which results in discomfort during their waits. Our findings offer empirical evidence for the positive impact of including natural elements in these waiting areas. We created four high-fidelity virtual environments that incorporated natural elements in three ways, i.e., the presence of plants, the use of nature images and natural materials, and a combination of those two, in addition to a controlled environment without natural elements. We tested how subjects responded to each environmental setting. Our findings demonstrated that the inclusion of natural elements significantly lowered patients' anxiety in hospital environments, confirming previous research, and the presence of natural elements improved perceived wait time, as well as service quality through anxiety and perceived wait time. The combination yielded higher scores in anxiety, perceived wait time, and service quality than the other conditions. Serial mediation analysis results revealed that underlying anxiety and patients' perceived wait time mediated the effect of natural elements on perceived service quality. Among the five dimensions of service quality, the mediating effects of anxiety and perceived wait time appeared stronger in reliability and responsiveness.
Background: Pre-operative anxiety in obese patients is expected to be more due to psychological reasons, body habitus, comorbidities, and fear of not waking up from anesthesia. It is associated with emotional and physical problems. Predictive factors are complexity of surgery, the anesthesia, post-operative pain, not being appropriately informed, and psychosocial characteristics of the patient. Not many such studies have been conducted in morbidly obese patients. Objectives: The objective of this study was to determine the correlation between pre-operative anxiety and post-operative pain in obese patients undergoing elective laparoscopic bariatric surgery. Methods: Total 200 patients of the American Society of Anesthesiologists Grade I–III were taken, with BMI >30 kg/m2, who were undergoing elective laparoscopic bariatric surgeries. The amsterdam preoperative anxiety and information scale (APAIS) score was recorded a day prior to surgery. Heart rate, blood pressure, respiratory rate, and SpO2 were recorded pre- and postoperatively. Patients were assessed for pain on the visual analog scale (VAS) in post-operative period at 0-, 1-, 2-, 6-, 12-, and 24-h intervals. All the data were entered in master chart and statistically analyzed (Pearson coefficient of correlation test). Results: There is a positive, weak, statistically significant correlation (r=0.157, p=0.026) between anxiety score (APAIS) and post-operative pain (the highest VAS across all hours). Conclusion: Pre-operative anxiety is directly linked to post-operative pain in obese patients undergoing elective laparoscopic bariatric surgery.
Background
There has been an increase in the use of spinal anaesthesia for Caesarean section (CS) in Nigeria in the past decades. There is, therefore, a need to evaluate the level of satisfaction among patients that had spinal anaesthesia, as an index of the quality of reproductive health care.
Methodology
A prospective observational study of 380 consenting parturients in ASA classes I, II, and III, who underwent CS under spinal anaesthesia between January and December 2019. Satisfaction score was assessed using a three-point Likert scale. Data were analysed using [IBM SPSS software version-22]. The level of statistical significance was set at p-value <0.05.
Results
A total of 380 consenting patients underwent spinal anaesthesia within the study period with 219 (57.6%) aged ≥30 years. Most were emergency CS 267 (70.3%). Most patients 294 (77.4%) expressed satisfaction for being involved in decision-making about the choice of anaesthesia technique. The majority of the patients 333 (87.6%) were satisfied with pain relief during the operation. The complications experienced by the patients intraoperatively included dizziness, 50 (13.2%), shivering, 139 (36.6%), and intraoperative nausea and vomiting, 48 (12.6%). Overall, 295 (77.6%) of the patients expressed willingness to have spinal anaesthesia again in the future, out of the 295, 293 (99.4%) were satisfied with the current spinal anaesthesia. P = 0.000
Conclusion
Maternal satisfaction to spinal anaesthesia in this study was high. This could be attributed to patient’s participation in decision-making, prompt treatment of complications, and overall good anaesthetic care.
60 ﺑﺴـﺘﺮي ﻫﻴﺴـﺘﺮﻛﺘﻮﻣﻲ ﻋﻤـﻞ ﺗﺤﺖ ﺑﻴﻤﺎر ﺑﻴﻤﺎرﺳﺘﺎن در وﻟﻲ ﻫﺎي ﻋﺼﺮ) ﻋﺞ (ﺳﺎل در ﺗﻬﺮان ﺷﺮﻳﻌﺘﻲ و 1391 ﻧﻤﻮﻧﻪ روش ﺑﻪ و اﻧﺘﺨـﺎب آﺳـﺎن ﮔﻴﺮي از ﻳﻜﻲ در ﺗﺼﺎدﻓﻲ ﻃﻮر ﺑﻪ 2 ﺷﺪﻧﺪ ﺗﻮزﻳﻊ ﺷﺎﻫﺪ ﻳﺎ و ﻣﺪاﺧﻠﻪ ﮔﺮوه. در را ﭘـﺎ ﻣﺎﺳـﺎژ ﻣﺪاﺧﻠﻪ ﮔﺮوه ﺑﻴﻤﺎران 3 ﺟﻠﺴﻪ ﻃﻲ در 3 ﻣﺘﻮ روز اﻟﻲ) ﺟﻠﺴﻪ ﻫﺮ 20 دﻗﻴﻘﻪ (ﻛﺮدﻧﺪ درﻳﺎﻓﺖ. ﺑـﻪ ﭘﮋوﻫﺸـﮕﺮ ﻛﻨﺘﺮل ﮔﺮوه ﺑﻴﻤﺎران در ﻣﺪت 20 ﺣﻀﻮر ﺑﻴﻤﺎران ﻛﻨﺎر در دﻗﻴﻘﻪ ﻳﺎﻓﺖ. در اﺿﻄﺮاب ﺳﻨﺠﺶ 7 در ﻣﺮﺣﻠﻪ 2 و ﻗﺒـﻞ ﮔـﺮوه، 30 دﻗﻴﻘـﻪ ﻣﺪاﺧﻠﻪ از ﺑﻌﺪ و روز ﻫﺮ در اﺷﭙﻴﻞ آﺷﻜﺎر اﺿﻄﺮاب ﭘﺮﺳﺸﻨﺎﻣﻪ ﻛﻤﻚ ﺑﻪ ﻋﻤﻞ از ﺑﻌﺪ ﻫﻔﺘﻪ ﻳﻚ ﻫﻤﭽﻨﻴﻦ ﺑﺮﮔـﺮ اﻧﺠﺎم ﮔﺮﻓﺖ. داده اﻧﺪازه ﺑﺎ وارﻳﺎﻧﺲ آزﻣﻮن از اﺳﺘﻔﺎده ﺑﺎ ﻫﺎ و ﺗﻜﺮاري ﮔﻴﺮي ﺗﻲ ﻣﺴﺘﻘﻞ ﺷﺪ ﺗﺤﻠﻴﻞ. ﻳﺎﻓﺘﻪ ﻫﺎ : ﻧـﺪاد ﻧﺸـﺎن ﻣﻌﻨﺎداري ﺗﻔﺎوت ﮔﺮوه دو در ﻣﺪاﺧﻠﻪ از ﻗﺒﻞ روز ﻳﻚ آﺷﻜﺎر اﺿﻄﺮاب ﻧﻤﺮات ﻣﻘﺎﻳﺴﻪ. ا ﺣﺎﻛﻲ ﮔﺮوه دو در ﻣﺪاﺧﻠﻪ ﺑﺎر ﻫﺮ از ﺑﻌﺪ و ﻗﺒﻞ اﺿﻄﺮاب ﻧﻤﺮه ﻣﻴﺎﻧﮕﻴﻦ ﺗﻐﻴﻴﺮات اﻣﺎ ﺑﻮد ﻣﻌﻨﺎدار اﺧﺘﻼف ز. داد ﻧﺸﺎن ﻣﻌﻨﺎدار آﻣﺎري اﺧﺘﻼف ﺑﻌﺪ ﻫﻔﺘﻪ ﻳﻚ ﮔﺮوه دو اﺿﻄﺮاب ﻧﻤﺮه ﻣﻴﺎﻧﮕﻴﻦ ﻣﻘﺎﻳﺴﻪ) 001 / 0 p< (. ﻧﺘﻴﺠﻪ ﮔﻴﺮي : ﺑﻪ ﻣﻲ ﭘﺎ ﻣﺎﺳﺎژ ﻛﺎرﮔﻴﺮي و ﻗﺒﻞ ﺑﻴﻤﺎران اﺿﻄﺮاب ﺗﻮاﻧﺪ دﻫﺪ ﻛﺎﻫﺶ را ﻫﻴﺴﺘﺮﻛﺘﻮﻣﻲ از ﺑﻌﺪ .
Introduction
The stressful pre-operative period exerts a profound impact on psychological, physiological and immunological outcomes. Oncological surgeries, in particular, elicit significantly higher stress responses than most other surgeries. Managing these responses through psychological interventions may improve long-term outcomes. The purpose of the current research was to review studies that have explored pre-operative psychological interventions in cancer patients in order to map the types of current interventions and provide an initial assessment of whether these interventions improved psychological, physiological, and/or immunological indices as well as long-term cancer outcomes.
Methods
A systematic literature search for studies that included pre-operative psychological interventions in oncology patients was conducted, using the databases PubMed and Web of Science. Inclusion criteria included studies pertaining to oncological surgery in adults, study designs that included a clearly defined pre-operative psychological intervention and control group.
Results
We found 44 studies, each using one of the following interventions: psychoeducation, cognitive interventions, relaxation techniques, integrated approaches. All the studies reported improved immediate post-operative psychological, physiological, and/or immunological outcomes. Only a few studies addressed long-term cancer outcomes, and only one reported improved survival.
Conclusions
Research on pre-operative interventions with cancer patients is missing systematic methods. Studies provide varying results, which makes it difficult to compare them and reach reliable conclusions. There is considerable heterogeneity in the literature regarding the specific intervention used, the timing of intervention, the characteristics of the patients studied and the outcome measures. In order to improve research in this field, including the measurement of long-term outcomes, we suggest some steps that should be taken in further research.
The goal of this dissertation is to contribute to the body of scientific knowledge on music interventions for stress reduction. To cope with the negative impact of stress, millions of people around the world use tranquilizing medication, which in turn is associated with numerous contraindications and negative side effects. Therefore, there is an urgent need to develop and examine innovative and non-pharmacological interventions for stress reduction, especially for patient populations known to be more vulnerable to stress such as those with mild intellectual disabilities (MID). Moreover, the stress-reducing qualities of music have been associated with a broad range of positive outcomes in both medical and mental healthcare settings. This dissertation therefore aims to increase scientific knowledge on (a) the effects of different types of music interventions on stress-related outcomes, (b) how and why music interventions may specifically lead to stress-reducing effects, and (c) how stress can be accurately assessed, specifically in people with MID. Overall, this dissertation demonstrates that music interventions in the form of both music listening interventions and in the context of music therapy can greatly benefit patients in medical and mental health care settings. Furthermore, the added value of a qualified music therapist offering the music interventions is emphasized, which can be explained by the personalized, tailored approach of the music therapist. Despite the difficulty of examining these music therapy interventions, more robust research is needed, especially in patient populations proven to be more vulnerable to stress as those with cognitive impairments. The results of this dissertation also highlight the need for continued efforts to develop high-quality self-report stress measures for people with the MID to assess stress-related outcomes as valid and reliable as possible. Future research that focuses on both efficacy and hypothesized therapeutic factors is crucial to the further implementation of music therapy interventions in healthcare settings, particularly when it comes to stress reduction.
Objective:
To evaluate the effect of personalized prechemotherapy education in the reduction of peri-chemotherapy anxiety in patients with colorectal cancer.
Methods:
Patients admitted to the Department of Oncology with a diagnosis of stage III or IV colorectal cancer and scheduled for initial chemotherapy from January 1, 2017, to June 30, 2019, were retrieved. Patients in the educated group completed the GAD-7 form to evaluate their anxiety level at admission and 14 days after personalized prechemotherapy education, the educator team of which included both physician and nurse staff. Patients in the control group only completed GAD-7 forms at admission and 14 days thereafter without personalized education.
Results:
Three hundred and sixty-four patients were enrolled for analysis, including 127 patients who received personalized prechemotherapy education and 237 patients who did not receive education. There were no significant differences in age, gender, education level, or pretreatment GAD-7 scores between the two groups, but significantly lower posttreatment GAD-7 score, and fewer medium to severe posttreatment anxiety patients in the educated group.
Conclusion:
Personalized prechemotherapy education involving physician for medical treatment and nursing staff for peri-treatment care, in contrast to traditional brief discussion with physicians during clinic visits and unified informed consent before treatments, may reduce peri-chemotherapy anxiety more efficiently.
Background and aim
Spinal anesthesia for cesarean section is now a day a popular plan of anesthesia because of its rapid onset and high frequency of successful blockade. It is a vital monitor to the quality of care in anesthesia. The main aim of this study was to assess the level of maternal satisfaction and associated factors after cesarean section under spinal.
Methods
Hospital-based cross-sectional study was conducted on mothers who underwent cesarean section with spinal anesthesia. Descriptive analysis and chi-square test were employed. Bivariable and multivariable logistic regression was used to measure the association of factors with the level of satisfaction. A p-value of ≤0.25 and ≤ 0.05 was used to decide statistical significance for bivariable and multivariable logistic regression respectively.
Findings
The overall satisfaction level of parturients after spinal anesthesia was 97(80.2%). The satisfaction level was 83.3% with PONV treatment, 98.3% with intraoperative analgesia, between 52.5% and 64.2% to preoperative activities, and 72.5% for postoperative patient care by the anesthetist. Having previous anesthesia was the independent factor that has a significant association with the level of satisfaction with AOR, 3.94; 95%CI, 1.24–12.45; P- 0.01.
Conclusion
In general, the overall satisfaction of the mothers towards spinal anesthesia was fair with a satisfaction score of 80.2%. Parturients were highly dissatisfied with the preoperative visit and information subscale as compared to the other subscales.
Introduction:
Psychological health is important to old patients with benign prostatic hyperplasia (BPH) after prostatic surgery. In this retrospective cohort study, we evaluated the effect of personalized preoperative education in the reduction of perioperative anxiety in old BPH patients after prostatic surgery.
Methods:
Senior patients (≥65 years) admitted with a diagnosis of BPH and scheduled for initial transurethral resection of the prostate from January 1, 2017 to November 30, 2019 were retrieved. Patients in the preoperatively educated group completed the Chinese version of generalized anxiety disorder 7-item scale (GAD-7) form to evaluate their anxiety level at admission and 14 days clinical visits after individual preoperative education. Patients in the control group completed GAD-7 forms but did not receive personalized preoperative education. Patients in both groups discussed their disease with physicians during clinic visits and after admission, and were given an informed consent about their treatment plans.
Results:
Seven hundred and twenty-four patients were retrieved, including 312 patients who received preoperative education and 412 patients who did not. There were significantly lower postoperative GAD-7 score and fewer moderate to severe postoperative anxiety patients in the preoperatively educated group (p < 0.01). Patients with education above secondary education level had less perioperative anxiety.
Conclusion:
Personalized education incorporated with shared valuable physiological and psychological experience and expectations dealing with BPH, in comparison to traditional uniformed patient education and informed consent before surgery, may reduce perioperative anxiety more efficiently in BPH patients. A higher educational level helps patients reduce perioperative anxiety before and after their personalized preoperative education.
Purpose: To investigate whether timing influences pain perception during cataract surgery and to investigate the possible mechanisms.
Methods: Patients scheduled for cataract surgery both in the morning and afternoon were consecutively enrolled. Questionnaires to evaluate anxiety, including the Simplified State–Trait Anxiety Inventory, Amsterdam Preoperative Anxiety and Information Scale, and a visual analogue scale (VAS) for anxiety, were completed preoperatively, whereas a VAS for pain and the Wong–Baker FACES® Pain Rating Scale questionnaire were completed after surgery. Preoperative blood pressure and heart rate were recorded. Blood samples were acquired before surgery, and plasma cortisol, adrenocorticotropic hormone, adrenalin, and noradrenalin were tested.
Results: Fifty-five patients underwent uneverntful cataract surgery (28 in the morning and 27 in the afternoon) were included in the final analysis. Greater intraoperative pain perception during cataract surgery was reported in the afternoon than in the morning. Overall anxiety levels were significantly higher in the afternoon. Plasma adrenalin levels were significantly higher in the afternoon. Cortisol levels were higher in the afternoon. Preoperative anxiety levels were closely related to intraoperative pain perception. Both adrenalin and cortisol correlated positively with preoperative anxiety, but only adrenalin correlated significantly with the pain scores.
Conclusions: Patients undergoing cataract surgery in the afternoon showed more preoperative anxiety, which may have increased their relevant stress hormones. Both the patient’s emotional state and hormone levels may together aggravate his/her perceived pain in the afternoon. Monitoring preoperative anxiety levels, blood pressure, and heart rate should help to identify patients at higher risk of perceived intraoperative pain.
Clinical trial registration :
Trial registration number: NCT02182921
Registration site: clinicaltrials.gov
Background:
Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery.
Objective:
The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing.
Methods:
The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22.
Results:
Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (β = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP.
Conclusions:
Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management.
Anxiety is often mentioned in people’s daily life, especially in the field of medicine and psychology. For nursing, a clear understanding of anxiety is conducive to clinical nursing practice and research. Under the guidance of the Walker and Avant method, this article conducts a concept analysis of anxiety that provides a comprehensive and rounded analysis of anxiety and helps nurses gain a better understanding of anxiety.
Background
The evaluation of one’s physical health and psychological wellbeing may be subjective. Aspects of functional capacity, including the patients’ own estimation of physical health and wellbeing, have been shown to be strong predictors of postoperative outcomes, therefore, they should be the focus of further research.
Aim
This study aimed to explore the associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among orthopaedic patients.
Methods
This is a longitudinal study with a quantitative approach.
Settings
A central county hospital in northern Sweden.
Results
A high ASA classification rated by anaesthetists was not associated with physical health and psychological wellbeing self-estimated as less than good. A high ASA classification was significantly associated with self-estimated anxiety prior to surgery. Three days and one month post-surgery, the situation was reversed, and the ASA I/II group, to a significantly higher extent, rated that they felt anxiety.
Conclusion
Preoperative screening systems for orthopaedic patients should not only focus on the medical and objective physical issues but also include the patients’ own estimation of their physical health and psychological wellbeing. It is essential that orthopaedic patients receive relevant information that provides a realistic outlook, as well as an honest and optimistic future view.
Total pelvic exenteration is a complex major operation involving the removal of all organs from the pelvis, which mandates diversion of both urine and faeces. The sequelae of surgery are undeniably life-altering. Carefully considered multidisciplinary, pre-operative preparation is essential to mitigate the psychological and physical stresses of such surgery. There are several areas of unmet need in cancer surgery, and these deficiencies are highlighted in procedures of this complexity. Multiple factors influence pre-operative preparation, including the quality, timing and format of patient information, as well as the patient's language needs and level of literacy. Surgical preparation should also include opportunities for prehabilitation, and therefore timing of information is crucial, particularly as these patients are usually undergoing intensive neo-adjuvant treatments, including chemo- and radiotherapy. Peer support is also considered important, although little is known about the benefits of peer relationships in major pelvic surgery. This article discusses how patients are prepared at the Royal Marsden NHS Foundation Trust and highlights opportunities for further research, the aim of which is to improve outcomes and quality of life.
Purpose:
The present study aimed to compare the effects of foot and hand massage on preoperative anxiety.
Design:
Three-arm randomized, nonblinded, placebo-controlled, parallel group trial.
Methods:
This study was conducted on 90 female candidates waiting for phacoemulsification cataract surgery in Arak Amirkabir Hospital, Iran. Patients were consecutively selected and randomly divided into three groups of hand (n = 30), foot (n = 30), and placebo (n = 30), using a random number generator software program. In each group, massage was performed 5 minutes for each hand or foot in the surgical waiting room about 10 minutes before surgery. Anxiety was measured before and after the intervention by visual analog scale and also assessing physiological indicators (heart rate, respiratory rate, systolic and diastolic blood pressures).
Findings:
All the 90 patients completed the study and were included in the final analysis. Both hand and foot massage resulted in a significant decrease compared with placebo massage in anxiety and heart rate. However, no significant difference was found between hand and foot massage in any of the measured parameters. In the foot group and hand group, a significant reduction was observed in heart rate and anxiety after the intervention, whereas the anxiety increased significantly in the placebo group after the intervention. Moreover, systolic blood pressure in the foot group and the respiratory rate in the hand group significantly decreased after the intervention.
Conclusions:
Application of hand or foot massage seems to be effective in managing anxiety in patients waiting for phacoemulsification cataract surgery.
Purpose:
To determine the views and current practice preferences of interventional radiologists and allied healthcare providers regarding management of preprocedural anxiety.
Materials and methods:
From March to April 2018, members of the Society of Interventional Radiology were surveyed regarding their opinions in the assessment and management of patient anxiety. Degree of responsibility for the management of anxiety was also queried through the use of a scale (1 = no responsibility; 2 = some responsibility; 3 = major responsibility).
Results:
Of 1163 respondents (23.8% response rate), most described preprocedural anxiety as somewhat to very important in their practice (n = 961, 82.6%), somewhat to very important to the patients (n = 1087, 93.5%), and at least sometimes interfering with delivery of care (n = 815, 70.1%). Most respondents did not measure preprocedural anxiety directly (n = 953, 81.9%), but would address it if raised by the patient (n = 911, 82.9%). Patient education (n = 921, 79.1%), medications (n = 801, 68.8%), and therapeutic or empathetic interactions (n = 665, 56.4%) were most preferred to manage anxiety. Radiologists, nurses, patients, primary care providers, family members, and psychologists or psychiatrists were all allocated responsibility to reduce anxiety.
Conclusions:
Interventional radiologists and other providers are aware of the importance of preprocedural anxiety. Despite the notion that most radiologists did not address anxiety directly, most indicated a willingness to discuss the issue if raised by patients. Patient education, medications, and several other techniques are preferred to manage preprocedural anxiety. Responsibility to reduce anxiety is perceived to be shared among radiologists, nurses, patients, family members, and other health care providers.
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