Effect of inhalation aromatherapy with lavender essential oil on stress and vital signs in patients undergoing coronary artery bypass surgery: A single-blinded randomized clinical trial

Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review

PURPOSE

Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem.

METHODS

A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed.

RESULTS

Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low.

CONCLUSIONS

Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.

Tunisian Clematis flammula Essential Oil Enhances Wound Healing: GC-MS Analysis, Biochemical and Histological Assessment

The aerial part of Clematis flammula (Ranunculaceae) has been traditionally used in the treatment of skin diseases including mycotic infection in the Tunisian traditional medicine. The study was undertaken to extract and determine the essential oil chemical composition of Clematis flammula aerial parts and to assess the potential of anemonin in wound healing on mechanically wounded wistar rats. The essential oil was obtained by hydrodistillation and analyzed by GC-MS. Anemonin was isolated and then incorporated as active in a cream for which the cytotoxicity was evaluated by methyl thiazolyl tetrazolium (MTT)-based colorimetric assay. Then, its potential in wound healing on mechanically wounded wistar rats was assessed. The GC-MS analysis showed that the major compound was protoanemonin (86.74%) which spontaneously dimerised in part to form the anemonin. The wound healing activity of anemonin cream exhibited a non toxic potential of anemonin at a concentration of 25 µg/mL with a cell migration efficiency that reaches more than 80% after 48 hours of treatment. Wound healing efficiency was evaluated by monitoring morphological and skin histological analyses. Comparable wound surface reduction of the group treated by anemonin cream (p ≥ 0.05) when compared to the reference treated group. The skin histological analysis showed the completely wound closure. Antioxidant activity was assessed by the malondialdehyde (MDA) rates and antioxidant enzymes (glutathione peroxidase (GPx) and catalase) determination. The results provided strong support for the effective wound healing activity of anemonin cream, making it a promising candidate as a therapeutic agent in tissue repairing processes.

The Effects of Aromatherapy on Intensive Care Unit Patients' Stress and Sleep Quality: A Nonrandomised Controlled Trial

Background

Stress has both physiological and psychological effects and can negatively impact patients' treatment and recovery. We examined whether the aromatherapy alleviated patients' stress and improved their sleep quality and provided data that can be utilized in clinical settings.

Methods

This was a nonrandomised controlled experimental study. Participants included lucid adult patients who were admitted to the intensive care unit and had spent more than two nights there. The experimental treatment required participants to engage in deep breathing with essential oils as part of the aromatherapy. The control group was instructed to go to sleep without receiving the lavender aroma oil.

Results

The experimental group and control group showed a significant difference in perceived stress (F = 60.11, p < .001), objective stress index (F = 25.65, p < .001), systolic blood pressure (F = 9.09, p < .001), diastolic blood pressure (F = 2.47, p = .046), heart rate (F = 5.71, p < .001), and sleep quality (F = 109.46, p < .001).

Conclusions

The results revealed that aromatherapy alleviated stress and improved sleep quality in intensive care unit patients after 2 days of the experimental treatment. These results demonstrate that aromatherapy affects stress and sleep quality, thus indicating its value in nursing interventions. This trial is registered with KCT0002344.

Essential oil of lavender in anxiety disorders: Ready for prime time?

Anxiety disorders are some of the most common psychiatric disorders, with potentially debilitating consequences on individual function. Existing pharmacotherapies for anxiety disorders are limited by delay to therapeutic effect, dependence, tolerance, withdrawal, and abuse potential. Therefore, safe and evidence-based complementary or alternative therapies may be important allies in the care of patients with anxiety disorders. Essential oils are lipophilic and concentrated botanical extracts that exhibit many properties of drugs, although they are not Food and Drug Administration approved and have limitations characteristic of herbal preparations. Lavender essential oil has an extensive anecdotal history of anxiolytic benefit that has recently been supported by clinical efficacy studies. The 2 primary terpenoid constituents of lavender essential oil, linalool and linalyl acetate, may produce an anxiolytic effect in combination via inhibition of voltage-gated calcium channels, reduction of 5HT1A receptor activity, and increased parasympathetic tone. The objectives of this article are to provide a brief overview of lavender oil in aromatherapy, explore variability in the constituents of lavender oil, summarize its pharmacology and safety profile, as well as describe its body of research that has been conducted for anxiety.

Effect of inhalation aromatherapy with lavender essence on pain associated with intravenous catheter insertion in preschool children: A quasi-experimental study

OBJECTIVE

The aim of this study was to assess the effect of inhalation aromatherapy with lavender essence on the pain severity of intravenous catheter insertion in hospitalized preschool children.

METHOD

A quasi-experimental study involving 60 participants using convenience sampling were assigned to control (n = 30) and aromatherapy (n = 30) groups. Children in the aromatherapy group inhaled 5 drops of the essence, while children in the control group inhaled 5 drops of distilled water, 20 min before venipuncture. Pain severity was measured using OUCHER scale 10 min after catheterization.

RESULTS

Mean of pain severity between the aromatherapy and control groups demonstrated a significant difference immediately (P = 0.002) and 5 (P = 0.001) and 10 min (P = 0.01) after intravenous catheter insertion. Mean of pain severity in the three assessed time points had significant differences in aromatherapy and control groups (P = 0.001).

CONCLUSION

Aromatherapy with Lavender essence helped to reduce pain severity of intravenous catheter insertion in children.

Biological Activities of Essential Oils: From Plant Chemoecology to Traditional Healing Systems

Essential oils are complex mixtures of hydrocarbons and their oxygenated derivatives arising from two different isoprenoid pathways. Essential oils are produced by glandular trichomes and other secretory structures, specialized secretory tissues mainly diffused onto the surface of plant organs, particularly flowers and leaves, thus exerting a pivotal ecological role in plant. In addition, essential oils have been used, since ancient times, in many different traditional healing systems all over the world, because of their biological activities. Many preclinical studies have documented antimicrobial, antioxidant, anti-inflammatory and anticancer activities of essential oils in a number of cell and animal models, also elucidating their mechanism of action and pharmacological targets, though the paucity of in human studies limits the potential of essential oils as effective and safe phytotherapeutic agents. More well-designed clinical trials are needed in order to ascertain the real efficacy and safety of these plant products.

Evaluation of the antidepressant-like effect of musk in an animal model of depression: how it works

Depression has become a common public health problem that is showing increasing prevalence. Slow onset of action, low response rates and drug resistance are potential limitations of the current antidepressant drugs. Alternative therapy using natural substances, specifically aromatherapy, is currently tried to treat depression. This work aimed to assess the efficacy of musk in relieving the behavioral, biochemical and hippocampal histopathological changes induced by exposure to chronic mild stress in mice and explore the possible mechanism behind this antidepressant-like effect. Forty male albino mice were divided into four groups (n = 10): control, a group exposed to chronic unpredictable mild stress (CUMS) and two groups exposed to CUMS and then treated with fluoxetine or musk. Behavioral changes and serum corticosterone levels were assessed at the end of the experiment. Protein and gene expressions of brain-derived neurotropic factor (BDNF) and glucocorticoid receptors (GRs) in the hippocampus were assessed using ELISA and real-time RT-PCR, respectively. Histopathological examination of the hippocampus and immunohistochemical techniques using glial fibrillary acidic protein (GFAP), Ki67, caspase-3, BDNF and GR were performed. Inhalation of musk had an antidepressant-like effect in an animal model of depression. Musk alleviated the behavioral changes and elevated serum corticosterone levels induced by exposure to chronic stress. It reduced the hippocampal neuronal apoptosis and stimulated neurogenesis in the dentate gyrus. Musk's action may be related to the upregulation of hippocampal GR and BDNF expressions. Musk is considered a potential antidepressant so it is advisable to assess its efficacy in treating depressed patient.

Wound healing potential of lavender oil by acceleration of granulation and wound contraction through induction of TGF-β in a rat model

Background

Although previous studies have suggested that lavender oil promote wound healing, no study has examined the molecular mechanisms of its effect. In this study, we investigated the effect of lavender oil on various steps of wound healing and its molecular mechanism, focusing on transforming growth factor-β (TGF-β).

Methods

Circular full-thickness skin wounds were produced on rats. Control solution or lavender oil was topically applied to the wounds on alternating days for 14 days.

Results

The area of wounds topically treated with lavender oil was significantly decreased as compared to that of wounds of control rats at 4, 6, 8, and 10 days after wounding. Topical application of lavender oil induced expression of type I and III collagen at 4 days after wounding, accompanied by an increased number of fibroblasts, which synthesize collagen. Induced expression of type III collagen by topical application of lavender oil was reduced to control level at 7 days after wounding although increased expression of type I collagen still continued even at 7 days, suggesting rapid collagen replacement from type III to type I in wounds treated with lavender oil. Importantly, expression of TGF-β in wounds treated with lavender oil was significantly increased as compared to control. Moreover, an increased number of myofibroblasts was observed in wounds treated with lavender oil at 4 days after wounding, suggesting promotion of differentiation of fibroblasts through induction of TGF-β, which is needed for wound contraction.

Conclusion

This study demonstrated that topical application of lavender oil promoted collagen synthesis and differentiation of fibroblasts, accompanied by up-regulation of TGF-β. These data suggest that lavender oil has the potential to promote wound healing in the early phase by acceleration of formation of granulation tissue, tissue remodeling by collagen replacement and wound contraction through up-regulation of TGF-β. The beneficial effect of lavender oil on wound healing may raise the possibility of new approaches as complementary treatment besides conventional therapy.

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial

Background:

Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing.

Materials and Methods:

A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics.

Results:

There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P < 0.001). Moreover, there was significant difference in reduction of pain intensity before and after aromatherapy in the experimental group (P < 0.05). Also, there was a significant reduction in severity of pain after dressing in the experimental group compared with the control group (P < 0.05).

Conclusions:

Inhalation aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief.

Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy

Background:

Breast cancer patients frequently experience psychological distress during the chemotherapy period.

Objectives:

This study aimed to evaluate the effect of relaxation with guided imagery on patients with breast cancer.

Patients and Methods:

A two-group, pretest-posttest, quasi-experimental design with a randomized controlled trial was conducted. Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study. These patients were randomly assigned to the experimental group (n = 32) or to the control group (n = 33). Both groups received chemotherapy self-care education, but the experimental group also received relaxation with guided imagery training. The training on relaxation with guided imagery was conducted before chemotherapy, and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy.

Results:

The experimental group showed significant decreases in insomnia (-0.34 ± 0.83, P < 0.05), pain (-0.28 ± 0.58, P < 0.05), anxiety (-3.56 ± 2.94, P < 0.00), and depression (-2.38 ± 2.70, P < 0.00) between the pretest and the posttest. Comparing the two groups, statistically significant differences were found in the overall symptom distress (B = 0.11, P < 0.05), insomnia (B = 0.50, P <0.05), depression (B = 0.38, P < 0.05), and numbness in physical symptoms (B = 0.38, P < 0.05), as well as in anxiety (B = 3.08, P < 0.00) and depression (B = 1.86, P < 0.00) in psychological distress. One week of relaxation with guided imagery can significantly improve the overall symptoms of distress, insomnia, depression, physical symptoms, and anxiety, and can decrease psychological distress.

Conclusions:

Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients.

Effects of aromatherapy on sleep quality and anxiety of patients

BACKGROUND

In intensive care units (ICUs), patients cannot sleep well. Aromatherapy is used for depression, anxiety, relaxation and disorders related with sleep and stress.

AIM

This study aimed to investigate the effect of lavender essential oil on the sleep quality and anxiety level of patients in coronary ICU.

PARTICIPANTS

A total of 60 patients in coronary ICU participated in this study.

DESIGN

A randomized controlled study was conducted with 60 patients in a province located in the southeast of Turkey.

METHODS

After informing the patients in both groups about the study, they were administered a questionnaire, Pittsburgh Sleep Quality Index (PSQI) and the Beck Anxiety Inventory (BAI) scale. The patients in the intervention group were given 2% lavender essential oil via inhalation for 15 days after which they were administered the same scales again to evaluate the sleep quality and anxiety. As for the control group, they were administered the same scales again after 15 days without the inhalation of lavender essential oil.

RESULTS

Comparison of the PSQI and BAI scores of the patients in the control and intervention groups before and after the intervention showed statistically significant differences in the change in favour of the intervention group (p < 0·05).

CONCLUSION

Lavender essential oil increased quality of sleep and reduced level of anxiety in patients with coronary artery disease.

RELEVANCE TO CLINICAL PRACTICE

As a non-invasive, cheap, easily applicable, cost-effective, independent nursing intervention and appropriate for cardiac patients, lavender essential oil could be applied in ICUs.