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

Efficacy of aromatherapy with Lavandula angustifolia oil on postoperative pain after cardiac surgery: A randomized clinical trial

OBJECTIVE

To evaluate the effect of aromatherapy through inhalation of Lavandula angustifolia essential oil in relieving pain during the immediate postoperative period of patients undergoing cardiac surgery.

METHODS

A single-blind, randomized and controlled clinical trial, with 52 patients in the immediate postoperative period of cardiac surgery were randomly distributed into experimental (n = 26) and control (n = 26) groups. The primary outcome was whether or not pain was relieved and secondary outcomes included changes in vital signs, sleep and facial relaxation. The control group received industry standard care and application of an essential oil-free ceramic diffuser necklace. The experimental group received the inhalation intervention with pure Lavandula angustifolia essential oil, with a drop of the oil on a ceramic diffuser necklace at a distance of 15-20 cm from the patient's nose for 30 min. Pain was measured using the Numerical Visual Scale, and vital signs using the multiparametric monitor before the intervention, 10 minutes after its start and 30 minutes after the total end of inhalation. Face relaxation was assessed before and after the intervention and sleep was assessed at the end of inhalation.

RESULTS

There was a decrease in pain levels (p < 0.001) 30 min after the end of inhalation in the Experimental Group, with a decrease in the measurements of Mean Blood Pressure (p= 0.008) and Respiratory Rate (p = 0.011). Furthermore, facial relaxation and sleep had a large effect size of 2.54 and 1.28, respectively.

CONCLUSION

Lavandula angustifolia essential oil was effective in relieving pain, causing sleep and relaxation, proving to be a low-cost and easy-to-use tool that the nursing team can use in their care.

Effects of Aromatherapy on Physical and Mental Health of Cancer Patients Undergoing Radiotherapy and/or Chemotherapy: A Meta-Analysis

BACKGROUP

Currently, aromatherapy is being increasingly utilized in clinical practice, particularly in managing the side effects associated with radiotherapy and chemoradiotherapy. However, it remains to be established whether aromatherapy can effectively alleviate these symptoms.

OBJECTIVE

To investigate the effects of aromatherapy on the physical and mental health of patients with cancer undergoing radiotherapy and chemotherapy.

METHODS

Seven databases were researched from inception until September 29, 2023, including PubMed, Scopus, and Web of Science, Chinese National Knowledge Infrastructure, Wanfang database, China Biology Medicine disc and VIP Chinese Medical Journal Database. Review Manager version 5.3 was utilized for data analysis. The Cochrane Risk of Bias tool RoB2 was employed to evaluate the quality of the literature included in the study. Evidence quality rating was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach through the GRADEpro GDT online tool.

RESULTS

Nineteen studies involving 1,541 patients were included. Aromatherapy can alleviate nausea [relative risk (RR)=0.64, 95% confidence interval (CI): 0.53 to 0.78, P<0.05, I2=46%; standardized mean difference (SMD)=-0.86, 95% CI: -1.21 to -0.51, P<0.05, I2=64%] and vomiting (RR=0.54, 95% CI: 0.42 to 0.69, P<0.05, I2=35%; SMD=-1.28, 95% CI: -1.52 to -1.03, P<0.05, I2=92%), improve sleep disorders [mean difference (MD)=-3.39, 95% CI: -3.95 to -2.84, P<0.05, I2=0%], relieve pain (SMD=-1.58, 95% CI: -1.96 to -1.21, P<0.05, I2=0%), mitigate fatigue (SMD=-1.28, 95% CI: -2.44 to -0.11, P<0.05, I2=93%) and enhance quality of life (SMD=0.50, 95% CI: 0.22 to 0.79, P<0.05, I2=0%) in cancer patients after radiotherapy and chemotherapy, but it may not have a significant effect on anxiety. The risk of bias was high in the included studies using the Cochrane Risk of Bias tool RoB2, and no studies were considered to be of high grade according to the GRADE system.

CONCLUSIONS

Aromatherapy is an efficacious, safe and economic adjunctive therapy for cancer patients, which can mend the physical symptoms and mental health of cancer patients. However, more high-quality studies are needed to verify it. (PROSPERO registration No. CRD42023390171).

Therapeutics to Treat Psychiatric and Neurological Disorders: A Promising Perspective from Algerian Traditional Medicine

Ancient people sought out drugs in nature to prevent, cure, and treat their diseases, including mental illnesses. Plants were their primary source for meeting their healthcare needs. In Algeria, folk medicine remains a fundamental part of the local intangible knowledge. This study aims to conduct a comprehensive ethnomedicinal investigation and documentation of medicinal plants and the different plant formulations traditionally used in Algeria for the treatment of pain, psychiatric, and neurological disorders. It also intends to improve the current knowledge of Algerian folk medicine. Several scientific databases were used to accomplish this work. Based on this investigation, we identified 82 plant species belonging to 69 genera and spanning 38 distinct botanical families used as remedies to treat various psychological and neurological conditions. Their traditional uses and methods of preparation, along with their phytochemical composition, main bioactive constituents, and toxicity were noted. Therefore, this review provides a new resource of information on Algerian medicinal plants used in the treatment and management of neurological and psychological diseases, which can be useful not only for the documentation and conservation of traditional knowledge, but also for conducting future phytochemical and pharmacological studies.

The Effect of Precolonoscopy Lavender Inhalation on Patient Anxiety and Comfort: A Randomized, Controlled, Double-Blinded, Single-Center Study

The purpose of this study was to determine the effect of lavender oil inhalation on the anxiety and comfort levels of patients scheduled for colonoscopy. Seventy-three experimental group patients scheduled for colonoscopy at a training and research hospital in the west of Turkey in June to September 2022 and 72 control group patients were included in this randomized, controlled, prospective study. Minimal sedation (propofol 2-3 mg/kg) was applied in both groups. Lavender inhalation was applied to the experimental group, whereas the control group patients received nursing care (vital sign monitoring, prevention of complications, and rest). The State-Trait Anxiety Inventory and the Shortened General Comfort Questionnaire were used for pre- and postprocedural data collection. Median ages were 53.00 years (47.25-59.00) in the experimental group patients and 51.00 (44.00-59.5) in the control group. Although postprocedural state anxiety scores were lower in the experimental group compared with the control group, the difference was not statistically significant ( p = .069). The general postcolonoscopy comfort score was significantly higher in the experimental group compared with the control group ( p < .001). Trait anxiety scores also increased as the number of colonoscopies increased in both groups. We conclude that lavender oil inhalation, a simple and inexpensive intervention, increases patient comfort while exhibiting a positive, albeit statistically insignificant, effect on anxiety.

Effectiveness of cold application and lavender oil on pain during drain removal: A randomized clinical trial

Background and Aim

Analgesics are frequently used to prevent acute pain while removing the drain. Additional non-pharmacological methods have come to the agenda as a result of the fact that the pain cannot be fully controlled, and the pharmacological treatment response is variable. Our research was intended to determine the effectiveness of lavender aromatherapy and cold application in controlling pain during drain removal procedure.

Materials and Methods

The sample of the prospective randomized controlled study consisted of 121 patients. Patient data were collected using the introductory information form and the numerical pain scale. Four groups of patients were formed (lavender oil, oxygen, cold application, control), respectively. In all groups, vital signs and pain levels were evaluated before the drain removal procedure, as soon as and 15 minutes after it was withdrawn.

Results

Within the limits of study, lavender aromatherapy and cold application to the drainage area were found to be effective in reducing pain during drainage. When the effect on vital signs was evaluated, it was found that the pre-procedure systolic blood pressure was higher in both the lavender group and the cold application group than the post-procedure systolic blood pressure, and the respiratory rate was higher in the control group during the procedure.

Conclusions

According to the study, it was found that applying lavender and cold application to the patients before the drainage procedure was effective in controlling pain.

Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting – A systematic review

OBJECTIVE

The purpose of this systematic review is to ascertain the impact of inhalation aromatherapy on stress and anxiety in clinical settings.

METHODS

A search strategy was developed using various databases. Randomised Controlled Trials (RCTs) as well as single and double-blind pilot clinical studies (non-RCT) using inhalation aromatherapy with an essential oil blend or a single essential oil were examined. All studies included a control intervention and use of a validated measurement tool. The time period under review was years 2000-2021. Due to the high level of heterogeneity and element of bias, a narrative synthesis was conducted.

RESULTS

The search strategy initially retrieved 628 studies and through application of the selection criteria and the removal of duplicates, 76 studies were selected for review with a total of 6539 patients. In 42% of the RCTs, physiological measures including vital signs and/or salivary cortisol were used in addition to questionnaires. Over 70% of the studies reported a positive effect on anxiety levels in the aromatherapy intervention groups compared with the control. However, in many cases this is limited by the absence of safety data, imprecise reporting of plant species and dosage of essential oil.

CONCLUSION

Inhalation aromatherapy has the potential to reduce stress and anxiety with data emerging to further support this result across a wide modality of clinical treatments. However, there is a clear need for the development of standard protocols for research in this area, generating measurable results which will create the opportunity for more rigorous evidence-based outcomes.

The Effects of Essential Oils on the Nervous System: A Scoping Review

Essential oils are a mixture of natural aromatic volatile oils extracted from plants. The use of essential oils is ancient, and has prevailed in different cultures around the world, such as those of the Egyptians, Greeks, Persians, and Chinese. Today, essential oils are used in traditional and complimentary medicines, aromatherapy, massage therapies, cosmetics, perfumes and food industries. The screening effect of essential oils has been studied worldwide. They demonstrate a range of biological activities, such as antiparasitic, antifungal, antibacterial, antiviral, antioxidant, anti-inflammatory, anticancer, antiaging, and neuroprotective properties. In this scoping review, we provide a 10-year updated comprehensive assessment of volatile oils and their effects on the nervous system. MEDLINE, Scopus, and Google Scholar were systematically and strategically searched for original studies investigating these effects from 2012 to 2022. Approximately seventy studies were selected as included studies. Among these studies, several outcomes were reported, including antistress, antianxiety, analgesic, cognitive, and autonomic effects. Some essential oils showed developmental benefits, with the potential to induce neurite outgrowth. The neurotransmitter receptor level can also be modified by essential oil application. Physiological and pathophysiological outcome measures were reported. For physiological outcomes, arousal, cognitive performance, circadian eating behavior, emotional modulation, consumer acceptance, preferences, and willingness to buy were investigated. For pathophysiological conditions, pain, depression, anxiety, stress, sleep disorder, mental fatigue, agitated behavior, and quality of life were measured. In conclusion, essential oils showed promising effects on the nervous system, which can be further applied to their use in functional foods, drinks, and alternative therapy.

Dental pain perception and emotional changes: on the relationship between dental anxiety and olfaction

BACKGROUND

The purpose of the study was to determine to what extent olfactory aromatherapy reduces the intensity of dental pain and the level of dental anxiety. It also attempted to corelate between olfactory aromatherapy, stages of dental visits, and various dental procedures.

METHODS

Female patients were enrolled in a randomized controlled study. Olfactory aromatherapy was performed using lavender oils. Patients were randomly assigned to one of two groups: the lavender group, in which patients inhaled 2% lavender vapors, and the control group, in which patients inhaled water vapors. Pain score, anxiety score, and changes in vital signs were among the predictable variables. Anxiety and pain were assessed using the Modified Dental Anxiety Scale (MDAS), Speilberger State-Trait Anxiety Inventory (STAI), and visual analog scales (VAS). The vital signs were systolic (SBP) and diastolic (DBP), heart rate (HR), respiratory rate (RR), and oxygen saturation (Spo2). Variables were evaluated before inhalations, 20 min after inhalations, at the end of settings, and on the following day.

RESULTS

Each group had 175 participants. Pain and anxiety scores were significantly reduced, and all vital signs improved, except for DBP. The MDAS, STAI, and pain scores are reduced by 3.4, 4.2, and 2.4 times, respectively, compared to the control group. Olfactory aromatherapy had the greatest impact during the phase of waiting rooms.

CONCLUSION

When compared to the control group, olfactory aromatherapy reduces anxiety scores three to four times more. Pain perception is reduced by twice as much as in the control group. It also significantly reduces the anxiety associated with minor to moderately stressful dental procedures.

Relaxing effects of music and odors on physiological recovery after cognitive stress and unexpected absence of multisensory benefit

Several studies have described, often separately, the relaxing effects of music or odor on the autonomic nervous system (ANS) activity. Only a few studies compared the presentation of these stimuli and their interaction within a same experimental protocol. Here, we examined whether relaxing music (slow-paced classical pieces) and odor (lavender essential oil) either presented in isolation or in combination would facilitate physiological recovery after cognitive stress. We continuously recorded the electrocardiogram to assess the high-frequency component of heart rate variability (HF-HRV), an index of parasympathetic activity, and electrodermal activity (EDA), an index of sympathetic activity, 10 min before, during and 30 min after a cognitive stress (i.e., completing timely constrained cognitively demanding tasks) in 99 participants allocated to four recovery conditions (control N = 26, music N = 23, odor N = 24, music+odor N = 26). The stressing event triggered both a significant increase in EDA and decrease in HF-HRV (compared to baseline). During the recovery period, the odor elicited a greater decrease in EDA compared to an odorless silent control, whereas no difference in HRV was observed. Conversely, during this period, music elicited a greater increase in HF-HRV compared to control whereas no difference in EDA was observed. Strikingly, in the multimodal music+odor condition, no beneficial effect was observed on ANS indexes 30 min after stress. Overall, our study confirms that both olfactory and musical stimuli have relaxing effects after stress on ANS when presented separately only, which might rely on distinct neural mechanisms and autonomic pathways.

The effect of aromatherapy with rose essential oil on apparent anxiety in patients with myocardial infarction

OBJECTIVES

Acute myocardial infarction (MI) and hospitalization are one of the most stressful situations for many patients. Aromatherapy is a branch of the complementary medicine that is effective in anxiety. The present study aims to determine the effect of aromatherapy with rose essential oil (REO) on apparent anxiety in patients with acute MI.

METHODS

This randomized clinical trial was carried out on patients with acute MI admitted to the cardiac ward of Heshmatieh Hospital in Sabzevar. Eighty patients were randomly assigned to two aromas and placebo groups, who received three drops of REO or placebo by inhalation three times a day for 3 days. Before and after the intervention, patients' anxiety levels were measured by the Spielberger questionnaire. Data were analyzed by chi-square and the independent and paired and t-tests.

RESULTS

Before the intervention, the mean of apparent anxiety was not significantly different in the intervention and control groups (48.44 ± 3.81 and 51.38 ± 7.21, respectively, p=0.16) while this parameter was significant after the intervention in both experimental groups (47.27 ± 7.11 and 44.16 ± 4.63, respectively, p=0.000), with a reduction in the mean of apparent anxiety in the intervention group. Moreover, the results of paired t-test revealed that the anxiety scores decreased significantly in the test group before and after the intervention (51.38 ± 7.21 and 44.16 ± 4.63, p=0.000).

CONCLUSIONS

Considering the positive effects of REO used in this study to reduce anxiety in patients with acute MI, the use of REO is recommended as a complementary treatment to reduce anxiety in these patients.

The effect of lavender on stress in individuals: A systematic review and meta-analysis

BACKGROUND

Lavender is considered as one of the medicinal plants to manage stress. Although many preliminary studies evaluated the effect of lavender on individuals' stress level, to the best of our knowledge, we did not find a study that summarizes the results. Therefore, the present study aimed to estimate the Pooled effect of lavender on the stress level of individuals using systematic review and meta-analysis.

METHOD

A systematic literature review based on PRISMA 2020 was performed on the SID, MagIran, Embase, PubMed, Scopus, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and ‎Free Text words,‎ including "Lavender*", "Lavandula*", "Stress*", "Stress Disorders, Traumatic", and "Stress, Psychological" with no time limitation until August 2021: We also searched two Iranain free local resourses including MagIran https://www.magiran.com and Scientific Information Database (SID) https://www.sid.ir. The quality assessment of studies was performed using JBI checklist. Heterogeneity among studies was quantified using I² index and Random Effects model was used to combine the data and perform the meta-analysis.

RESULTS

In the initial search, 1520 articles were found. After excluding the irrelevant studies, finally, 21 articles with a sample size of 791 in the intervention group and 804 in the control group were included in the meta-analysis. As a result of combining the studies, stress score after using lavender in the intervention group showed a significant decrease of 0.63 ± 0.13 (95% CI) more than that in the control group (P < 0.001). The results of subgroup analysis demonstrated that the highest standardized mean difference (SMD) before and after the intervention in the intervention group compared to the control group was related to L. angustifolia species with 0.73 ± 0.22, student groups with 2.27 ± 1.34, and diagnostic tool of Perceived Stress Scale (PSS) with 0.82 ± 0.42, indicating that the difference between the groups was statistically significant (P < 0.001).

CONCLUSION

The pooled estimation of this systematic reiew and meta-analysis revealed that lavender significantly reduces individuals' stress. Therefore, it seems that the use of lavender can be considered as a part of a stress management programs, especially in student groups.

Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis

BACKGROUND

Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression.

OBJECTIVE

The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice.

METHODS

We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I²) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I²≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2).

RESULTS

The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I²=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I²=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I²=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low.

CONCLUSIONS

eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required.

TRIAL REGISTRATION

PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.

Role of Aromatherapy as a Natural Complementary and Alternative Therapy in Cardiovascular Disease: A Comprehensive Systematic Review

Background

The purpose of this study was a comprehensive review of studies on the effect of aromatherapy with plant essential oils on the improvement of some conditions, for example, anxiety, stress, sleep quality, fatigue, and pain in people with cardiovascular disease.

Materials and Methods

We carried out this systematic review based on the instructions of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Ethical agreement was not necessary as main data have not been collected. During March 2022, we searched the main English databases, for example, Google Scholar, Web of Sciences, EMBASE, EBSCO, ScienceDirect, Scopus, and PubMed/MEDLINE, with limitation to human clinical trials. For this study, no time limit was applied for the publication of articles.

Results

Out of 1380 papers, 52 papers up to March 2022 were eligible for review in this systematic review. Based on the obtained results, the most widely used medicinal plants for aromatherapy in patients with cardiovascular diseases were Lavandula angustifolia (lavender, 55.7%), Rosa damascena (Damask rose, 11.5%), and Mentha piperita (peppermint, 5.8%), respectively. Most studies have been performed on the effect of aromatherapy on coronary angiography (21 papers, 40.4%), followed by artery bypass graft surgery (14 studies, 26.9%), and cardiac patients (5 studies, 9.6%). Most studies on the effect of aromatherapy in cardiovascular diseases were performed on anxiety (31 papers, 59.6%), sleep quality (8 studies, 15.4%), and hemodynamic parameters (6 studies, 11.5%), respectively.

Conclusion

This study systematically reviewed the effects of aromatherapy in patients with cardiovascular diseases. The review of studies showed that lavender, Damask rose, and peppermint are the most frequents plants used for aromatherapy, whereas they significantly improved some illnesses and conditions, especially anxiety and sleep quality. Therefore, it can be concluded that cardiologist can used aromatherapy as a natural complementary and alternative therapy particularly with lavender, Damask rose, and peppermint to improve quality of life and some conditions such as anxiety and sleep quality.

Inhalation Aromatherapy via Brain-Targeted Nasal Delivery: Natural Volatiles or Essential Oils on Mood Disorders

Mood disorders, also often referred to as affective disorders, are a group of psychiatric illnesses that severely impact mood and its related functions. The high medical expenditures have placed a significant financial burden on patients and their families. Aromatherapy is an alternative and complementary treatment that utilizes essential oils (EOs) or volatile oils (VOs) to achieve major therapeutic goals. In general, EOs are volatile chemicals that enter the body primarily through skin absorption and/or nasal inhalation. In addition, they can work through oral administration. Inhalation aromatherapy has shown unique advantages for treating mood disorders, especially depression, anxiety and mental disorders such as sleep disorder, which have been validated over the last decade through clinical and animal studies. Accumulating evidence has shown that EOs or VOs can bypass the blood-brain barrier to target brain tissue through the nasal-brain pathway. Subsequently, they act on the cerebral cortex, thalamus, and limbic system in the brain to improve symptoms of anxiety, depression and improve sleep quality. Here, we review the natural aromatic plants’ volatiles or essential oils used commonly as adjuncts to manage mood disorders and illustrate the mechanisms of inhalation aromatherapy, and mainly summarized the application of transnasal inhalation aromatherapy in depression, anxiety, and sleep disorders. We conclude that aromatherapy does not cause side-effects, which is vastly different from commonly used psychotropic drugs. Inhalation aromatherapy via brain-targeted nasal delivery offers potentially efficacious treatment for mental disorders and merits further study.

The Effect of Environmental Stressors on Patient Experience in Medical, Surgical, and COVID-19 Intensive Care Unit

This study was conducted to evaluate the effects of environmental stressors on patients’ intensive care experiences in medical, surgical, and COVID-19 intensive care units (ICUs). The sample group consisted of 231 patients hospitalized in medical and surgical ICUs and agreed to participate in the study. The data analysis was performed with IBM SPSS Statistics 25. The average age of the patients was 53.67 ± 13.3, 55.4% were male, 47.6% were high school graduates, and 45.5% were followed up in the COVID-19 ICU. It was also found that there was a negative and moderate degree of correlation between the Intensive Care Experience Scale (ICES) and the Intensive Care Unit Environmental Stressors Scale (ICUESS). Environmental stressors in ICUs are associated with patient experiences. It is clear that ICU stressors create a negative perception in the patient and this situation is emotionally exhausting.

Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection

Objective

To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia.

Background

Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia.

Method

Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba.

Result

As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design.

Conclusion

We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.

IMPLANTAÇÃO DE UM SERVIÇO PARA PESSOAS COM DISTÚRBIOS DO ASSOALHO PÉLVICO

Objetivo:objetivou-se descrever os procedimentos técnicos operacionais e dados clínicos relacionados à implantação de um programa de atenção à saúde das pessoas com distúrbios do assoalho pélvico em um serviço público de atenção secundária. Método: trata-se de um relato de experiência, baseado em vivências relacionadas à assistência acadêmico-profissional na implantação de serviço voltado aos distúrbios do assoalho pélvico na região do Cariri cearense, realizado de maio a julho de 2021. Resultados: para a implantação do serviço, adotaram-se as seguintes estratégias: rastreamento da rede de atenção à saúde da pessoa com distúrbios do assoalho pélvico; estruturação organizacional do serviço; captação de pessoas com disfunções pélvicas; início dos atendimentos; e seguimento terapêutico. Conclusão: face ao exposto, evidencia-se que o programa de atenção à saúde das pessoas com distúrbios do assoalho pélvico pôde ser implantado satisfatoriamente, tendo em vista a infraestrutura, ao expressivo quantitativo de atendimentos realizados e ao seguimento terapêutico alcançado. Assim, com este relato, espera-se contribuir para o desenvolvimento de novos serviços ambulatoriais voltados a essa área de atuação do enfermeiro estomaterapeuta e da equipe multidisciplinar.

IMPLEMENTATION OF A SERVICE FOR PEOPLE WITH PELVIC FLOOR DISORDERS

Objective: the objective was to describe the technical operational procedures and clinical data related to the implementation of a health care program for people with pelvic floor disorders in a public secondary care service. Method: this is an experience report, based on experiences related to academic and professional assistance in the implementation of a service aimed at pelvic floor disorders in the Cariri region of Ceará, carried out from May to July 2021. Results: for the implementation of the service, the following strategies were adopted: tracking the health care network for people with pelvic floor disorders; organizational structuring of the service; capturing people with pelvic dysfunctions; start of care; and therapeutic follow-up. Conclusion: in view of the above, it is evident that the health care program for people with pelvic floor disorders could be implemented satisfactorily, considering the infrastructure, the significant amount of care provided and the therapeutic follow-up achieved. Thus, with this report, it is expected to contribute to the development of new outpatient services aimed at this area of work of the stomatherapist nurse and the multidisciplinary team.

The Effects of Aroma Essential Oil Inhalation on Stress, Pain, and Sleep Quality in Laparoscopic Cholecystectomy Patients: A Randomized Controlled Trial

PURPOSE

Patients undergoing cholecystectomy report experiencing stress related to the surgery, complaining of pain and poor sleep quality. Aromatherapy is known to have positive effects on these complaints. However, the effect of aromatherapy on cholecystectomy patients has yet to be determined. The aim of this study, therefore, was to investigate the effects of aromatherapy on laparoscopic cholecystectomy patients' stress, pain, and sleep quality.

METHODS

This study was a randomized controlled trial involving 69 adults who underwent laparoscopic cholecystectomy. Essential oil therapy was given to an intervention group and almond oil was given to a placebo group. The outcome variables were stress, pain, and sleep quality.

RESULTS

There were no differences between the groups in terms of demographic and clinical characteristics and pre-treatment dependent variables. After the intervention, subjective stress (F = 7.43, p < .001), objective stress (F = 2.70, p = .034), parasympathetic nerve activity (F = 2.65, p = .036), pain (F = 8.74, p < .001), analgesics administration (F = 22.43, p < .001), and sleep quality (F = 5.23, p < .001) were significantly different between the intervention, placebo, and control groups. Sympathetic nerve activity was not significantly different. The effect sizes regarding the sleep quality of the intervention vs control group and the intervention vs placebo group were 1.92 and 1.52, respectively.

CONCLUSION

Postoperative aromatherapy received by cholecystectomy patients was effective in reducing stress and pain and improving sleep quality. No side effects of the aromatherapy were reported during the experimental treatment.

The effects of aromatherapy on patients undergoing coronary angiography: A systematic review of clinical trials

As a diagnostic and therapeutic technique for coronary artery disease, angiography is usually associated with some disorders and complications such as fear, pain, discomfort, limited mobility, and anxiety. The present study is a systematic review determining the effects of aromatherapy with different plants in patients undergoing angiography. This review was conducted according to the 06-PRISMA guideline and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database. The English databases were Google Scholar, PubMed, Scopus, Web of Science, EBSCO, and ScienceDirect to search articles regarding the effects of aromatherapy with different plants in patients experiencing angiography without a date limitation. The searched keywords in this study were "aromatherapy", "angiography", "coronary artery disease", "anxiety", "stress", and "cardiovascular diseases". Out of 1835 papers, 20 papers up to 2021, met the inclusion criteria for discussion in this systematic review with the data extracted. Most studies were intended to evaluate the effect of aromatherapy on patients’ anxiety with coronary artery bypass graft surgery (11 papers, 55.0%). The most widely used essential oil belonged to the lavender essential oil (13 papers, 65.0%). The results of the current review confirmed that aromatherapy management with lavender, damask rose, orange, and peppermint is able to significantly decrease anxiety, pain, nausea and vomiting, sleep quality, hemodynamic indices, blood pressure, etc. in patients with coronary angiography. However, more investigation is required to confirm the precise mechanisms and side effects of the alternative treatment.

Lavender Aromatherapy to Reduce Anxiety During Intrauterine Insemination: A Randomized Controlled Trial

Background

Infertility is a global public health issue. Therapies such as intrauterine insemination (IUI) are effective but may be associated with considerable anxiety. Preliminary data suggest that decreasing this anxiety might lead to improved outcomes.

Objective

To determine whether lavender aromatherapy (LA) reduces anxiety during an IUI procedure.

Methods

A randomized controlled trial of women undergoing IUI at a hospital-based fertility clinic. The intervention and comparison were the use of LA vs water. Measurements were the change in anxiety level during an IUI procedure, with secondary assessment of pain scores, patient satisfaction, and pregnancy rates.

Results

In total, 67 women were screened, and 62 women randomly assigned to either placebo (n = 31) or LA (n = 31). No differences were observed in baseline demographic characteristics or visual analog scores for anxiety before IUI (mean [95% CI], 33.9 [25.2 to 45.6] mm vs 41.0 [33.0 to 49.0] mm) in the LA and placebo groups. However, a statistically significant change in anxiety was observed after LA inhalation during the procedure (mean [95% CI], −11.2 [−19.1 to −3.2]) compared with placebo (mean [95% CI], 1.3 [−5.6 to 8.2]; P = .02). No significant difference was observed in pain during IUI in the LA group vs placebo group. Patient satisfaction was high, with 93% of respondents in the LA group satisfied with the aromatherapy during their procedure. Additionally, 76% of participants who received placebo reported that they would prefer to use LA during their IUI. No statistically significant difference was detected in pregnancy rates between the 2 groups: 19.4% with LA vs 9.7% with placebo (P = .47).

Conclusion

LA reduced anxiety and was preferred by women during IUI fertility treatments.

Effectiveness of aromatherapy inhalation on anxiety and haemodynamic variables for patients with cardiovascular disease: A systematic review and meta-analysis

BACKGROUND

Anxiety can negatively affect patients' prognosis in cardiovascular disease. Aromatherapy helps reduce anxiety level in chronic diseases. However, the effectiveness of aromatherapy on anxiety and haemodynamic variables remains uncertain.

OBJECTIVE

To evaluate the evidence for the effectiveness of aromatherapy on anxiety and haemodynamic variables in patients with cardiovascular disease.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS

The CINAHL COMPLETE, Cochrane Central, Web of Science, Pubmed, Scopus, Science Direct, Ovid and ProQuest databases were searched. The study was conducted in line with the Cochrane and PRISMA guideline. Examination for bias in the included studies was conducted with the Cochrane bias guideline. Heterogeneity and publication bias were evaluated.

RESULTS

Twelve studies published from 2012 to 2020 were included in the meta-analysis. Lavender aromatherapy inhalation was used the most for anxiety in patients. Aromatherapy had a highly significant effect on anxiety, systolic blood pressure and heart rate, a moderate effect on breathing rate and a non-significant effect on diastolic blood pressure. The Cochrane GRADE approach was used to assess the rating of the certainty of evidence. A high level of evidence was found for the effect of aromatherapy on heart rate, a moderate level for the effect of aromatherapy on anxiety and breathing rate and a low level for the effects of aromatherapy on blood pressure and lavender on anxiety.

CONCLUSION

It was found that aromatherapy reduced anxiety, systolic blood pressure, heart rate and breathing rate in patients with cardiovascular disease. This study provides information to researchers and health professionals about the effectiveness of aromatherapy on decreasing anxiety and haemodynamic variables in patients with cardiovascular disease. Also, the study can contribute to planning studies which are better designed, conducted and reported.

The effects of lavender, rosemary and orange essential oils on memory problems and medication adherence among patients undergoing hemodialysis: A parallel randomized controlled trial

BACKGROUND

hemodialysis patients' daily use of medications is essential for the disease management. One of the causes of medication non-adherence is that they forget to take medications, and non-adherence to treatment following memory loss is a common problem in patients on hemodialysis.

OBJECTIVE

the current study aimed to compare the effects of Lavender, Rosemary, and Orange essential oils on memory problems (both retrospective and prospective aspects of memory) and medication adherence in hemodialysis patients.

DESIGN

this study was a parallel randomized controlled trial.

SETTING

the two main hemodialysis centers in Kerman, southeastern Iran.

PARTICIPANTS

eighty-six patients under chronic hemodialysis were randomly allocated into four groups (Lavender, Rosemary, Orange, and control) by simple randomization method.

INTERVENTIONS

The samples of the intervention group, in addition to routine care, received Lavender or Rosemary or Orange essential oils three times a week for a month. A gauze containing with five drops of the essential oil was placed at a distance of 10 cm from the patient's nose one hour after hemodialysis, and the patient was asked to inhale it for 30 min.

MAIN OUTCOME MEASURES

retrospective and prospective memory, and medication adherence were assessed before, immediately and one month after the intervention.

RESULTS

prospective memory problems in Lavender, Rosemary and Orange groups did not change significantly over time (P > 0.05). Prospective memory problems in the control group had a significant increase (P = 0.002). No significant difference was found in prospective memory problems between the four groups (P > 0.05). Retrospective memory problems in the Lavender and Rosemary groups decreased significantly over time (P <0.05). The decreasing retrospective memory problems in the Orange and control groups were not statistically significant over time (P > 0.05). There was no significant difference in retrospective memory problems between the four groups (P > 0.05). No significant difference was observed between the four groups in medication adherence score during the study (P > 0.05).

CONCLUSION

aromatherapy with Lavender or Rosemary can reduce some memory problems in hemodialysis patients. However, the results of this study could not justify the effect of aromatherapy on the rate of medication adherence in patients on hemodialysis, so further studies are required.

TRIAL REGISTRATION

IRCT20190428043410N1.

Musk (Moschus moschiferus) Attenuates Changes in Main Olfactory Bulb of Depressed Mice: Behavioral, Biochemical, and Histopathological Evidence

BACKGROUND

Musk (Moschus moschiferus) has been described to have a significant impact on the central nervous system, as well as anticonvulsion and antidepressant effects. This study was designed to evaluate the efficacy of musk in alleviating alterations induced in olfactory bulb of depressed mice exposed to chronic stress and identify the mechanism behind it.

METHODS

Fifty male albino mice were divided into five groups (n = 10 each): control, musk, chronic unpredictable mild stress (CUMS), fluoxetine-treated, and musk-treated groups were included in this study. Behavioral changes and serum levels of corticosterone and proinflammatory cytokines included tumor necrosis factor α, interleukin 6, and oxidant/antioxidant profile were assessed at the end of the experiment. Main olfactory bulb (MOB) has been processed for histopathological examination. Gene expression of caspase-3, glial fibrillary acidic protein, and Ki67 were assessed in the MOB using quantitative real-time polymerase chain reaction.

RESULTS

The study showed that musk inhalation significantly reduced (p < 0.001) corticosterone level, immobility time, inflammatory cytokines, and oxidative stress markers in CUMS-exposed mice compared to the untreated CUMS group. Musk lessened CUMS-associated neuronal alterations in the MOB and significantly reduced apoptosis and enhanced neural cell proliferation (p < 0.001) comparable to fluoxetine. Musk significantly enhanced the level of antioxidants in the serum and significantly reduced inflammatory cytokines. The anti-inflammatory and antioxidant activity of musk and its constituents seemed to be behind its neuroprotective effect observed in this study.

CONCLUSION

Musk effectively ameliorated the chronic stress-induced behavioral, biochemical, and neuronal structural changes in MOB mostly through its antioxidant and anti-inflammatory effect.

Effect of aromatherapy with Melissa essential oil on stress and hemodynamic parameters in acute coronary syndrome patients: A clinical trial in the emergency department

Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department.

METHODS

In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t-test, and post-hoc Tukey's test.

RESULTS

Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05).

CONCLUSION

Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions.

Effectiveness of lavender inhalation aromatherapy on pain level and vital signs in children with burns: a randomized controlled trial

BACKGROUND

Burns are a source of pain, which cannot be fully treated with medications.

OBJECTIVES

This study aims is to test the effectiveness of lavender oil inhalation aromatherapy applied before dressing change on vital signs and pain levels of children with burns.

DESIGN

This randomized controlled study was held between May 2018 and May 2019. A total of 108 children who met the inclusion criteria were studied in three groups: Lavender-15 Group inhaled lavender oil for 15 min before dressing (n:36), Lavender-60 Group inhaled lavender oil for 60 min before dressing (n:36), and Control Group inhaled jojoba (placebo) oil for 15 min before dressing (n:36). Baseline pain levels and vital signs of the children were measured before inhalation. Pain levels and vital signs of the children were re-measured at the 1st and 30th minutes after dressing.

RESULTS

There was no significant difference between the groups in terms of pain levels (p = 0.750) and vital signs before dressing. In post-dressing measurements, the number of respiration (after 1 min p = 0.000, after 30 min p = 0.000), heart rate (after 1 min p = 0.000, after 30 min p = 0.000), mean arterial blood pressure (after 1 min p = 0.010, after 30 min p = 0.000) and pain levels (after 1 min p = 0.000, after 30 min p = 0.000) were lower in the Lavender groups compared to the placebo group.

DISCUSSION

The result of this research reveals that inhalation aromatherapy which applied before dressing in children with burns affects the reduction of pain levels and stabilization of vital signs.

The Effects of Lavender and Citrus aurantium on Anxiety and Agitation of the Conscious Patients in Intensive Care Units: A Parallel Randomized Placebo-Controlled Trial

Background

Conscious patients admitted to intensive care units (ICU) suffer from anxiety and agitation for various reasons, which can affect their recovery processes.

Aims

To compare the effects of lavender and Citrus aurantium essential oils on anxiety and agitation of conscious patients admitted to ICUs.

Design

A randomized parallel placebo-controlled trial.

Methods

One hundred and fifty conscious patients admitted to ICUs were selected by convenience sampling and were randomly divided into three groups, groups of lavender aromatherapy and Citrus aurantium aromatherapy, in addition to the routine care and inhalation of five drops of lavender or Citrus aurantium essential oils for 30 minutes. The placebo group, in addition to routine care, was provided with 5 drops of normal saline for 30 minutes. Anxiety was assessed with the state subscale of State-Trait Anxiety Inventory, and agitation was examined with Richmond Agitation-Sedation Scale before, immediately, one hour, and three hours after the intervention.

Results

All three groups suffered from relatively severe state anxiety before the intervention. The level of anxiety in the lavender and Citrus aurantium groups was significantly lower than that of the placebo group immediately and three hours after the intervention (P < 0.05). No significant difference was observed between the two groups of lavender and Citrus aurantium. The majority of the samples in all three groups were agitated before the intervention, but agitation of all three groups decreased after the intervention. Restless/agitation reduced significantly in all three groups. Although restless/agitation of the lavender and Citrus aurantium groups reduced more than that of the placebo, no significant difference was found between the three groups.

Conclusion

The results of the present study showed the positive effects of lavender aromatherapy and Citrus aurantium aromatherapy on reducing the anxiety of patients admitted to ICUs. Relevance to Clinical Practice. Aromatherapy can be used as an effective and safe intervention to reduce anxiety in ICUs.

Ultrasound-Assisted Extraction of Lavender (Lavandula angustifolia Miller, Cultivar Rosa) Solid By-Products Remaining after the Distillation of the Essential Oil

FINNOVER is an EU Interreg-Alcotra project that aims to bring new perspectives to floriculture enterprises by recovering useful bioproducts from the waste produced during processing of several aromatic species. In this study, a new operation strategy to recover lavender (Lavandula angustifolia Mill.) solid by-products remaining after the extraction of the essential oil was developed. Pulsed ultrasound-assisted extraction was employed as a sustainable and eco-compatible technology to extract, in a very short time (10 min), this agricultural waste using a food-grade solvent (a mixture of ethanol/water). All the extracts obtained from both flower and leaf waste and flower-only residues, exhibit a promising total phenolic content (38–40 mg gallic acid/g of dry waste), radical scavenging activity (107–110 mg Trolox/g of dry waste) and total flavonoid content (0.11–0.13 mg quercetin/g of dry waste). Moreover, the chromatographic analysis of these extracts has shown that this overlooked agriculture waste can represent a valuable source of multifunctional compounds. Particularly, they exhibit a content of polyphenols and flavonoids up to 200 times higher than the corresponding leachate, and they are a valuable source of gentisic acid (1.4–13 mg/g dry waste) representing a new low-cost ingredient usable in different fields (i.e., cosmetic).

Impact of inhalation aromatherapy with Damask Rose (Rosa damascena) on stress, anxiety and hemodynamic parameters of patients undergoing coronary angiography: a single blind randomized clinical trial

OBJECTIVES

Coronary arteries angiography is used commonly for diagnosing cardiovascular diseases. In spite of the low risk of coronary artery angiography method, it could lead to stress, anxiety and consequently hemodynamic changes in patients. This study aimed to assess the effects of inhalation aromatherapy with Rosa damascena on stress, anxiety, and hemodynamic parameters of patients undergoing coronary angiography.

METHODS

A single-blind randomized clinical trial was conducted on 98 patients in Besat Educational Hospital, Hamadan, Iran. Before coronary angiography, patients at aromatherapy group inhaled five drops of 40% Rosa damascena for 20 min and in the control group, patients inhaled distilled water. Stress, anxiety, and hemodynamic parameters were measured before and after the intervention using DASS-21 questionnaire and checklist.

RESULTS

Data were analysed by SPSS 16 software using descriptive and inferential statistics such as paired t-test and non-parametric tests. There were significant differences in terms of stress and anxiety severity in patients at aromatherapy group (p=0.005) and control group (p=0.001). There were significant differences in terms of hemodynamic parameters such as heart rate (p=0.001), mean arterial pressure (p=0.001), systolic (p=0.003) and diastolic blood pressure (p=0.001) and SpO₂ (p=0.02).

CONCLUSIONS

Inhalation aromatherapy with Rosa damascena can significantly decrease stress and anxiety severity and improve hemodynamic parameters of patients undergoing coronary angiography.

REGISTRY NUMBER

This study has registered with the number IRCT201702019759N8 at Iranian Registry Clinical Trial.

Effect of aromatherapy on autonomic nervous system regulation with treadmill exercise-induced stress among adolescents

Introduction

Stress is a major health issue in adolescents owing to the important transitions experienced during this period. Aromatherapy is an effective method for the reduction of stress in adolescents.

Purpose

The aims of this study were to examine the effect of aromatherapy on the regulation of the autonomic nervous system (ANS) along with stress relief and to explore the effect of aromatherapy on adolescents with different levels of stress.

Methods

This quasi-experimental study comprised three types of treatments: control (no essential oil), pure essential oil therapy (sandalwood), and blended essential oil therapy (sandalwood-lavender). The heart rate variability (HRV) was calculated to evaluate the post-exercise recovery of the ANS to the baseline level in the recruited adolescents. To examine the efficiency of aromatherapy, Friedman test was used to assess the significance of difference in all parameters (i.e., mean heart rate, SDNN, normalized LF, normalized HF, and LF/HF) between baseline and after exercise among the three treatment conditions.

Results

The participants comprised 43 junior college students (8 males and 35 females) with a mean age of 18.21 ± 0.99. Significant differences in changes of two HRV parameters (normalized LF and LF/HF) were associated with both essential oil therapies compared to those in the control group (p<0.05), and one more HRV parameter (normalized HF) exhibited significant difference related to blended essential oil therapy compared to that of the control group. Besides, changes in two HRV parameters (mean heart rate and normalized HF) of both essential oil therapies in the low level stress subgroup showed significant differences compared to those of the control group (p<0.05).

Conclusions

This study demonstrated that aromatherapy could be used for ANS regulation with stress-relieving effects in adolescents. The participants with a low stress level appeared to respond better to the blended essential oil therapy, whereas those with medium to high levels of stress appeared to respond poorly to aromatherapy compared to the control.

Effects of lavender and Citrus aurantium on pain of conscious intensive care unit patients: A parallel randomized placebo-controlled trial

BACKGROUND

Conscious patients admitted to intensive care units (ICUs) suffer from pain for various reasons, which can affect their recovery process.

OBJECTIVE

The present study compared the effects of aromatherapy with Citrus aurantium and lavender essential oils against placebo for reducing pain in conscious intensive care patients.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

This study was a parallel randomized placebo-controlled trial. The ICUs of two educational hospitals in Kerman in Southeastern Iran were the study setting. One hundred and fifty conscious intensive care patients were randomly divided into three groups using a stratified block randomization method. Two groups received aromatherapy with essential oils: one with lavender and the other with C. aurantium; these patients received a 30-minute therapy session using their assigned essential oil on the second day of their intensive care stay. The placebo group used 5 drops of normal saline instead of essential oil during their session.

MAIN OUTCOME MEASURES

Patient's pain was assessed using a visual analog scale before the aromatherapy intervention, as well as immediately after and one and three hours after intervention.

RESULTS

The mean pain score of the lavender group was 40.01 before the aromatherapy intervention and fell to 39.40, 30.60 and 23.68 immediately after the intervention, and at hour one and three post-intervention, respectively. The mean pain score of the C. aurantium group was 45.48 before the intervention and was reduced to 32.34 at three hours after the intervention. The mean pain of the placebo group decreased from 42.80 before the intervention to 35.20 at three hours after the intervention. Pain scores of all groups decreased during the study (P < 0.001). The mean pain of the lavender group was significantly lower than that of the placebo group at three hours after the intervention.

CONCLUSION

The results of this study showed that aromatherapy with lavender essential oil reduced pain in conscious ICU patients. Our data could not justify the use of C. aurantium for reducing pain in this population.

TRIAL REGISTRATION

No. IRCT20170116031972N9 (https://en.irct.ir/trial/40827).

The effects of Lavender and Chamomile essential oil inhalation aromatherapy on depression, anxiety and stress in older community-dwelling people: A randomized controlled trial

BACKGROUND

Considering the prevalence of mental health problems in older adults, this study aims to investigate the effect of inhalation aromatherapy using lavender and chamomile essential oils on depression, anxiety, and stress of community-dwelling older people.

METHODS

A three-armed, parallel, randomized, and controlled trial design was used in this study. 183 participants were enrolled and randomly assigned to three groups (n = 61): the lavender, chamomile, and control groups. The participants in the experimental groups inhaled three drops of 1.5% lavender and chamomile essential oils for 30 nights. The participants in the control group inhaled only distilled water in a similar fashion. Data were collected using the Depression, Anxiety, and Stress-Scale (DASS) at baseline, immediately after the intervention, and one month after the intervention. Chi-square, Fisher's exact, one-way ANOVA, and repeated measures ANOVA were used for data analysis.

RESULTS

Statistically significant improvement occurred in depression, anxiety, and stress levels immediately and one month after the intervention in lavender and chamomile groups compared to the control group (p < 0.01).

CONCLUSION

Inhalation aromatherapy with both lavender and chamomile essential oils helped decrease depression, anxiety, and stress levels in community-dwelling older adults.

Effect of Lavender Aromatherapy on Sleep Quality and Physiological Indicators in Patients after CABG Surgery: A Clinical Trial Study

Background

Sleep disorders occur in the first days after heart surgery. One of the major causes of sleep disorders after coronary artery bypass graft (CABG) is subsequent changes in physiological indicators, such as systolic blood pressure (BP), respiratory rate (RR), saturation of oxygen (O₂), and heart rate (RR). This study is aimed to determine the effect of lavender aromatherapy on patients’ sleep quality and physiological indicators after CABG.

Materials and methods

This study was a randomized clinical trial. Patients after CABG surgery were randomly allocated into the lavender and distilled water groups. Patients in the intervention group inhaled lavender while those in the control group inhaled distilled water for 10 hours. Sleep quality and physiological postoperative data were collected for 3 days. Data were analyzed using repeated measurement test, sample t-test, and Chi-square test.

Results

Repeated measurement test showed no significant difference between the lavender and distilled water groups in terms of systolic BP, RR, O₂ saturation, HR, and body temperature after matching the effect of time and its interactive effect with the intervention (p > 0.05). This test revealed a significant difference between the lavender and distilled water groups in terms of sleep quality (p < 0.001), such that the sleep quality was higher in the lavender group.

Conclusion

Lavender aromatherapy can increase patients’ sleep quality after CABG surgery. However, it cannot completely treat sleep disorders in such patients. Furthermore, aromatherapy with lavender does not affect the physiological parameters, such as HR, BP, RR, and O₂ saturation.

How to cite this article

Davari H, Ebrahimian A, Rezayei S, Tourdeh M. Effect of Lavender Aromatherapy on Sleep Quality and Physiological Indicators in Patients after CABG Surgery: A Clinical Trial Study. Indian J Crit Care Med 2021;25(4):429–434.

Effect of rosa damascene aromatherapy on anxiety and sleep quality in cardiac patients: A randomized controlled trial

INTRODUCTION

Anxiety and sleep disorders are the most common disorders of patients admitted to the cardiac care units. The purpose of this study is to investigate the effect of Rosa damascene fragrance on anxiety and sleep quality of hospitalized patients in the cardiac care units.

METHODS

In this Randomized clinical trial, 60 patients who had the inclusion criteria were conveniently sampled and randomly allocated to the experimental and control groups. Patients were enrolled in the study 24 h after hospitalization. Those diagnosed with dysrhythmia, ACS, and CHF were included. Patient recruitment lasted from October 2018 to December 2019. In these groups, in addition to the routine care, the intervention was performed for three consecutive nights from 22:00 to 06:00. In the experimental group, patients inhaled five drops of Rosa damascene essence 40% in distilled water, while in the control group, patients inhaled five drops of distilled water as placebo. In both groups, anxiety and sleep quality were examined before and after three consecutive nights using the St. Mary's Hospital Sleep Quality Questionnaire (SMHSQ) and the Spiel Berger State-Trait Anxiety Inventory (STAI) questionnaire.

RESULTS

The results of this study showed that the use of Rosa damascene aroma in patients hospitalized in the cardiac care unit significantly reduces anxiety and increases the improvement of sleep quality in the experimental group compared to the control group (P < 0.05). The significance level for anxiety and sleep quality was (P = 0.001).

CONCLUSION

Aromatherapy with Rosa damascene reduces anxiety and increases the sleep quality of patients hospitalized in the cardiac care unit. Therefore, along with other treatment measures, Rosa damascene can be used as a complementary method to reduce anxiety and improve sleep quality.

The Immediate Effects of Lavender Aromatherapy Massage versus Massage in Work Stress, Burnout, and HRV Parameters: A Randomized Controlled Trial

Background

Occupational stress is a common issue faced by workers in every discipline. Complementary and alternative medicine (CAM) therapies, such as aromatherapy massage or massage, have antistress effects in the literature. The purpose of this randomized clinical trial with triple blinds is to evaluate the immediate effects of lavender aromatherapy massage for improving work stress, burnout, and HRV parameters of female employees in a university.

Methods

A total of 53 subjects in experimental group whereas 57 subjects in control group completed interventions and measurement and led to power of 0.98. Inferential statistics, as independent t-test, paired t-test, and Chi-Square test, were performed to verify the expected relationships.

Results

The present study found that subjects in experimental group reported a lower role stress and less inclined to type A personality trait after aromatherapy massage with lavender. For control group, only less inclined to type A personality trait was reported after receiving massage. For burnout, a significant lower personal burnout and work-related burnout were reported after aromatherapy massage whereas only increased client-related burnout was reported in control group. For HRV, both the experimental and control groups reported higher SDNN and RMSSD in time domain after intervention. Contradictory HRT and PSI in time domain were significantly lower after intervention. In frequency domain of HRV, both groups reported significantly higher value in VLF and HF. In addition, the experimental group reported significantly higher value in TP and LF after intervention.

Conclusions

Both the lavender aromatherapy massage and massage did show immediate effect on different dimensions of work stress, burnout, and HRV. These two interventions can be applied as routine leisure activities by personal preference to reduce stresses occurring in work environment.

The Effect of Massage With and Without Aromatic Oil on Delirium After Open-Heart Surgery: A Randomized Controlled Trial

Objective

The current study aimed to determine the effect of massage with and without aromatic oil on the delirium of patients hospitalized in the cardiac intensive care unit.

Methods

This study was a single-blind, randomized, controlled trial. Using a convenience method, 150 patients were selected and assigned into 3 groups: control, massage with aroma, and massage without aroma using the minimization method. Only routine care was provided for the control group. Brown massage with 4% rose oil in the base of sweet almond oil was given to the massage group with aroma 1 day after the surgery. The same steps and massage techniques with sweet almond oil were performed for the massage group without aroma. The incidence and severity of delirium were evaluated at the end of each day using the Neelon and Champagne Confusion Scale.

Results

Delirium scores were not significantly different among the 3 groups on the first, second, and third days (P > .05). Also, the incidence of delirium significantly decreased in all 3 groups from day 1 to day 3.

Conclusion

The results of this study could not prove the beneficial effects of massage with and without aroma on delirium incidence. Further studies are suggested to determine the best intervention to reduce delirium in patients undergoing coronary artery surgery.

Effects of lavender oil intervention before endoscopic retrograde cholangiopancreatography on patients' vital signs, pain and anxiety: A randomized controlled study

BACKGROUND

This study was carried out to determine the effects of lavender oil intervention before endoscopic retrograde cholangiopancreatography (ERCP) on patients' vital signs, pain and anxiety.

MATERIALS AND METHODS

This study was designed as a randomized controlled study. The population of the study consisted of adult patients who were going to receive ERCP at the gastroenterology clinic of a university hospital. Ninety patients participated in the study. The data were collected using a Patient Information Form, a Pre-Post Test Record Form, VAS and the State Anxiety Scale.

RESULTS

After lavender oil intervention, the pulse rate, systolic-diastolic blood pressure, pain and anxiety levels of the patients in the experiment group were reduced, their oxygen saturation levels were increased, and the difference between the groups was statistically significant (p < 0.05).

CONCLUSION

Lavender oil applied on the patients before the ERCP procedure reduced their pulse rate, systolic-diastolic blood pressure, pain and anxiety levels, while it increased their oxygen saturation levels.

Comparing the effect of aromatherapy with peppermint and lavender on the sleep quality of cardiac patients: a randomized controlled trial

Background

Sleep disorder is a critical problem in cardiac patients. This study aimed to compare the effects of aromatherapy ‌with peppermint and lavender essential oils on the sleep quality of cardiac patients.

Methods

A total of 105 patients were randomly allocated to three groups of peppermint essential oil, lavender essential oil, and control. In each experimental group, the patients inhaled three drops of lavender and peppermint essential oils, whereas the control group received aromatic distilled water. Data were collected using the Pittsburgh Sleep Quality Index (PSQI). The participants completed PSQI before and after the intervention.

Results

There was a significant difference in the mean score of PSQI in each of the experimental groups before and after the intervention; however, the difference was not statistically significant between the experimental groups.

Conclusion

Aromatherapy with lavender and peppermint essential oils can improve the sleep quality of cardiac patients. Therefore, use of this non-pharmacological intervention, as an effective and simple approach, is recommended for cardiac patients.

Trial registration

IRCT, IRCT201601244736N10. Registered 4 November 2016.

Effectiveness of Aromatherapy for Relief of Pain, Nausea, and Vomiting after Percutaneous Nephrolithotomy: A Randomized Controlled Trial

BACKGROUND

Postoperative pain, nausea, and vomiting are common side effects of percutaneous nephrolithotomy. Nowadays, non-pharmacological and complementary therapies have been noticed. Therefore, a study was conducted to determine the effectiveness of lavender and clary sage on the pain, nausea, and vomiting after percutaneous nephrolithotomy.

METHODS

This is a randomized clinical trial study on 79 patients undergoing percutaneous nephrolithotomy. Patients were randomly divided into three groups of lavender aromatherapy (n = 27), clary sage aromatherapy (n = 26), and a control group (n = 26). Each of the intervention groups received the inhalation aromatherapy immediately and 3 and 6 h after the operation. Pain, nausea, and emetic episodes in patients of the three groups were measured before the intervention and 30 min after each intervention using a visual analog scale and checklist.

RESULTS

Pain decreased significantly in the clary sage aromatherapy group. Nausea had a downward trend in the two groups of aromatherapy. The lavender aromatherapy group had the lowest incidence of emetic episodes compared to the other groups.

CONCLUSION

Regarding the annoying pain, nausea, and vomiting after percutaneous nephrolithotomy for patients, and taking into account the complications of drug therapy, the use of complementary non-pharmacological methods can help increase the comfort of patients.

The effect of aromatherapy with rose and lavender on anxiety, surgical site pain, and extubation time after open-heart surgery: A double-center randomized controlled trial

To determine the effect of aromatherapy with rose and lavender on the patient outcomes after open-heart surgery (OHS). In the clinical trial, patients were randomized to four groups. One group received routine care, the placebo group received a cotton swab soaked in water and the other two groups received either a cotton swab containing three drops of rose or lavender essence (0.2 ml). A total of 160 patients were randomized into four groups. Intergroup anxiety was not significantly different; however, the reciprocal time-group effect was significant among the four groups. The extubation time was significant among the four groups which related to rose essence group compared with the control group (p < .001) and placebo group (p = .029). The surgical site pain was significant in the rose essence and lavender groups compared to the control group. Aromatherapy can reduce extubation time, surgical site pain severity, and anxiety in patients undergoing OHS.

Efficacy of inhaled Lavandula angustifolia Mill. Essential oil on sleep quality, quality of life and metabolic control in patients with diabetes mellitus type II and insomnia

ETHNOPHARMACOLOGIC RELEVANCE

Lavandula angustifolia Mill (lavender) odor was traditionally used as sleep enhancer. Previous studies have shown interaction between insomnia, quality of life and control of diabetes mellitus (DM). Insomnia is suggested to increase the risk of depression and decrease the quality of life in diabetic patients. The aim of this study was to evaluate the efficacy of inhaled Lavandula angustifolia Mill. as a complementary therapy for insomnia in diabetic patients.

METHODS

In a randomized crossover placebo-controlled clinical trial, 52 patients with type II diabetes mellitus (DM) and insomnia, defined as Pittsburgh Insomnia Rating Scale-20(PIRS-20)>5,were treated with inhaled lavender or placebo for two periods of 4 weeks duration with one week interval as washing period. Sleep quality, quality of life and mood status were assessed by PIRS-20, WHO Quality of Life-BREF(WHOQOL-BREF) Questionnaire and Beck Depression Inventory (BDI) scale respectively, at baseline and end of each period of study. Fasting blood glucose (FBS), calorie intake and physical activity were measured before and after the interventions.

RESULTS

At the end of study, data of 37 patients (all received both lavender and placebo in cross-over design) were analyzed. Based on crossover analysis the first treatment was not effective on the second treatment. Inhaled lavender resulted in a significant better outcome compared to placebo according to mean PIRS-20, WHOQOL-BREF and Beck Depression Inventory scores in both crossover arms. Likewise there was a significant better outcome in PIRS-20 domains for quality and quantity of sleep after Inhaled lavender compared to placebo. No significant improvement was observed in fasting glucose in lavender compared to placebo administration period.

CONCLUSION

Inhaled lavender can improve sleep quality and quantity, quality of life and mood in diabetic patients suffering from insomnia with no significant effect on metabolic status.

Efficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders: A network meta-analysis

A systematic review and network-meta analysis (NMA) were performed to estimate significance of the anxiolytic effect of lavender essential oil taken as silexan capsules versus other comparators (i.e., placebo/paroxetine/lorazepam). The outcome of interest was Hamilton Anxiety Scale (HAMA). Weighted mean differences (WMD) were calculated to estimate the treatment effect at the confidence interval of 95%. League tables were generated using treatment effect, for all pairwise comparisons, where WMD < 0 favors the column-defining treatment. Five studies were identified with a total of 524 participants receiving treatment with silexan 80 mg and 121 participants taking silexan 160 mg. The NMA results indicated that consumption of silexan 160 mg resulted in higher decline of HAMA score [WMD −1.14 (−1.10, 3.39)] in comparison to silexan 80 mg, placebo [−2.20 (−4.64, 0.24)] and paroxetine [−1.24 (−5.34, 2.85)]. The effect of silexan 80 mg was observed to be same as that of paroxetine. Overall, silexan 160 mg was noticed to be a more efficient treatment giving significant decline in HAMA score across other comparators. However, no improvements in HAMA score was observed for the group receiving lorazepam 0.5 mg when compared to silexan 160 mg, silexan 80 mg, paroxetine 20 mg, and placebo.

Effects of lavender on anxiety: A systematic review and meta-analysis

BACKGROUND

Anxiety is one of the uprising psychiatric disorders of the last decades and lavender administration has been traditionally suggested as a possible treatment. The objective of this review is to assess the efficacy of lavender, in any form and way of administration, on anxiety and anxiety-related conditions.

METHODS

The PRISMA guidelines were followed. Retrieved data were qualitatively and quantitatively synthesized. Randomized Controlled Trials (RCTs) and Non-Randomized Studies (NRSs) which investigated the efficacy of lavender, in any form and way of administration, on patients with anxiety, involved in anxiety-inducing settings or undergoing anxiety-inducing activities, compared to any type of control, without language restrictions, were identified through electronic database searches. Medline via PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Google Scholar were systematically searched. All databases were screened up to November 2018. Risk of bias was assessed with the Cochrane risk-of-bias tool and the following domains were considered: randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.

RESULTS

65 RCTs (7993 participants) and 25 NRSs (1200 participants) were included in the qualitative synthesis and 37 RCTs (3964 participants) were included in the quantitative synthesis. Overall, the qualitative synthesis indicated that 54 RCTs and 17 NRSs reported at least a significant result in favor of lavender use for anxiety. The quantitative synthesis showed that lavender inhalation can significantly reduce anxiety levels measured with any validated scale (Hedges' g = -0.73 [95% CI -1.00 to -0.46], p < 0.00001, 1682 participants), as well as state anxiety (Spielberger's state-trait anxiety inventory (STAI)-State mean difference = -5.99 [95% CI -9.39 to -2.59], p < 0.001, 901 participants) and trait anxiety (STAI-Trait mean difference = -8.14 [95% CI -14.44 to -1.84], p < 0.05, 196 participants). Lavender inhalation did not show a significant effect in reducing systolic blood pressure as a physiological parameter of anxiety. A significant effect in diminishing anxiety levels was also found in favor of the use of oral Silexan® 80 mg/die for at least 6 weeks (Hamilton Anxiety Scale mean difference = -2.90 [95% CI -4.86 to -0.95], p = 0.004, 1173 participants; Zung Self-rating Anxiety Scale mean difference = -2.62 [95% CI -4.84 to -0.39], p < 0.05, 451 participants) or of the administration of massage with lavender oil (Hedges' g = -0.66 [95% CI -0.97 to -0.35], p < 0.0001, 448 participants).

DISCUSSION

The most important limitation of this review is the low average quality of available studies on the topic. The majority of included RCTs were characterized by a high overall risk of bias. Another limitation regards the heterogeneity of study designs, especially with regard to non-oral ways of administration. Overall, oral administration of lavender essential oil proves to be effective in the treatment of anxiety, whereas for inhalation there is only an indication of an effect of reasonable size, due to the heterogeneity of available studies. Lavender essential oil administered through massage appears effective, but available studies are not sufficient to determine whether the benefit is due to a specific effect of lavender. Further high-quality RCTs with more homogeneous study designs are needed to confirm these findings. Available information outlines a safe profile for lavender-based interventions, although more attention should be paid to the collection and reporting of safety data in future studies. Considering these findings, since treatments with lavender essential oil generally seem safe, and, in the case of inhalation, also simple and inexpensive, they are a therapeutic option which may be considered in some clinical contexts.

OTHER

The present systematic review was not funded and was registered in PROSPERO under the following number: CRD42019130126.

Behavioral and Neural Changes Induced by a Blended Essential Oil on Human Selective Attention

Selective attention refers to the selecting and preferential processing of specific information while simultaneously suppressing irrelevant distractors, activities linked to various cognitive skills and academic achievements. The influence of essential oils on the cognition of humans has been extensively explored. However, the effects of essential oils on human selective attention and the underlying neural mechanisms remain unclear. In the present study, participants were divided into a “blended essential oil” group and a “no essential oil” group and enrolled on a negative priming task, including a control condition and a negative priming condition. The event-related potential technique was used to examine the brain mechanisms underlying the blended essential oil effects on human selective attention. Behavioral results showed that individuals responded more quickly in the negative priming condition when exposed to the blended essential oil. In addition, the blended essential oil eliminated the differences in the P300 amplitude in the postcentral area of the brain between the negative priming condition and the control condition. Moreover, the blended essential oil led to stronger functional connectivity during the task. The present study thus suggests that blended essential oil can significantly change brain activity and functional connections in human beings, which may improve human selective attention.

Essential Oils to Reduce Postoperative Nausea and Vomiting

PURPOSE

The purpose of this study was to determine if using essential oil products for adult patients reduced the need for antiemetics for postoperative nausea and vomiting (PONV).

DESIGN

A prospective and retrospective cross-sectional design using a convenience sample.

METHODS

Double blinded to the type of essential oil, subjects randomly selected a nasal inhaler containing peppermint, ginger, or a combination of both. A prophylactic dose was given preoperatively, and during the postoperative period nausea was assessed using verbal descriptive scale.

FINDINGS

Overall 322 same day surgical patients were analyzed (control group [n = 179] and intervention group [n = 143]). The intervention group had a greater history of PONV but received fewer doses of antiemetics postoperatively compared with the control group. There was no significant difference in the effectiveness of the three types of inhalers.

CONCLUSIONS

Aromatherapy demonstrated a statistically significant (P < .05) reduction in the need for antiemetics to treat PONV.

Could complementary health approaches improve the symptom experience and outcomes of critically ill adults? A systematic review of randomized controlled trials

OBJECTIVE

The purpose of this systematic review was to critically evaluate the safety and effectiveness of various complementary health approaches (CHAs) in treating symptoms experienced by critically ill adults.

METHODS

The review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Electronic databases (PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Center, Medline, PsychInfo) were searched for studies published from 1997-2017. Randomized controlled trials (RCTs), in English with terms ICU/critical care, music, Reiki, therapeutic touch, healing touch, aromatherapy, essential oil, reflexology, chronotherapy, or light therapy were eligible for inclusion. Studies conducted outside the ICU, involving multiple CHAs, or enrolling pediatric patients were excluded. Data were extracted and assessed independently by two authors and reviewed by two additional authors. The Cochrane risk of bias tool was used to assess study quality.

RESULTS

Thirty-two RCTs were included involving 2,987 critically ill adults. CHAs evaluated included music (n = 19), nature based sounds (NBSs) (n = 4), aromatherapy (n = 3), light therapy (n = 2), massage (n = 2), and reflexology (n = 2). Half of all studies had a high risk of bias for randomization but had low or unclear biases for other categories. No study-related adverse events or safety-related concerns were reported. There were statistically significant improvements in pain (music, NBSs), anxiety (music, NBSs, aromatherapy, massage, reflexology), agitation (NBSs, reflexology), sleep (music, aromatherapy, reflexology), level of arousal (music, massage), and duration of mechanical ventilation (music, reflexology).

CONCLUSIONS

Evidence suggests CHAs may reduce the symptom burden of critically ill adults.