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Rajjoub R, Sammak SE, Rajjo T, Rajjoub NS, Hasan B, Saadi S, Kanaan A, Bydon M. Meditation for perioperative pain and anxiety: A systematic review. Brain Behav 2024; 14:e3640. [PMID: 39073307 DOI: 10.1002/brb3.3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Effective pain and anxiety management during the perioperative phase remains a challenge for patients undergoing surgeries and other invasive procedures. The current standard of care involves prescribing analgesics to treat these conditions; however, there has been recent interest in applying multimodal strategies that limit the use of these medications. One such modality is meditation, which has been shown to be effective in alleviating various physical and psychological symptoms in other settings. This systematic review aims to assess how current meditative practices affect perioperative pain and anxiety. METHODS We conducted a systematic review of randomized controlled trials following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted using PubMed MEDLINE, Embase, PsycINFO, APA PsycINFO, EBM Reviews, Scopus, and Web of Science for all available dates. Our primary outcomes of interest were patient-reported pain and anxiety scores using the Visual Analog Scale, the Brief Pain Inventory, the Depression Anxiety Stress Scale, the State-Trait Anxiety Inventory (STAI), and the Hospital Anxiety and Depression Scale (HADS). For the HADS and STAI scales, only the anxiety and anxiety-state subgroups were reported, respectively. RESULTS The literature search yielded 1746 articles. A total of 286 full-text articles were screened, and 16 studies were included in this systematic review. A total of eight studies assessed pain scores after invasive procedures; five reported improvements in pain scores, and three reported no change after meditative practices. Ten studies assessed anxiety outcomes after invasive procedures: nine reported a decrease in overall anxiety levels as a result of meditation practices while one study reported no change in anxiety scores. CONCLUSION Data from this limited literature suggests that different meditation practices could be effective in alleviating pain and anxiety within the perioperative phase for patients undergoing various types of invasive procedures. Future prospective studies are needed to determine whether routine meditation in the perioperative setting is effective in mitigating perioperative pain and anxiety.
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Affiliation(s)
- Rami Rajjoub
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Sally El Sammak
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Tamim Rajjo
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Noora S Rajjoub
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bashar Hasan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Samer Saadi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Adel Kanaan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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Cozowicz C, Zhong H, Illescas A, Athanassoglou V, Poeran J, Reichel JF, Poultsides LA, Liu J, Memtsoudis SG. The Perioperative Use of Benzodiazepines for Major Orthopedic Surgery in the United States. Anesth Analg 2022; 134:486-495. [PMID: 35180165 DOI: 10.1213/ane.0000000000005854] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite numerous indications for perioperative benzodiazepine use, associated risks may be exacerbated in elderly and comorbid patients. In the absence of national utilization data, we aimed to describe utilization patterns using national claims data from total hip/knee arthroplasty patients (THA/TKA), an increasingly older and vulnerable surgical population. METHODS We included data on 1,863,996 TKAs and 985,471 THAs (Premier Healthcare claims data, 2006-2019). Benzodiazepine utilization (stratified by long- and short-acting agents) was assessed by patient- and health care characteristics, and analgesic regimens. Given the large sample size, standardized differences instead of P values were utilized to signify meaningful differences between groups (defined by value >0.1). RESULTS Among 1,863,996 TKA and 985,471 THA patients, the utilization rate of benzodiazepines was 80.5% and 76.1%, respectively. In TKA, 72.6% received short-acting benzodiazepines, while 7.9% received long-acting benzodiazepines, utilization rates 68.4% and 7.7% in THA, respectively. Benzodiazepine use was particularly more frequent among younger patients (median age [interquartile range {IQR}]: 66 [60-73]/64 [57-71] among short/long-acting compared to 69 [61-76] among nonusers), White patients (80.6%/85.4% short/long-acting versus 75.7% among nonusers), commercial insurance (36.5%/34.0% short/long-acting versus 29.1% among nonusers), patients receiving neuraxial anesthesia (56.9%/56.5% short/long-acting versus 51.5% among nonusers), small- and medium-sized (≤500 beds) hospitals (68.5% in nonusers, and 74% and 76.7% in short- and long-acting benzodiazepines), and those in the Midwest (24.6%/25.4% short/long-acting versus 16% among nonusers) in TKA; all standardized differences ≥0.1. Similar patterns were observed in THA except for race and comorbidity burden. Notably, among patients with benzodiazepine use, in-hospital postoperative opioid administration (measured in oral morphine equivalents [OMEs]) was substantially higher. This was even more pronounced in patients who received long-acting agents (median OME with no benzodiazepines utilization 192 [IQR, 83-345] vs 256 [IQR, 153-431] with short-acting, and 329 [IQR, 195-540] with long-acting benzodiazepine administration). Benzodiazepine use was also more frequent in patients receiving multimodal analgesia (concurrently 2 or more analgesic modes) and regional anesthesia. Trend analysis showed a persistent high utilization rate of benzodiazepines over the last 14 years. CONCLUSIONS Based on a representative sample, 4 of 5 patients undergoing major orthopedic surgery in the United States receive benzodiazepines perioperatively, despite concerns for delirium and delayed postoperative neurocognitive recovery. Notably, benzodiazepine utilization was coupled with substantially increased opioid use, which may project implications for perioperative pain management.
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Affiliation(s)
- Crispiana Cozowicz
- From the Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Alex Illescas
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Vassilis Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, United Kingdom
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai/Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, New York, New York
| | - Julia Frederica Reichel
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Lazaros A Poultsides
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.,Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.,Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Stavros G Memtsoudis
- From the Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.,Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
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Ferede YA, Bizuneh YB, Workie MM, Admass BA. "Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section": A cross-sectional study. Ann Med Surg (Lond) 2022; 74:103272. [PMID: 35198163 PMCID: PMC8844776 DOI: 10.1016/j.amsu.2022.103272] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 01/26/2023] Open
Abstract
Background Anxiety is the most common problem in the preoperative period. This anxiety increases postoperative pain, delay healing, and prolong the hospital stay. Among the surgical population, a higher level of preoperative anxiety has been seen in obstetric patients. Objective The aim of this study was to assess the prevalence and associated factors of preoperative anxiety among obstetric patients undergoing cesarean section. Methods An institutional-based cross-sectional study was conducted from January 01, 2021, to May 30, 2021. A total of 376 obstetric patients who underwent cesarean sections were included. Descriptive statistics, cross-tabs, and binary logistic regression analysis were performed to identify the association shivering and independent variables. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and a p-value<0.05 was considered as statistically significant state versions of state-trait anxiety inventory scale (S-STAI) were used for this study. Results The overall prevalence rate of preoperative anxiety was 63% (95% CI: 58.2, 68.1). The patient's preoperative mean anxiety score of STAI was (43.81 ± 8.81). There was a high level of preoperative anxiety in patients undergoing emergency cesarean section as compared to elective patients. Patients' age less than 30 years, level of education, and previous anesthesia and surgery exposure were also highly associated with the dependent variable. Conclusion In this study, fear of complications and fear of death result of operation were the most common factors responsible for preoperative anxiety while few patients were anxious about financial loss and osmotic issues. The prevalence rate of preoperative anxiety was 63% among obstetric patients. Preoperative anxiety was highly related to fear of complications and fear of death. Age, Level of education were significantly associated with preoperative anxiety. Previous anesthesia exposure was also significantly associated with anxiety. Preoperative anesthesia visits are important to reduce anxiety.
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Affiliation(s)
- Yonas Admasu Ferede
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Yosef Belay Bizuneh
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Misganaw Mengie Workie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Biruk Adie Admass
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Guerrier G, Pisanu G, Baillard C. Assessing Preoperative Anxiety: Nurses Versus Health Care Assistants. J Perianesth Nurs 2021; 36:514-517. [PMID: 34303612 DOI: 10.1016/j.jopan.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 10/20/2022]
Abstract
PURPOSE Our objective was to compare the difference in anxiety levels self-reported by patients and those estimated by health care assistants and nurses in two ambulatory surgery settings. DESIGN We performed a prospective study. METHODS Patients' preoperative anxiety was graded using a visual analog scale. FINDINGS Between September 1 and November 31, 2019, a total of fifteen health care assistants and fourteen nurses assessed anxiety scores of 170 patients, including 92 women and 78 men. At admission, the mean visual analog scale anxiety score declared to health care assistants and nurses was 5.3 (SD = 2.9) and 4.2 (SD = 3.1), respectively (P = .02). The correlation between health care assistants' assessment of the patients' anxiety and the declared level of anxiety was significantly higher than nurses' assessment (r = 0.83 vs r = 0.12; P < .001). CONCLUSIONS Nurse assistants estimate patients' preoperative anxiety with more accuracy than nurses in our hospital. Nursing education curriculum should continue to include addressing preoperative patient anxiety.
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Affiliation(s)
- Gilles Guerrier
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Gianluca Pisanu
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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A prospective observational study of effect-site targeted, patient-maintained propofol sedation for lower limb orthopaedic surgery performed under spinal anaesthesia. Eur J Anaesthesiol 2019; 36:381-383. [PMID: 30946176 DOI: 10.1097/eja.0000000000000927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arakelian E, Färdig M, Nyholm L. Nurses anaesthetists' versus patients' assessment of anxieties in an ambulatory surgery setting. J Perioper Pract 2019; 29:400-407. [PMID: 30888940 DOI: 10.1177/1750458919838198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Failure to assess patients’ anxiety perioperatively by means of a validated instrument makes the assessment arbitrary. Studies are lacking about how well nurse anaesthetists estimate patients’ preoperative worries. Purpose To compare the nurse anaesthetists’ estimations of patients’ preoperative anxieties with the patients’ own assessment of their anxieties. Design Quantitative prospective design. Methods Eighty-five pairs of patients and nurse anaesthetists in two ambulatory surgery units in a university hospital in Sweden were included. Patients’ perioperative anxieties were graded using the Numeric Visual Analogue Anxiety Scale. Results The nurse anaesthetist overestimated the patients’ level of preoperative anxiety in 53% of patients and underestimated patients’ anxieties in 31% of the patients. Consensus was seen in 16% of the pairs. In fifty-six pairs (65%), the difference between the estimation of level of patients’ anxiety according to Numeric Visual Analogue Anxiety Scale was between −3 (overestimation) and +3 levels (underestimation). Median levels of anxiety were estimated as 3 within the patient group and 4 among the nurse anaesthetists. Conclusions Systematic assessment of patients’ level of anxiety could lead to identifying patients with severe anxiety levels and to offer more individualised treatment. The patients’ own estimation must form the basis for the discussion and treatment.
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Affiliation(s)
| | - Martin Färdig
- Departement of Neurology Sciences/Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Lena Nyholm
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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C. Sturmbauer S, Hock M, Rathner EM, R. Schwerdtfeger A. Das Angstbewältigungsinventar für medizinische Situationen (ABI-MS). DIAGNOSTICA 2019. [DOI: 10.1026/0012-1924/a000233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Das „Angstbewältigungsinventar für medizinische Situationen“ (ABI-MS) ist ein Situations-Reaktions-Inventar, das habituelle Präferenzen für den Einsatz kognitiv vermeidender und vigilanter Bewältigungsstrategien in potenziell bedrohlichen medizinischen Kontexten messen soll. Im ABI-MS, das sich konzeptuell und methodisch an das Angstbewältigungs-Inventar (ABI; Krohne & Egloff, 1999 ) anlehnt, werden 4 Szenarien vorgegeben (Blutabnahme, Schnittwunde, Darmspiegelung und Narkose), in die sich die Personen hineinversetzen sollen. Zu jedem Szenario werden jeweils 4 kognitiv vermeidende und 4 vigilante Reaktionsoptionen gegeben, deren Zutreffen die Personen beurteilen. In der vorliegenden Untersuchung wurden Struktur und psychometrische Qualität des ABI-MS geprüft. Konfirmatorische Faktorenanalysen ( N = 2 131) auf der Basis des Zwei-Parameter Logistischen Item-Response-Modells bestätigen die Annahme zweier situationsübergreifender Faktoren der Angstbewältigung in medizinischen Kontexten. Das Inventar erreicht zufriedenstellende Reliabilitäten. Eine Retest-Untersuchung belegt, dass primär habituelle Präferenzen erfasst werden. Korrelationen mit Verfahren zur Messung von Angstbewältigung und Persönlichkeitseigenschaften geben Hinweise auf die konvergente und diskriminante Validität des ABI-MS.
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Arakelian E, Nyholm L, Öster C. How Anesthesiologists and Nurse Anesthetists Assess and Handle Patients' Perioperative Worries Without a Validated Instrument. J Perianesth Nurs 2019; 34:810-819. [DOI: 10.1016/j.jopan.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 01/10/2023]
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Sprinks J, Worcester F, Breedon P, Watts P, Hewson D, Bedforth N. A Prototype Patient-Maintained Propofol Sedation System Using Target Controlled Infusion for Primary Lower-Limb Arthroplasty. J Med Syst 2019; 43:247. [PMID: 31243603 PMCID: PMC6594991 DOI: 10.1007/s10916-019-1377-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
Abstract
Each year, many operations in the UK are performed with the patient awake, without the use of general anaesthesia. These include joint replacement procedures, and in order to reduce patient anxiety, the supervising anaesthetist delivers the sedative propofol intravenously using a target-controlled infusion (TCI) device. However, it is clinically challenging to judge the required effect-site concentration of sedative for an individual patient, resulting in patient care issues related to over or under-sedation. To improve the process, patient-maintained propofol sedation (PMPS), where the patient can request an increase in concentration through a hand-held button, has been considered as an alternative. However, due to the proprietary nature of modern TCI pumps, the majority of PMPS research has been conducted using prototypes in research studies. In this work, a PMPS system is presented that effectively converts a standard infusion pump into a TCI device using a laptop with TCI software. Functionally, the system delivers sedation analogous to a modern TCI pump, with the differences in propofol consumption and dosage within the tolerance of clinically approved devices. Therefore, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved the system as a safe alternative to anaesthetist-controlled TCI procedures. It represents a step forward in the consideration of PMPS as a sedation method as viable alternative, allowing further assessment in clinical trials.
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Affiliation(s)
- James Sprinks
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK
| | - Frank Worcester
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK
| | - Philip Breedon
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK.
| | - Paul Watts
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK
| | - David Hewson
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nigel Bedforth
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Williams H, Jajja MR, Baer W, Balch GC, Maithel SK, Patel AD, Patel D, Patel SG, Stetler JL, Winer JH, Gillespie TW, Kooby DA. Perioperative anxiety and depression in patients undergoing abdominal surgery for benign or malignant disease. J Surg Oncol 2019; 120:389-396. [DOI: 10.1002/jso.25584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mohammad Raheel Jajja
- Department of SurgeryEmory University Atlanta Georgia
- Winship Cancer Institute, Emory University Atlanta Georgia
| | - Wendy Baer
- Winship Cancer Institute, Emory University Atlanta Georgia
- Department of PsychiatryEmory University Atlanta Georgia
| | - Glen C. Balch
- Department of SurgeryEmory University Atlanta Georgia
- Winship Cancer Institute, Emory University Atlanta Georgia
| | - Shishir K. Maithel
- Department of SurgeryEmory University Atlanta Georgia
- Winship Cancer Institute, Emory University Atlanta Georgia
| | | | - Dipan Patel
- Department of SurgeryEmory University Atlanta Georgia
| | | | | | - Joshua H. Winer
- Department of SurgeryEmory University Atlanta Georgia
- Winship Cancer Institute, Emory University Atlanta Georgia
| | - Theresa W. Gillespie
- Department of SurgeryEmory University Atlanta Georgia
- Winship Cancer Institute, Emory University Atlanta Georgia
| | - David A. Kooby
- Department of SurgeryEmory University Atlanta Georgia
- Winship Cancer Institute, Emory University Atlanta Georgia
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Aubrun F, Baillard C, Beuscart JB, Billard V, Boddaert J, Boulanger É, Dufeu N, Friggeri A, Khiami F, Salmon PK, Merloz P, Minville V, Molliex S, Mouchoux C, Pain L, Piriou V, Raux M, Servin F. Recommandation sur l’anesthésie du sujet âgé : l’exemple de fracture de l’extrémité supérieure du fémur. ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hewson DW, Worcester F, Sprinks J, Smith MD, Buchanan H, Breedon P, Hardman JG, Bedforth NM. Anaesthetist-controlled versus patient-maintained effect-site targeted propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia (ACCEPTS): study protocol for a parallel-group randomised comparison trial. Trials 2019; 20:129. [PMID: 30760311 PMCID: PMC6374891 DOI: 10.1186/s13063-019-3228-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation. METHODS The trial is an open-label, randomised, controlled superiority trial recruiting adults who are undergoing elective primary lower-limb arthroplasty with sedation by propofol infusion by effect-site targeting into two equal-sized parallel arms: PMPS and ACPS. The primary research objective is to compare the body-weight-normalised rate of propofol consumption when sedation for surgery on adults undergoing elective primary lower-limb arthroplasty under spinal anaesthesia is patient-maintained versus when it is anaesthetist-controlled. The study primary null hypothesis is that there is no difference in the rate of propofol consumption when sedation is patient-maintained versus anaesthetist-controlled. DISCUSSION This is the first trial to test the superiority of effect-site-targeted patient-maintained propofol sedation versus anaesthetist-controlled propofol sedation in terms of total propofol consumption during the sedation period. The results of this trial will help inform clinicians and device manufacturers of the clinical efficacy and safety of patient-maintained propofol sedation applied to a common operative setting. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Registry, ISRCTN29129799 . Prospectively registered on 12 June 2018.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Frank Worcester
- Medical Design Research Group, Nottingham Trent University, Nottingham, UK
| | - James Sprinks
- Medical Design Research Group, Nottingham Trent University, Nottingham, UK
| | - Murray D Smith
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
| | - Heather Buchanan
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Philip Breedon
- Medical Design Research Group, Nottingham Trent University, Nottingham, UK
| | | | - Nigel M Bedforth
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Burton D, King A, Bartley J, Petrie KJ, Broadbent E. The surgical anxiety questionnaire (SAQ): development and validation. Psychol Health 2018; 34:129-146. [DOI: 10.1080/08870446.2018.1502770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dominic Burton
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amy King
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jim Bartley
- Department of Otorhinolaryngology – Head and Neck Surgery, Counties Manukau District Health Board, Otahuhu, Auckland, New Zealand
| | - Keith J. Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Bethune A, Davila-Foyo M, Valli M, da Costa L. e-Consent: approaching surgical consent with mobile technology. Can J Surg 2018; 61:339-344. [PMID: 30247010 DOI: 10.1503/cjs.016017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Patient recall of information about procedures, including risks and benefits and potential outcomes, is often insufficient. We sought to determine whether a multimedia educational tool enhances the informed consent discussion for elective neurosurgical procedures by increasing patient knowledge of the procedure. Methods Adult patients from a single neurosurgical site eligible for 4 neurosurgical procedures (lumbar spine or cervical spine decompression for degenerative disease, craniotomy for brain tumour or trigeminal neuralgia treatment) were offered enrolment. Patients were randomly assigned to either the control arm (standard consent discussion) or the intervention arm (review of an e-book containing information tailored to their disease/injury plus standard consent discussion). Participants completed a 14-item questionnaire before and after the consent discussion. Results Questionnaires were completed by 38 participants, 18 in the control group and 20 in the intervention group. The mean age was 62.2 (standard deviation [SD] 13.6) years and did not differ significantly between the 2 groups. The mean
baseline questionnaire scores were similar for the control and intervention groups (20.4 [SD 7.3] v. 20.6 [SD 6.7]). However, the mean scores on the follow-up questionnaire were significantly different between the 2 groups (20.2 [SD 4.0] v. 23.2 [SD 4.9], p = 0.02). There was no change in the scores on the 2 questionnaires in the control group, whereas, in the intervention group, the mean score was significantly higher after the intervention (p = 0.03). Conclusion The use of an electronic booklet appears to improve patients’ knowledge of their surgical procedure. The use of multimedia booklets in clinical practice could help standardize and optimize the consent process, ensuring that patients
receive the relevant information to make a truly informed decision.
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Affiliation(s)
- Allison Bethune
- From the Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Bethune, Costa, Davila-Foyo); and the Institute of Medical Sciences, University of Toronto, Toronto, Ont. (Valli)
| | - Marisol Davila-Foyo
- From the Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Bethune, Costa, Davila-Foyo); and the Institute of Medical Sciences, University of Toronto, Toronto, Ont. (Valli)
| | - Mikaeel Valli
- From the Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Bethune, Costa, Davila-Foyo); and the Institute of Medical Sciences, University of Toronto, Toronto, Ont. (Valli)
| | - Leodante da Costa
- From the Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Bethune, Costa, Davila-Foyo); and the Institute of Medical Sciences, University of Toronto, Toronto, Ont. (Valli)
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[Assessment of the therapeutic communication in order to improve the welcoming of patients in the operating room: impact study]. Can J Anaesth 2018; 65:1138-1146. [PMID: 29949092 DOI: 10.1007/s12630-018-1167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 10/14/2022] Open
Abstract
PURPOSE We wanted to assess the awareness of the nursing staff to therapeutic communications on improving the welcoming experience of patients in the operating room for outpatient surgery. METHODS This was a single centre prospective impact study performed in an outpatient surgery clinic. In a first phase, a questionnaire was administered by the anesthetist nurse upon arrival of the patient to assess the patient's comfort (NRSc) and satisfaction on a simple numeric scale, and calculate a negative communication score ('NC'). In the second phase, the awareness of the nursing staff on therapeutic communication was emphasized on listening, empathy and the use of positive wording, using educational videos. In the third phase, after the staff awareness-raising period, the questionnaire was repeated. Quantitative variables (primary outcome criterion made of the number of patients with a NC score ≥ 5, NRSc, satisfaction), and qualitative variables before and after the awareness raising phase to therapeutic communications were compared. RESULTS A total of 234 patients were included (109 before and 125 after). Following the staff awareness session to therapeutic communication, the NC score ≥ 5 decreased significantly from 20% to 6% as well as the median NRSc [P25-P75] before (8 [8-9] vs 8 [7-8]) and after (8 [8-9] vs 8 [7-8]) anesthesia. The proportion of less anxious patients before the initiation of anesthesia was significantly higher after the therapeutic communication (32% vs 17%). Satisfaction significantly increased after the awareness phase (8 [7-10] vs (9 [8-10]). CONCLUSION This preliminary study shows a mild improvement of the patients' comfort and satisfaction after therapeutic communication. A controlled randomized trial is needed to confirm those results.
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Abstract
BACKGROUND It is widely recognized that patients have increased anxiety before elective surgery, however, previous research investigating the effect of preassessment clinics (PACs) on anxiety levels has been limited specifically to patient information literature or multimedia use, rather than the consultation process itself. The aim was to investigate the effect attendance at PAC had on patients' anxiety levels, associated with their subsequent surgery and anesthetic. MATERIALS AND METHODS This survey consisted of a cross-sectional, questionnaire-based, quantitative study investigating patients' anxiety levels before and after attendance at the PAC. The questionnaire consisted of a series of statements concerning the surgery and anesthetic and rated using a Likert-type scale. All adult patients who attended an appointment at the PAC were eligible to participate in the study. Those unable to read and understand the questionnaire were excluded. RESULTS Overall 121 participants were included in the study. Participants felt less anxious about their subsequent surgery and anesthetic following consultation at the PAC (P < 0.001). This was true for both gender subgroups (P < 0.05) Concerns about intraoperative complications generated the most anxiety. Postoperatively, male participants were most anxious about pain and females about nausea and vomiting. Participants also reported high satisfaction rates for the service at the PAC. CONCLUSIONS This study contributes to a greater understanding of preoperative anxiety and has important implications for PACs. This clinical survey has been able to demonstrate that consultation at the PAC has a statistically significant positive effect on alleviating patients' anxieties in regards to their surgery and anesthetic.
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Affiliation(s)
- Stephen Davidson
- Adult Mental Health Services, Pluscarden Clinic, Dr. Gray's Hospital, Elgin, Moray IV30 1SN, United Kingdom
| | - Douglas McKendrick
- Department of Anesthetics, Dr. Gray's Hospital, Elgin, Moray IV30 1SN, United Kingdom
| | - Tara French
- Digital Health Institute, The Glasgow School of Art, Glasgow, G3 6RQ, United Kingdom
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Gürsoy A, Candaş B, Güner Ş, Yılmaz S. Preoperative Stress: An Operating Room Nurse Intervention Assessment. J Perianesth Nurs 2016; 31:495-503. [PMID: 27931701 DOI: 10.1016/j.jopan.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/08/2015] [Accepted: 08/08/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this research study was to determine the effect of preoperative visits by the operating room (OR) nurse on patient stress levels before undergoing surgery. DESIGN This research was a quasi-experimental study. METHODS The research sample included patients (N = 179) who were hospitalized for surgery during 6 months in the general surgery department of a public hospital in the Eastern Black Sea Region. The OR nurse, part of the medical staff for surgery, visited patients in the experimental group 1 day before surgery. The OR nurse collected information that was consistent with the requirements of the patients. Patients in the control group were provided with preoperative care that was consistent with hospital procedure. Research data were collected using question forms, patient satisfaction scores, and Burford Distress Thermometer scale. Statistical evaluations included t tests and receiver operating characteristic analysis for independent groups. FINDING Most patients stated that they felt stressed because of the impending surgery. Patients made the following most common statements of the factors that caused stress; fear of unknown, anesthesia phobia, and fear of OR environment and complications that may occur during surgery. Patients in both groups experienced a significant decrease in postoperative stress levels. The perceived distress in the experimental group was significantly lower than the control group during the postoperative period. Patients in the experimental group reported that the OR nurse's visit effectively minimized their stress levels. CONCLUSIONS OR nurse visits to patients before surgery contributed to decreased preoperative stress levels.
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Beydon L, Rouxel A, Camut N, Schinkel N, Malinovsky JM, Aveline C, Marret E, Bildea A, Dupoiron D, Liu N, Daniel V, Darsonval A, Chrétien JM, Rault L, Bruna J, Alberti C. Sedative premedication before surgery – A multicentre randomized study versus placebo. Anaesth Crit Care Pain Med 2015; 34:165-71. [DOI: 10.1016/j.accpm.2015.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
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20
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Assessing preoperative anxiety using a questionnaire and clinical rating: a prospective observational study. Eur J Anaesthesiol 2014; 30:758-63. [PMID: 23787971 DOI: 10.1097/eja.0b013e3283631751] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preoperative anxiety and need for information can be detected during preoperative consultation via structured and standardised screening by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. OBJECTIVE To identify the prevalence of preoperative anxiety and need for information, with regard to influencing factors such as age, sex, previous operation and grade of surgery, and to examine the level of agreement between patients' self-rating and physicians' ratings. DESIGN Prospective observational study. SETTING Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany. PATIENTS Two hundred seventeen patients scheduled for elective surgery. INTERVENTIONS The patients completed questionnaires prior to the interaction with the anaesthesiologist. Physicians were blinded to the patients' ratings and provided their subjective ratings about patients' anxiety and need for information immediately after seeing the patient. MAIN OUTCOME MEASURE Degree of anxiety and need for information, agreement of patients' self-reports and physician's rating. RESULTS 18.9% of patients were classified as 'anxiety cases' (31.8% in women and 10.6% in men). The grade of the intended surgery but no other investigated factor was related to patients' anxiety. Age (older patients) was correlated with information requirement (r = 0.21, P = 0.002). Analysis of agreement showed only weak correlations between patients' self-reports and physicians' ratings, demonstrated in low weighted Kappa-coefficients (0.12 to 0.32). CONCLUSION The APAIS is a useful instrument to assess the level of patients' preoperative anxiety and the need for information. Given the relationship between preoperative anxiety and postoperative outcome, it seems justified to incorporate this approach into the preoperative consultation. TRIAL REGISTRATION German Clinical Trials Register DRKS00003084.
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Mıngır T, Ervatan Z, Turgut N. Spinal Anaesthesia and Perioperative Anxiety. Turk J Anaesthesiol Reanim 2014; 42:190-5. [PMID: 27366419 DOI: 10.5152/tjar.2014.99705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/10/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Anxiety is a pathological condition with a feeling of fear accompanied by somatic symptoms due to hyperactivity of the autonomic nervous system. In this study, we aimed to compare perioperative anxiety status and the effects of age, gender, educational status, and The American Society of Anesthesiologists physical status classification (ASA) score on perioperative anxiety in patients undergoing elective surgery under spinal anaesthesia. METHODS After IRB approval and signed informed consent, 100 healthy patients undergoing elective surgery under spinal anaesthesia were enrolled. The demographic data of patients and ASA scores were recorded. After spinal anaesthesia, State Trait Anxiety Inventory (STAI) and anxiety levels were measured. RESULTS The mean anxiety score in patients undergoing surgery under spinal anaesthesia indicate the presence of an intermediate level of anxiety (44.58±19.06). A statistically significant positive correlation was found between anxiety scores and age of patients with increased age (p<0.01). Statistically significant differences were found between anxiety scores of patients according to gender, and women's anxiety scores were found to be significantly higher than in men (p<0.05). Anxiety scores did not differ significantly between education levels. A statistically significant difference was found between anxiety scores regarding ASA scores (p<0.05). Evaluation of patients revealed that the anxiety score of patients with ASA score 1 was significantly higher than the anxiety score of patients with ASA score 2. There was no significant difference between anxiety score of patients with ASA scores 2 and 3. CONCLUSION There is a mid-level anxiety, associated more with advanced age, female gender, and low ASA score, in patients undergoing elective surgery under spinal anaesthesia.
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Affiliation(s)
- Tarkan Mıngır
- Clinic of Anaesthesiology and Reanimation, The Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Zekeriya Ervatan
- Clinic of Anaesthesiology and Reanimation, The Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Namigar Turgut
- Clinic of Anaesthesiology and Reanimation, The Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
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The effect of the kampo medicine yokukansan on preoperative anxiety and sedation levels. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:965045. [PMID: 24799947 PMCID: PMC3988893 DOI: 10.1155/2014/965045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/03/2014] [Indexed: 12/13/2022]
Abstract
Background. Preoperative anxiety can lead to unfavorable physiological response such as tachycardia and hypertension. Prevention of preoperative anxiety improves surgical outcome and decreases inpatient stay. Yokukansan is one of prescriptions in Kampo, traditional Japanese herbal medicine, and is known to exert anxiolytic effects. The aim of the present study was to compare the effects of diazepam and Yokukansan on preoperative anxiety, salivary amylase activity, and sedation levels. Methods. Seventy American Society of Anesthesiologists physical status I or II patients presenting for hemicolectomy under general anesthesia combined with epidural anesthesia were enrolled. The Diazepam group received diazepam 5 mg orally and the Yokukansan group received Yokukansan 2.5 g orally. Results. Although levels of anxiety and salivary amylase activity were not different between the two groups, the modified Observer's Assessment of Alertness/Sedation Scale of the Yokukansan group was significantly higher compared to that of the Diazepam group. Conclusion. Yokukansan alleviated preoperative anxiety without undesirable sedation, when compared with diazepam.
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Abstract
The number of patients treated by elective day-case surgery in the UK is growing. Patient preoperative anxiety can be considerable, although the opportunity to help to reduce fears is minimal. Day surgery patients (n = 674) were surveyed and 82% were found to be anxious. General anaesthesia patients were more anxious than local anaesthesia patients and females more anxious than males. The results indicate that general anaesthesia patients may require more preoperative information, and gender differences associated with waiting may need to be given greater consideration.
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Affiliation(s)
- Mark Mitchell
- School of Nursing, Midwifery & Social Work, Room 166, Mary Seacole Building, University of Salford, Salford, M5 4WT.
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Carroll JK, Cullinan E, Clarke L, Davis NF. The role of anxiolytic premedication in reducing preoperative anxiety. ACTA ACUST UNITED AC 2012; 21:479-83. [PMID: 22585076 DOI: 10.12968/bjon.2012.21.8.479] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prevention of preoperative anxiety with anxiolytic premedication is associated with improved preoperative outcomes in surgical patients. The objective of the authors' study was to evaluate the percentage of surgical patients that are prescribed premedication for preoperative anxiety before their anticipated surgical procedure. A prospective study was carried out by theatre nursing staff in the theatre reception bay of a university teaching hospital. A questionnaire was designed to record the number of patients that described symptoms consistent with preoperative anxiety. The number of patients that had been offered anxiolytic premedication for preoperative anxiety was also recorded. Consent was obtained from 115 consecutive surgical patients (male, n=52; female, n=63). Of these, 66% (n=76) reported anxiety before their surgical procedure (male: n=27, female: n=49). Premedication with a low-dose benzodiazepine was prescribed by an anaesthetist in 4% of cases (n=5). Patients that received premedication preoperatively reported effective relief of their anxiety symptoms This study demonstrates that preoperative patient anxiety is highly prevalent. The authors' findings suggest that premedication with anxiolytic pharmacological therapy may be an underused therapeutic resource for managing preoperative patient anxiety.
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Affiliation(s)
- Jennifer K Carroll
- Department of Perioperative Nursing, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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Abstract
AIM To investigate the possible influence of gender and anaesthesia type on anxiety prior to day surgery. BACKGROUND Elective surgery undertaken on a day, short stay or 'day of surgery' basis is growing and much emphasis also placed on 'enhanced recovery' for in-patient surgery. During such brief episodes preoperative apprehension can be considerable but the opportunity to help reduce anxiety is minimal and formal plans uncommon. METHOD As part of a larger study, a questionnaire was distributed to 1606 patients undergoing day surgery, with anaesthesia (2005-2007). Participants were requested to return the questionnaire by mail 24-48 hours following surgery, with 674 returned. Data were analysed using descriptive statistics and multivariate analysis of variance. RESULTS Of the total patients 82·4% experienced anxiety on the day of surgery with the wait, anaesthesia and possible pain being common anxiety-provoking aspects. The majority preferred to receive information between 1-4 weeks in advance and participants experiencing general anaesthesia required information at a statistically significantly earlier stage. General anaesthesia patients were statistically significantly more anxious than local anaesthesia patients and desired more information. Female patients were statistically significantly more anxious, anxiety commenced earlier and they preferred to wait with a relative/friend or talk with other patients. CONCLUSIONS Anxiety was experienced by the majority of participants but was more prevalent amongst general anaesthesia and female patients. For general anaesthesia patients, a comprehensive level of information may be required a number of weeks prior to surgery and gender differences associated with the preoperative wait may require greater consideration.
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Affiliation(s)
- Mark Mitchell
- Mark Mitchell MSc PhD RN Senior Lecturer College of Health and Social Care, University of Salford, Greater Manchester, UK.
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Adudu OP, Onyeka TC, Kolawole IK, Desalu I, Ekumankama O. Appropriate practice of anesthesia: A plea for better training. Saudi J Anaesth 2011; 5:170-2. [PMID: 21804798 PMCID: PMC3139310 DOI: 10.4103/1658-354x.82788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The role of the anesthesiologist is often unknown among patients. But, the situation where the anesthesiologist is uncertain of his/her function gives more cause for concern. Methods: A questionnaire survey on the appraisal of anesthetic practices was carried out over 5 months using the style of clinical practice. Results: One-third of the anesthesiologists who responded to the survey attached little importance to the work they did by not communicating the same to their patients while 45.2% did not discuss the intraoperative findings with the surgeons. Although 57 (59.4%) of the respondents usually visit their patients on the ward preoperatively, only 16 (21.6%) discussed the proposed anesthetic procedure with the patients. Thirty-nine (40.2%) respondents claimed that they do not wear ward coats to the ward at the preoperative visit. Less than 20% consistently conducted a postoperative visit. The majority of the respondents would treat all patients as important, irrespective of social status, while 74.5% of them considered obtaining informed consent for anesthesia from patients as significantly important. Conclusion: The current practice of anesthesia has been found wanting in several aspects. Knowledgeable discussion by anesthesiologists with surgeons as well as enlightenment of patients and their relatives about their work will improve the quality of anesthesia care remarkably. Changes in the anesthesia training curriculum to reflect these deficiencies would be helpful.
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Affiliation(s)
- O P Adudu
- Department of Anesthesia, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
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Abstract
AIM This paper is a report of a study carried out to uncover the most anxiety-provoking aspects of general anaesthesia and determine what interventions may help to alleviate such anxiety. BACKGROUND General anaesthesia has proved to be highly anxiety-provoking. With the rise in elective day surgery, this aspect of patients' experience has become a prominent issue. Indeed, with brief hospital stays, limited contact with healthcare professionals, restricted formal anxiety management and the acute psychological impact of day surgery, such anxiety may be increasing. METHOD As part of a larger study, a questionnaire was given on the day of surgery to 1250 adult patients undergoing surgery with general anaesthesia over a two year period from 2005-2007. The issue examined was anxiety in relation to the environment, hospital personnel and general anaesthesia. Participants were requested to return the questionnaire by mail 24-48 hours following surgery, and 460 completed questionnaires were returned. FINDINGS A total of 85% of respondents experienced some anxiety on the day of surgery. Immediate preoperative experiences and concerns about unconsciousness were highly anxiety-provoking. Using factor analysis Preoperative Anaesthetic Information, Anaesthetic Catastrophising, Final Support, Personal Support, Imminence of Surgery, Possible Adverse Events and Final Preoperative Experiences were identified as central features. Multiple regression demonstrated Preoperative Anaesthetic Information, Anaesthetic Catastrophising and Imminence of Surgery were statistically significantly associated with an overall increased level of anxiety. CONCLUSIONS Focusing on the timely, formal delivery of information about anaesthesia management, emphasizing the notion of 'controlled unconsciousness' and dispelling misconceptions associated with general anaesthesia may help to limit patient anxiety.
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Affiliation(s)
- Mark Mitchell
- Faculty of Health and Social Care, University of Salford, UK.
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Bibliography: current world literature. Curr Opin Anaesthesiol 2007; 20:157-63. [PMID: 17413401 DOI: 10.1097/aco.0b013e3280dd8cd1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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