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Akelma FK, Altınsoy S, Nalbant B, Özkan D, Ergil J. Comparison of classical and patient-preferred music on anxiety and recovery after ınguinal hernia repair: a prospective randomized controlled study. Perioper Med (Lond) 2024; 13:89. [PMID: 39143577 PMCID: PMC11325758 DOI: 10.1186/s13741-024-00434-3] [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: 01/28/2024] [Accepted: 07/03/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND We aimed to evaluate the effects of preoperative listening to patient-preferred music and classical music on postoperative anxiety and recovery. METHODS A prospective, randomized controlled, single-blind study included 255 patients who were scheduled for elective inguinal hernia operation under general anesthesia. Spielberger state State-Trait Anxiety Inventory form 1,2 (STAI-I, STAI-II), Quality of Recovery Score-40 (QoR-40) were applied in the preoperatively. In the preoperative period, the preferential music group (group P) patients listened to their favorite music, while patients in the classical music group (group C) listened to classical music, music was not played in the control group (group N). STAI-I, QoR-40 questionnaire, pain status, and patient satisfaction in the postoperative period were recorded by a blinded investigator. RESULTS A total of 217 patients participated in the study analysis. Postoperative STAI-1 score was lower in group P than in group N (p = 0.025) and was similar among other groups. The postoperative QoR-40 score was significantly higher in group P than in group N (p = 0.003), and it was similar between the other groups. While SBP, DBP and HR premusic and post-music changes were significant, there was no difference in other groups. There was no difference between the groups in the NRS score. The patient satisfaction score was significantly higher in group P. CONCLUSIONS Preoperative patient-preferred music application reduces postoperative anxiety and improves recovery quality compared to classical music. In addition, regulation of hemodynamic data and patient satisfaction increase in a preferential music application, but pain scores do not change. TRIAL REGISTRATION NCT04277559| https://www. CLINICALTRIALS gov/.
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Affiliation(s)
- Fatma Kavak Akelma
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
- Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Savaş Altınsoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences,, Ankara, Turkey
- Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkey
| | - Burak Nalbant
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Derya Özkan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences,, Ankara, Turkey
- Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkey
| | - Jülide Ergil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences,, Ankara, Turkey
- Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkey
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van Beek S, Nieboer D, Klimek M, Stolker RJ, Mijderwijk HJ. Development and external validation of a clinical prediction model for predicting quality of recovery up to 1 week after surgery. Sci Rep 2024; 14:387. [PMID: 38172591 PMCID: PMC10764891 DOI: 10.1038/s41598-023-50518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and externally validate a clinical prediction model that predicts quality of recovery up to one week after surgery. The modelling procedure consisted of two models of increasing complexity (basic and full model). To assess the internal validity of the developed model, bootstrapping (1000 times) was applied. At external validation, the model performance was evaluated according to measures for overall model performance (explained variance (R2)) and calibration (calibration plot and slope). The full model consisted of age, sex, previous surgery, BMI, ASA classification, duration of surgery, HADS and preoperative QoR-40 score. At model development, the R2 of the full model was 0.24. At external validation the R2 dropped as expected. The calibration analysis showed that the QoR-40 predictions provided by the developed prediction models are reliable. The presented models can be used as a starting point for future updating in prediction studies. When the predictive performance is improved it could be implemented clinically in the future.
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Affiliation(s)
- Stefan van Beek
- Department of Anaesthesiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Hendrik-Jan Mijderwijk
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Rhee J, Vazquez R, Ma H. Pro-Con Debate: Judicious Benzodiazepine Administration for Preoperative Anxiolysis in Older Patients. Anesth Analg 2023; 137:280-288. [PMID: 37450906 PMCID: PMC10358369 DOI: 10.1213/ane.0000000000006337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In this Pro-Con commentary article, we discuss the risks and benefits of administering preoperative benzodiazepines to older patients to decrease preoperative anxiety. The Pro side first focuses on the critical importance of treating preoperative anxiety and that benzodiazepines are the best tool to achieve that goal. The competing argument presented by the Con side is that myriad options exist to treat preoperative anxiety without simultaneously increasing the risk for devastating complications such as postoperative delirium. Both sides call for more high-quality investigations to determine the most effective strategies for decreasing preoperative anxiety in older adults while improving outcomes and reducing morbidity.
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Affiliation(s)
- James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Pillai AK, Guzzi J, Treggiari MM, Yanez ND, Hyman JB. Comparison of electronic versus phone-based administration of the Quality of Recovery-40 survey after ambulatory surgery. J Clin Anesth 2023; 86:111054. [PMID: 36641953 DOI: 10.1016/j.jclinane.2023.111054] [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: 07/25/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE Studies that track patient-centered outcomes are better suited to evaluate the relative benefits and harms of an intervention in ambulatory surgery as severe morbidity and mortality have become increasingly rare. This pilot study aimed to assess for differences in response rate and survey scores for phone-based and electronic administration of the Quality of Recovery-40 (QoR-40) survey in patients undergoing general anesthesia for ambulatory surgery. DESIGN A single-center prospective observational study. SETTING Yale New Haven Hospital (September 22-November 2, 2021). PATIENTS 100 consecutive patients undergoing ambulatory surgery under general anesthesia. INTERVENTIONS Patients were randomized to receive QoR-40 surveys via email or phone. MEASUREMENTS The QoR-40 survey is a 40-item questionnaire that provides a global score across five dimensions: patient support, comfort, emotions, physical independence, and pain. The primary outcome was the response rate following the administration of the QoR-40 survey on postoperative days 1, 2, and 7. The secondary outcome was the mean QoR-40 score during the study period. MAIN RESULTS A total of 109 patients consented to participate and 100 patients were randomized in this study. A total of 76%, 72%, and 68% of patients completed the survey on POD 1, 2, and 7, respectively. There were no differences in the response rate of patients who completed the survey between phone (78%) versus electronic (74%) administration (difference 4%, 95% confidence interval (CI): -13%, 21%, respectively) on POD 1, 2 (74% vs 70%, difference 4%, 95% CI -14%, 22%, respectively) or 7 (68% vs 68%, difference 0%, 95% CI -18%, 18%, respectively). The mean (standard deviation) QoR-40 score was 176.2 (18.1), 179.8 (19.4), 187.7 (13.1) on POD 1, 2, and 7, respectively. There were no significant differences in the mean QoR-40 scores between groups at any of the time points. CONCLUSION The response rate following the electronic administration of the QoR-40 survey did not differ from the phone-based administration during the postoperative period following ambulatory surgery. The use of an electronic version of the survey may allow for larger sample sizes with fewer resources utilized in future interventional studies.
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Affiliation(s)
| | - John Guzzi
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - Miriam M Treggiari
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - N David Yanez
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA
| | - Jaime B Hyman
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA.
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Kakar E, van Ruler O, van Straten B, Hoogteijling B, de Graaf EJR, Ista E, Lange JF, Jeekel J, Klimek M. Implementation of music in colorectal perioperative standard care-barriers and facilitators among patients and healthcare professionals. Colorectal Dis 2022; 24:868-875. [PMID: 35194930 PMCID: PMC9544166 DOI: 10.1111/codi.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/08/2023]
Abstract
AIM Perioperative anxiety and pain are still prevalent among patients undergoing surgery. Inflammatory bowel disease and colorectal cancer patients are known to have higher anxiety rates than the general population. Perioperatively applied music intervention has been proven to be effective in reducing perioperative anxiety and pain, resulting in a decrease of intra-operative sedative use, postoperative opioid requirement and neurohormonal stress response. IMPROVE evaluates the adherence to music intervention in colorectal perioperative standard care during systematic implementation. METHOD The Consolidated Framework for Implementation Research (CFIR) was used for implementation in three steps. This study addresses the first step in which barriers and facilitators for implementing perioperative music were identified by surveying patients who underwent colorectal surgery and healthcare professionals involved in perioperative care. Also, perioperative anxiety scores were assessed and data on perioperative pain was collected from the patients' medical records. RESULTS Fifty patients and 69 professionals (response rate 68.3%) were surveyed. For patients, all domains of the CFIR were facilitating implementation. The median reported preoperative and postoperative anxiety scores were 4.5 (1.0-7.0) and 3.0 (1.0-5.75) respectively. The median postoperative pain score on the first postoperative day was 2.8 (2.0-3.7). Also, for professionals most domains were facilitating, except for some factors related to work climate and culture among nurses. CONCLUSIONS In this study it was identified that facilitating factors for implementing music in standard perioperative care were more prominent in both patients and healthcare professionals and therefore successful implementation is probable. Also, this study provides a guideline for assessing facilitators and barriers in other settings.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care UnitErasmus MCUniversity Medical CentreRotterdamThe Netherlands
| | - Oddeke van Ruler
- Department of SurgeryIJsselland HospitalCapelle aan den IJsselThe Netherlands
| | | | - Bas Hoogteijling
- Department of AnesthesiologyIJsselland HospitalCapelle aan den IJsselThe Netherlands
| | | | - Erwin Ista
- Department of Internal MedicineSection Nursing ScienceUniversity Medical CentreErasmus MCRotterdamThe Netherlands
| | - Johan F. Lange
- Department of SurgeryUniversity Medical CentreErasmus MCRotterdamThe Netherlands
| | - Johannes Jeekel
- Department of SurgeryUniversity Medical CentreErasmus MCRotterdamThe Netherlands
| | - Markus Klimek
- Department of AnesthesiologyUniversity Medical CentreErasmus MCRotterdamThe Netherlands
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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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Updating Clinical Prediction Models: An Illustrative Case Study. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 134:109-113. [PMID: 34862534 DOI: 10.1007/978-3-030-85292-4_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The performance of clinical prediction models tends to deteriorate over time. Researchers often develop a new prediction if an existing model performs poorly at external validation. Model updating is an efficient technique and promising alternative to the de novo development of clinical prediction models. Model updating has been recommended by the TRIPOD guidelines. To illustrate several model updating techniques, a case study is provided for the development and updating of a clinical prediction model assessing postoperative anxiety in data coming from two double-blinded placebo-controlled randomized controlled trials with a very similar methodological framework. Note that the developed model and updated model are for didactic purposes only. This paper discusses some common considerations and caveats for researchers to be aware of when planning or applying updating of a prediction model.
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Joshi GP. General anesthetic techniques for enhanced recovery after surgery: Current controversies. Best Pract Res Clin Anaesthesiol 2021; 35:531-541. [PMID: 34801215 DOI: 10.1016/j.bpa.2020.08.009] [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: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
General anesthesia technique can influence not only immediate postoperative outcomes, but also long-term outcomes beyond hospital stay (e.g., readmission after discharge from hospital). There is lack of evidence regarding superiority of total intravenous anesthesia over inhalation anesthesia with regards to postoperative outcomes even in high-risk population including cancer patients. Optimal balanced general anesthetic technique for enhance recovery after elective surgery in adults includes avoidance of routine use preoperative midazolam, avoidance of deep anesthesia, use of opioid-sparing approach, and minimization of neuromuscular blocking agents and appropriate reversal of residual paralysis. Given that the residual effects of drugs used during anesthesia can increase postoperative morbidity and delay recovery, it is prudent to use a minimal number of drug combinations, and the drugs used are shorter-acting and administered at the lowest possible dose. It is imperative that the discerning anesthesiologist consider whether each drug used is really necessary for accomplishing perioperative goals.
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Affiliation(s)
- Girish P Joshi
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA.
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Auricular stimulation for preoperative anxiety - A systematic review and meta-analysis of randomized controlled clinical trials. J Clin Anesth 2021; 76:110581. [PMID: 34781116 DOI: 10.1016/j.jclinane.2021.110581] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE Previous randomized controlled trials (RCTs) suggest that auricular stimulation (AS) is safe and effective in treatment of preoperative anxiety; however, a systematic evaluation is lacking. The aim was to summarize the evidence on efficacy and safety of AS for preoperative anxiety, as well as for other outcomes. DESIGN We conducted a systematic review of RCTs including patients from all available populations. The search was done through MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and Scopus Database from inception to June 2020. Study selection and data extraction were performed in by 2 independent reviewers with ability to resolve disagreements by a third author. Meta-analyses as well as the risk of bias and evidence quality assessments were performed according to the Cochrane 6.2, 2021 handbook recommendations. INTERVENTIONS We compared AS with pharmacological and non-pharmacological interventions for different outcomes. MEASUREMENTS We assessed the repercussion of the evaluated interventions over anxiety scores and their safety, physiological parameters, perioperative medications requirement and intensity of postoperative pain. MAIN RESULTS We have included 15 studies with 1603 patients. AS has presented reduced anxiety scores as compared to the sham control (Standardized Mean Difference (SMD) -0.72, 95% confidence interval (CI) -1.09 to -0.36, p < 0.0001; 8 trials; 701 patients; heterogeneity: I2 80%; GRADE: moderate certainty) and to no intervention (SMD -1.01, 95% CI -1.58 to -0.45, p = 0.0004; 4 trials; 420 patients; heterogeneity: I2 84%; GRADE: very low certainty). There was no difference between AS and benzodiazepines (SMD -0.03; 95% CI: -0.34 to 0.28; p = 0.84; 3 trials; 158 patients; heterogeneity: I2 0%; GRADE: very low certainty). No trials reported serious adverse effects of AS. CONCLUSIONS AS may be useful in treatment of preoperative anxiety. Due to heterogenous certainty in effect estimates, further research is needed to clarify the actual efficacy of AS for preoperative anxiety.
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Kakar E, Ista E, Klimek M, Jeekel J. Implementation of music in the perioperative standard care of colorectal surgery: study protocol of the IMPROVE Study. BMJ Open 2021; 11:e051878. [PMID: 34711596 PMCID: PMC8557300 DOI: 10.1136/bmjopen-2021-051878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Perioperative music intervention has been proven effective in reducing anxiety, pain, neurohormonal stress response and medication requirement. Unfortunately, there is a gap between new effective interventions and their (interventions) integration in standard care protocols. The aim of this preimplementation and postimplementation study is to investigate the adherence to a music intervention in a tailored, multilevel, systematic implementation strategy and the initial impact of the implementation on postoperative pain in patients undergoing colorectal surgery. METHODS AND DESIGN A monocentre prospective preimplementation and postimplementation study was set up using The Consolidated Framework for Implementation Research to conduct a systematic implementation of music intervention in three phases. Primary outcomes are adherence to the music intervention and the initial impact of the music intervention implementation on postoperative pain scores on the first postoperative day. At least 100 patients will be included in the study. Secondary outcomes include adherence to the implementation strategy, penetration of music intervention in the standard care, assessment of the determinants for implementation, impact of the implemented music intervention on pain during the entire admission, anxiety, medication usage, complications, hospital and intensive care unit (ICU) length of stay. ETHICS AND DISSEMINATION The Medical Ethics Review Board of Erasmus MC University Medical Centre Rotterdam, The Netherlands, has approved this protocol. The study is being conducted in accordance with the Declaration of Helsinki. Results of this trial will be published in peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION Dutch Trial Register NL8071.
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Affiliation(s)
- Ellaha Kakar
- General Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Intensive Care Unit, Erasmus MC, Rotterdam, Netherlands
| | - Erwin Ista
- Intensive Care Unit, Erasmus MC, Rotterdam, Netherlands
- Pediatric surgery, Intensive Care Unit, Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - M Klimek
- Anesthesiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Johannes Jeekel
- General Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Neuroscience, Erasmus MC, Rotterdam, Netherlands
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Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open 2021; 11:e042510. [PMID: 33972331 PMCID: PMC8112429 DOI: 10.1136/bmjopen-2020-042510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients. METHODS The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported. RESULTS Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group. CONCLUSIONS Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed. PROSPERO REGISTRATION NUMBER CRD42020167783.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, The Netherlands
| | - Esmée Venema
- Maastricht University, Maastricht, The Netherlands
| | - Johannes Jeekel
- Department of Surgery and Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Kakar E, Billar RJ, van Rosmalen J, Klimek M, Takkenberg JJM, Jeekel J. Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis. Open Heart 2021; 8:openhrt-2020-001474. [PMID: 33495383 PMCID: PMC7839877 DOI: 10.1136/openhrt-2020-001474] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives Previous studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery. Methods Five electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated. Results Twenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01). Conclusions Offering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.
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Affiliation(s)
- Ellaha Kakar
- Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands .,Neuroscience, Erasmus MC, Rotterdam, South-Holland, The Netherlands
| | - Ryan J Billar
- Pediatric Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands
| | | | - Markus Klimek
- Anesthesiology, Erasmus MC, Rotterdam, South-Holland, Netherlands
| | - Johanna J M Takkenberg
- CardioThoracic Surgery, Erasmus University Medical Center, Rotterdam, South-Holland, Netherlands
| | - Johannes Jeekel
- Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands.,Neuroscience, Erasmus MC, Rotterdam, South-Holland, The Netherlands
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14
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Rousseaux F, Faymonville ME, Nyssen AS, Dardenne N, Ledoux D, Massion PB, Vanhaudenhuyse A. Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial. Trials 2020; 21:330. [PMID: 32293517 PMCID: PMC7157998 DOI: 10.1186/s13063-020-4222-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Different non-pharmacological techniques, including hypnosis and virtual reality (VR) are currently used as complementary tools in the treatment of anxiety, acute and chronic pain. A new technique called virtual reality hypnosis (VRH), which encompasses a combination of both tools, is regularly used although its benefits and underlying mechanisms remain unknown to date. With the goal to improve our understanding of VRH combination effects, it is necessary to conduct randomised and controlled research trials in order to understand their clinical interest and potential benefits. Methods Patients (n = 100) undergoing cardiac surgery at the Liège University Hospital will be randomly assigned to one of four conditions (control, hypnosis, VR or VRH). Each patient will receive two sessions of one of the techniques: one the day before the surgery and one the day after. Physiological assessments will be made on the monitor and patients will rate their levels of anxiety, fatigue, pain, absorption and dissociation. Discussion This study will help to expand knowledge on the application of virtual reality, hypnosis and VRH in the specific context of cardiac and intensive care procedures, and the influence of these non-pharmacological techniques on patient’s anxiety, fatigue, pain and phenomenological experience. Trial registration ClinicalTrials.gov: NCT03820700. Date registered on 29 January 2019. Study recruitment date: October 6, 2018. Study anticipated completion date: December 28, 2020.
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Affiliation(s)
- Floriane Rousseaux
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, ULiège (B32), Quartier Agora - Place des Orateurs, 2, 4000, Liège, Belgium. .,Algology Department, University Hospital of Liège, CHU Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000, Liège, Belgium. .,Sensation and Perception Research Group, GIGA Consciousness, University of Liège, GIGA (B34), Quartier Hôpital - Avenue de l'Hôpital, 11, 4000, Liège, Belgium.
| | - Marie-Elisabeth Faymonville
- Algology Department, University Hospital of Liège, CHU Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000, Liège, Belgium.,Sensation and Perception Research Group, GIGA Consciousness, University of Liège, GIGA (B34), Quartier Hôpital - Avenue de l'Hôpital, 11, 4000, Liège, Belgium
| | - Anne-Sophie Nyssen
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, ULiège (B32), Quartier Agora - Place des Orateurs, 2, 4000, Liège, Belgium.,Sensation and Perception Research Group, GIGA Consciousness, University of Liège, GIGA (B34), Quartier Hôpital - Avenue de l'Hôpital, 11, 4000, Liège, Belgium
| | - Nadia Dardenne
- Public Health Department, Biostatistics, University of Liège, CHU (B35), Quartier Hôpital - Avenue de l'Hopital, 11, 4000, Liège, Belgium
| | - Didier Ledoux
- Intensive Care Units, University Hospital of Liège, CHU (B35), Quartier Hôpital - Avenue de l'Hopital, 11, 4000, Liège, Belgium.,Anesthesia & Intensive care, GIGA Consciousness, University of Liège, GIGA (B34), Quartier Hôpital - Avenue de l'Hôpital, 11, 4000, Liège, Belgium
| | - Paul B Massion
- Intensive Care Units, University Hospital of Liège, CHU (B35), Quartier Hôpital - Avenue de l'Hopital, 11, 4000, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Algology Department, University Hospital of Liège, CHU Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000, Liège, Belgium. .,Sensation and Perception Research Group, GIGA Consciousness, University of Liège, GIGA (B34), Quartier Hôpital - Avenue de l'Hôpital, 11, 4000, Liège, Belgium.
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15
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Che YJ, Gao YL, Jing J, Kuang Y, Zhang M. Effects of an Informational Video About Anesthesia on Pre- and Post-Elective Cesarean Section Anxiety and Recovery: A Randomized Controlled Trial. Med Sci Monit 2020; 26:e920428. [PMID: 32265432 PMCID: PMC7165245 DOI: 10.12659/msm.920428] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Showing an informational anesthesia video can reduce the preoperative anxiety of parturients undergoing elective cesarean section (CS). However, the best method for presenting such videos remains unclear, and whether such videos can reduce the anxiety level of women during the entire perioperative period for CS (including preoperative and postoperative) has not been studied yet. Material/Methods This study was a single-center prospective randomized trial. We randomly divided 121 pregnant women who were scheduled to undergo elective cesarean section (CS) into 2 groups: one group was shown an informational video (video group) and another group was not (control group). Spielberger’s state-trait anxiety inventory was used to evaluate the perioperative anxiety level of parturient women at 3 time points: 1 day before CS, after video education, and 2 days after CS. Salivary cortisol level was evaluated to assess the patients’ anxiety level at these 3 time points. Finally, the maternal satisfaction scale for CS and an obstetric quality-of-recovery score (OBsQoR-11) were used to evaluate the satisfaction and recovery of the parturient women 2 days after CS. Results Watching a video about anesthesia significantly reduced the anxiety level of the parturient women during the perioperative period (1 day before CS: p=1.00, p=0.96; after video education: p<0.01, p=0.004; 2 days after CS: p=0.01, p=0.01). The postoperative satisfaction scores were significantly improved in the video group (p=0.007). OBsQoR-11 scores in the video group and control group were not significantly different (p=0.48). Maternal anxiety level was moderately positively correlated with cortisol hormone level. Conclusions Showing an informational video about anesthesia (video+education) can significantly reduce perioperative anxiety and improve satisfaction after CS. Although it did not improve the postoperative recovery, it was still significant for anesthesia.
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Affiliation(s)
- Ying-Jie Che
- Department of Anesthesiology, Third Affiliated Hospital, School of Medicine, Shihezi University (Shihezi People's Hospital), Shihezi, Xinjiang, China (mainland)
| | - Yuan-Li Gao
- Department of Anesthesiology, Anhui Maanshan People's Hospital, Maanshan, Anhui, China (mainland)
| | - Jun Jing
- Department of Anesthesiology, Anhui Maanshan People's Hospital, Maanshan, Anhui, China (mainland)
| | - Yong Kuang
- Department of Anesthesiology, Anhui Maanshan People's Hospital, Maanshan, Anhui, China (mainland)
| | - Meng Zhang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China (mainland)
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16
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Takmaz O, Bastu E, Ozbasli E, Gundogan S, Karabuk E, Kocyigit M, Dede S, Naki M, Kose F, Gungor M. Perioperative Duloxetine for Pain Management After Laparoscopic Hysterectomy: A Randomized Placebo-Controlled Trial. J Minim Invasive Gynecol 2020; 27:665-672. [DOI: 10.1016/j.jmig.2019.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
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17
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van Beek S, Kroon J, Rijs K, Mijderwijk HJ, Klimek M, Stolker RJ. The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial. Can J Anaesth 2019; 67:32-41. [PMID: 31576513 DOI: 10.1007/s12630-019-01494-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/21/2019] [Accepted: 07/27/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Despite the uncertain effects of anxiolytic premedication with benzodiazepines on the quality of postoperative recovery, perioperative benzodiazepine administration is still a common practice in many hospitals. We evaluated the effect of premedication with midazolam on the quality of recovery in hospitalized patients undergoing a laparotomy. METHODS We conducted a single-centre randomized placebo-controlled, double-blinded clinical trial from July 2014 to September 2015. We included 192 patients aged > 18 yr scheduled for elective laparotomy with a planned postoperative stay of ≥ three days. Participants were randomized into two groups to receive either midazolam 3 mg or sodium chloride 0.9% intravenously as premedication prior to surgery. Patients were followed up for up to one week after surgery. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day (POD) 3. The secondary outcomes included the QoR-40 score on POD 7, and the State-Trait Anxiety Inventory, State-Trait Anger Scale, Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale scores. RESULTS The mean (standard deviation) postoperative QoR-40 scores on POD 3 were not significantly different in the midazolam group compared with controls [166.4 (17.0) vs 163.9 (19.8), respectively; mean difference, 2.3; 95% confidence interval, - 2.9 to 8.4; P = 0.35]. There were no between-group differences in any of the secondary outcomes. CONCLUSIONS Administration of midazolam as premedication for laparotomy patients did not improve the quality of recovery up to one week after surgery. General prescription of midazolam as premedication can be questioned and might only suit some patients. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01993459); registered 29 October, 2013.
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Affiliation(s)
- Stefan van Beek
- Department of Anesthesiology, Erasmus University Medical Centre, PO 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jeroen Kroon
- Department of Anesthesiology, Erasmus University Medical Centre, PO 2040, 3000 CA, Rotterdam, The Netherlands
| | - Koen Rijs
- Department of Anesthesiology, Erasmus University Medical Centre, PO 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hendrik-Jan Mijderwijk
- Department of Anesthesiology, Erasmus University Medical Centre, PO 2040, 3000 CA, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Centre, PO 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robert J Stolker
- Department of Anesthesiology, Erasmus University Medical Centre, PO 2040, 3000 CA, Rotterdam, The Netherlands
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Gebhardt V, Kiefer K, Weiss C, Schmittner MD. Influence of anxiolytic premedication on vasovagal reactions and home readiness following outpatient intrathecal anaesthesia-A retrospective analysis. Acta Anaesthesiol Scand 2019; 63:468-474. [PMID: 30511415 DOI: 10.1111/aas.13297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vasovagal reactions during application of intrathecal anaesthesia (IA) are associated with high anxiety levels. A high percentage of patients undergoing outpatient surgery suffer from anxiety. Anxiolytic premedication in day-surgery is suspected to delay recovery and discharge and is, therefore, not routinely used. The aim of this retrospective analysis was to detect the influence of anxiolytic premedication on the incidence of vasovagal reactions and time until discharge home. METHODS Anaesthesia records of all patients undergoing outpatient surgery under low-dose IA from January 2008 to June 2017 were analysed. Incidences of vasovagal reactions with a decrease in blood pressure and/or heart rate and need for cardiovascular activating medications were documented. Patients were categorised as having received an anxiolytic premedication or not. The time from intrathecal injection of the local anaesthetic until readiness for discharge was recorded. RESULTS The records of 2747 patients were analysed. One thousand two hundred and ninety-one of them received an anxiolytic premedication of 1-2 mg midazolam intravenously. Three hundred and fourteen patients had vasovagal incidents during application of IA (no premedication n = 217 [15.0%], premedication n = 97 [7.5%], P < 0.0001). Premedication did not prolong time to achieve readiness for discharge (mepivacaine: P = 0.5886, chloroprocaine: P = 0.1555). However, in the prilocaine group, premedication led to a significantly earlier achievement of readiness for discharge (P = 0.0002). CONCLUSION Anxiolytic premedication significantly reduces the incidence of vasovagal reactions during the application of IA and does not affect time until readiness for discharge.
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Affiliation(s)
- Volker Gebhardt
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim; Ruprecht-Karls-University Heidelberg; Mannheim Germany
| | - Kevin Kiefer
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim; Ruprecht-Karls-University Heidelberg; Mannheim Germany
| | - Christel Weiss
- Department of Medical Statistics, University Medical Centre Mannheim, Heinrich-Lanz-Zentrum; Ruprecht-Karls-University Heidelberg; Mannheim Germany
- Medical Faculty; Mannheim of Heidelberg University, Ruprecht-Karls-University Heidelberg; Mannheim Germany
| | - Marc D. Schmittner
- Medical Faculty; Mannheim of Heidelberg University, Ruprecht-Karls-University Heidelberg; Mannheim Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine; BG Klinikum Unfallkrankenhaus Berlin gGmbH; Berlin Germany
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Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, Cattano D. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiol 2018; 84:1307-1317. [DOI: 10.23736/s0375-9393.18.12520-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Mijderwijk HJ, Stolker RJ, Duivenvoorden HJ, Klimek M, Steyerberg EW. Prognostic model for psychological outcomes in ambulatory surgery patients: A prospective study using a structural equation modeling framework. PLoS One 2018; 13:e0193441. [PMID: 29641522 PMCID: PMC5894974 DOI: 10.1371/journal.pone.0193441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/12/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Surgical procedures are increasingly carried out in a day-case setting. Along with this increase, psychological outcomes have become prominent. The objective was to evaluate prospectively the prognostic effects of sociodemographic, medical, and psychological variables assessed before day-case surgery on psychological outcomes after surgery. METHODS The study was carried out between October 2010 and September 2011. We analyzed 398 mixed patients, from a randomized controlled trial, undergoing day-case surgery at a university medical center. Structural equation modeling was used to jointly study presurgical prognostic variables relating to sociodemographics (age, sex, nationality, marital status, having children, religion, educational level, employment), medical status (BMI, heart rate), and psychological status associated with anxiety (State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS-A)), fatigue (Multidimensional Fatigue Inventory (MFI)), aggression (State-Trait Anger Scale (STAS)), depressive moods (HADS-D), self-esteem, and self-efficacy. We studied psychological outcomes on day 7 after surgery, including anxiety, fatigue, depressive moods, and aggression regulation. RESULTS The final prognostic model comprised the following variables: anxiety (STAI, HADS-A), fatigue (MFI), depression (HADS-D), aggression (STAS), self-efficacy, sex, and having children. The corresponding psychological variables as assessed at baseline were prominent (i.e. standardized regression coefficients ≥ 0.20), with STAI-Trait score being the strongest predictor overall. STAI-State (adjusted R2 = 0.44), STAI-Trait (0.66), HADS-A (0.45) and STAS-Trait (0.54) were best predicted. CONCLUSION We provide a prognostic model that adequately predicts multiple postoperative outcomes in day-case surgery. Consequently, this enables timely identification of vulnerable patients who may require additional medical or psychological preventive treatment or-in a worst-case scenario-could be unselected for day-case surgery.
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Affiliation(s)
- Hendrik-Jan Mijderwijk
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hugo J. Duivenvoorden
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kim MH, Kim MS, Lee JH, Seo JH, Lee JR. Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery. Medicine (Baltimore) 2017; 96:e6107. [PMID: 28207530 PMCID: PMC5319519 DOI: 10.1097/md.0000000000006107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Preoperative anxiety is known to be related with the postoperative outcomes, although it remains unclear whether pharmacologic anxiolysis preoperatively leads to better postanesthesia recovery. Hence, the purpose of this study was to assess whether midazolam premedication would result in improved Quality of Recovery-40 survey scores, as a postoperative recovery parameter, in female patients undergoing mastectomy. METHODS This randomized double-blind study was performed at Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. Eighty-two females undergoing breast cancer surgery with propofol-remifentanil anesthesia were enrolled and randomized to receive midazolam 0.02 mg kg (group M) or saline (group C). Anesthesia was conducted with total intravenous anesthesia using propofol and remifentanil. On postoperative day 1, the Quality of Recovery-40 survey scores were surveyed. RESULTS The global Quality of Recovery-40 survey scores on postoperative day 1 did not significantly differ between groups M and C (183 vs 181, P = 0.568). However, the induction time was significantly shorter in group M (3.2 vs 4.5 min, P < 0.001), as was the total intraoperative propofol consumption (705 vs 1004 mg; P = 0.022). CONCLUSION Midazolam premedication does not seem to improve the postoperative quality of recovery, though group M showed faster induction and less propofol consumption.
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Affiliation(s)
- Myoung Hwa Kim
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Min Soo Kim
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Jae Hi Seo
- Department of Anesthesiology and Pain Medicine
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
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Linet T. Interruption volontaire de grossesse instrumentale. ACTA ACUST UNITED AC 2016; 45:1515-1535. [DOI: 10.1016/j.jgyn.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
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Mijderwijk H, Klimek M, van Beek S, van Schaik RHN, Duivenvoorden HJ, Stolker RJ. Implication of UGT2B15 Genotype Polymorphism on Postoperative Anxiety Levels in Patients Receiving Lorazepam Premedication. Anesth Analg 2016; 123:1109-1115. [DOI: 10.1213/ane.0000000000001508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Mijderwijk H, Stolker RJ, Duivenvoorden HJ, Klimek M, Steyerberg EW. Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making. Can J Anaesth 2016; 63:1022-32. [PMID: 27282374 DOI: 10.1007/s12630-016-0673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/22/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters. METHODS We prospectively assessed 383 mixed ambulatory surgery patients for psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days after surgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. A prediction model was constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of the model, in addition to measures for overall model performance (Nagelkerke's R (2) ). RESULTS In this population, 137 (36%) patients were identified as being psychologically vulnerable after surgery for at least one of the psychological outcomes. The most parsimonious and optimal prediction model combined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression). Model performance was promising: R (2) = 30% and ORC = 0.76 after correction for optimism. CONCLUSION This study identified a substantial group of vulnerable patients in ambulatory surgery. The proposed clinical prediction model could allow healthcare professionals the opportunity to identify vulnerable patients in ambulatory surgery, although additional modification and validation are needed. (ClinicalTrials.gov number, NCT01441843).
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Affiliation(s)
- Herjan Mijderwijk
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hugo J Duivenvoorden
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Castro-Alves LJ, Oliveira de Medeiros ACP, Neves SP, Carneiro de Albuquerque CL, Modolo NS, De Azevedo VL, De Oliveira GS. Perioperative Duloxetine to Improve Postoperative Recovery After Abdominal Hysterectomy. Anesth Analg 2016; 122:98-104. [DOI: 10.1213/ane.0000000000000971] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Stessel B, Fiddelers AA, Joosten EA, Hoofwijk DMN, Gramke HF, Buhre WFFA. Prevalence and Predictors of Quality of Recovery at Home After Day Surgery. Medicine (Baltimore) 2015; 94:e1553. [PMID: 26426622 PMCID: PMC4616829 DOI: 10.1097/md.0000000000001553] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traditionally, major complications and unanticipated admission/readmission rates were used to assess outcome after day surgery. However, in view of the relative absence of major complications the quality of recovery (QOR) should be considered one of the principal endpoints after day surgery. In our study, the level of QOR is defined by a combination of the Global Surgical Recovery (GSR) Index and the Quality of Life (QOL). The aim of this study was to analyze prevalence and predictors of QOR after day surgery on the fourth postoperative day. Elective patients scheduled for day surgery from November 2008 to April 2010 were enrolled in a prospective cohort study. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. Primary outcome parameter is the QOR and is defined as good if the GSR index >80% as well as the postoperative QOL is unchanged or improved as compared with baseline. QOR is defined as poor if both the GSR index ≤ 80% and if the postoperative QOL is decreased as compared with baseline. QOR is defined as intermediate in all other cases. Three logistic regression analyses were performed to determine predictors for poor QOR after day surgery. A total of 1118 patients were included. A good QOR was noted in 17.3% of patients, an intermediate QOR in 34.8%, and a poor QOR in 47.8% 4 days after day surgery. The best predictor for poor QOR after day surgery was type of surgery. Other predictors were younger age, work status, and longer duration of surgery. A history of previous surgery, expected pain (by the patient) and high long-term surgical fear were significant predictors of poor QOR in only 1 of 3 prediction models. The QOR at home 4 days after day surgery was poor in the majority of patients and showed a significant procedure-specific variation. Patients at risk for poor QOR can be identified during the preoperative period based on type of surgery, age, work status, and the duration of the surgery.
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Affiliation(s)
- Björn Stessel
- From the Department of Anesthesiology, Jessa Hospital, Hasselt, Belgium (BS) and Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands (BS, AAF, EAJ, DMNH, H-FG, WFFAB)
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Anesthésie et analgésie pour la chirurgie oncologique du sein en ambulatoire. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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