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Esquerré T, Mure M, Minville V, Prevost A, Lauwers F, Ferré F. Bilateral ultrasound-guided maxillary and mandibular combined nerves block reduces morphine consumption after double-jaw orthognathic surgery: a randomized controlled trial. Reg Anesth Pain Med 2024:rapm-2024-105497. [PMID: 38697776 DOI: 10.1136/rapm-2024-105497] [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: 03/22/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Double-jaw surgeries are known to be painful and to require opioids. Maxillary (V2) and mandibular (V3) nerves block could provide adequate pain management with minimal opioid-related side effects. Our main objective was to evaluate the analgesic effect of bilateral ultrasound-guided V2 and V3 combined nerves block in patients undergoing double-jaw orthognathic surgery. METHODS In this single-blind, randomized control study, 50 patients were prospectively allocated to either bilateral ultrasound-guided V2 and V3 combined nerves block or intraoral infiltration of local anesthetic. Primary outcome was the cumulative oral morphine equivalent (OME) consumption assessed at postoperative day 1. Secondary outcomes were cumulative OME consumption and pain scores in recovery room and at postoperative day 2, intraoperative anesthetic consumption, and opioid-related side effects. Preoperative anxiety was investigated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). RESULTS Compared with infiltration, ultrasound-guided regional anesthesia reduced cumulative OME consumption on day 1 (45.7±37.6 mg vs 25.5±19.8 mg, respectively, mean difference of -20.1 (95% CI -37.4 to -2.9) mg, p=0.023) and day 2 (64.5±60 mg vs 35.8±30.2 mg, respectively, mean difference of -28.7 (95% CI -55.9 to -1.43) mg, p=0.040). Interestingly, worst pain score and cumulative OME consumptions on day 2 were positively correlated with the APAIS (Pearson's correlation coefficient of 0.42 (p=0.003) and 0.39 (p=0.006), respectively). CONCLUSION Bilateral ultrasound-guided V2 and V3 combined nerves block reduces postoperative opioid consumption by about 50% in patients undergoing double-jaw surgery. TRIAL REGISTRATION NUMBER NCT05351151.
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Affiliation(s)
- Thomas Esquerré
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, University Hospital Centre Toulouse, Toulouse, France
| | - Marion Mure
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, University Hospital Centre Toulouse, Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, University Hospital Centre Toulouse, Toulouse, France
| | - Alice Prevost
- Department of Plastic and Maxillofacial Surgery, University Hospital Centre Toulouse, Toulouse, France
| | - Frédéric Lauwers
- Department of Plastic and Maxillofacial Surgery, University Hospital Centre Toulouse, Toulouse, France
| | - Fabrice Ferré
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, University Hospital Centre Toulouse, Toulouse, France
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Sommer JL, Reynolds K, Hebbard P, Smith MSD, Mota N, Mutch WAC, Maples-Keller J, Roos L, El-Gabalawy R. Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study. JMIR Form Res 2024; 8:e46367. [PMID: 38231570 PMCID: PMC10831694 DOI: 10.2196/46367] [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: 02/08/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. OBJECTIVE This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. METHODS Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. RESULTS Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). CONCLUSIONS This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - W Alan C Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Leslie Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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Amraoui J, Bordenave L, Leclerc G, Salvignol G, Jarlier M, Fiess C, Philibert L, Fuzier R, Touraine C. Benefits of cardiac coherence combined with medical hypnosis on preoperative anxiety before cancer surgery: the COHEC II study trial protocol. BMJ Open 2023; 13:e072215. [PMID: 38086587 PMCID: PMC10729073 DOI: 10.1136/bmjopen-2023-072215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Preoperative anxiety is a frequent problem that can lead to complications both during anaesthesia and in the postoperative period, especially in oncology. Studies have shown that it can be managed using non-pharmacological approaches, but few works have evaluated psychoeducational programmes. The aim of the COHErence Cardiaque (COHEC) II Study is to evaluate the combination of medical hypnosis (MH) and cardiac coherence (CC) training to manage preoperative anxiety in patients with cancer. METHODS AND ANALYSIS COHEC II is an ongoing multicentre randomised clinical trial carried out in three French comprehensive cancer centres. In total, 296 patients who will undergo surgery for cancer will be recruited during 18 months and will be randomised in the control arm or the intervention arm. Patients in the intervention arm will follow a daily programme that combines MH and CC, starting 7 days before surgery. The control arm will receive the standard treatment to manage preoperative anxiety. The primary endpoint is the anxiety level on surgery day, measured using a Visual Analogue Scale. Secondary endpoints are patient adherence to the programme, satisfaction and postsurgery recovery quality. ETHICS AND DISSEMINATION The study protocol was approved by the French Ethics Committee (Comité de Protection des Personnes EST-II) on 24 November 2021 and will be carried out following the good practice guidelines and the Declaration of Helsinki. Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT05197972.
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Affiliation(s)
- Jibba Amraoui
- Department of Anaesthesia, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Gilles Leclerc
- Department of Anaesthesia, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Marta Jarlier
- Biometrics Unit, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Catherine Fiess
- Clinical Research and Innovation Department, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Laurent Philibert
- Department of Pharmacy, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Célia Touraine
- Biometrics Unit, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
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Varış O, Peker G. Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty. Sci Rep 2023; 13:20787. [PMID: 38012209 PMCID: PMC10682380 DOI: 10.1038/s41598-023-48291-2] [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: 03/17/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023] Open
Abstract
This study examined the effect of preoperative anxiety level on postoperative pain, opioid and nonopioid analgesic use requirements and joint function in patients undergoing primary knee arthroplasty for knee osteoarthritis. 106 patients were included in the study. Situational anxiety score (STAI-S) and trait anxiety score (STAI-T) were divided into two groups as below and above 40. Visual analog scale (VAS), Lysholm scores, and anxiety levels were assessed preoperatively, at the third and sixth month postoperatively to investigate their effects on the use of opioid and non-opioid drugs during the postoperative period. For those with low situational and trait anxiety scores, the median duration of hospital stays was significantly shorter compared to those with high anxiety scores. In groups where anxiety levels were initially low, the median anxiety levels at the postoperative 3rd month were also observed to be lower compared to the other group. In the same groups, the median VAS values and the median Lysholm knee scores were significantly better both preoperatively and at the postoperative 3rd month compared to the other group. There was no significant difference in Lysholm score between the two groups at the 6th postoperative month. Similarly, in the preoperative period, groups with low anxiety levels had a significantly lower median usage of both opioids and non-opioids compared to the other group. These findings suggest that high preoperative anxiety may have a negative effect on functional outcomes in the early postoperative period, but this effect disappeared at 6 months. It can be concluded that reducing preoperative anxiety may have a positive effect on early outcomes. We believe that preoperative psychological evaluation and treatment can increase the satisfaction level in patients undergoing total knee arthroplasty (TKA).
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Affiliation(s)
- Onur Varış
- University of Healt Sciences, Trabzon Faculty of Medicine, Kanuni Training and Research Hospital, Trabzon, Turkey.
| | - Gökhan Peker
- University of Healt Sciences, Trabzon Faculty of Medicine, Kanuni Training and Research Hospital, Trabzon, Turkey
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Tan M, Li H, Wang X. Analysis of patients' privacy and associated factors in the perioperative period. Front Med (Lausanne) 2023; 10:1242149. [PMID: 37901407 PMCID: PMC10600398 DOI: 10.3389/fmed.2023.1242149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background Healthcare professionals recognize how to protect patient privacy in order to effectively reduce the occurrence of conflict between the two parties. Therefore, understanding the protection of patient privacy during the perioperative period and the relevant factors affecting privacy is essential to improving healthcare delivery. Methods This was a cross-sectional survey of a convenience sample of 400 perioperative patients. General demographic information, the perioperative privacy scale (PPS), and the Amsterdam preoperative anxiety and information scale (APAIS) were used for the survey. And factors affecting patient privacy were investigated by ANOVA or t-test analysis, Pearson correlation analysis, and linear regression models. Results This study found that perioperative patient privacy satisfaction scores were (53.51 ± 12.54). The results of the univariate analysis showed that factors affecting privacy satisfaction included gender, age, and the number of surgeries (p < 0.05). Preoperative anxiety and Information Needs Scale was negatively associated with the perioperative patient privacy satisfaction (r = -0.807, p < 0.01). Further analysis was performed using linear regression models to finally obtain five factors affecting perioperative patient privacy: gender, age, anesthesia modality, the number of surgeries, and the Amsterdam preoperative anxiety and information. Conclusion Healthcare professionals working in healthcare facilities need to be aware of the sensitivity of different populations to privacy when protecting patient privacy. Patients' preoperative anxiety and information need status affect privacy satisfaction. This will mean that healthcare professionals will be able to identify key privacy concerns early and take appropriate action.
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Affiliation(s)
- Mingyang Tan
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- Institute of Medical Education, Jinzhou Medical University, Jinzhou, China
| | - Xiaofei Wang
- Institute of Medical Education, Jinzhou Medical University, Jinzhou, China
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Chiu PL, Li H, Yap KYL, Lam KMC, Yip PLR, Wong CL. Virtual Reality-Based Intervention to Reduce Preoperative Anxiety in Adults Undergoing Elective Surgery: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2340588. [PMID: 37906193 PMCID: PMC10618840 DOI: 10.1001/jamanetworkopen.2023.40588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
IMPORTANCE Preoperative anxiety is common among adult patients undergoing elective surgery and is associated with negative outcomes. Virtual reality (VR)-based interventions have been considered simpler, safer, and more effective for reducing anxiety in patients undergoing surgery than conventional care. OBJECTIVE To examine the effectiveness of a VR-based intervention with preoperative education in reducing preoperative anxiety among adult patients undergoing elective surgery. DESIGN, SETTING, AND PARTICIPANTS An assessor-blinded prospective randomized clinical trial was conducted to recruit adult patients aged 18 years or older who were scheduled for their first elective surgery procedure under general anesthesia within the next 2 to 4 weeks at a preanesthesia assessment clinic in Hong Kong from July to December 2022. INTERVENTIONS Participants were randomly assigned to either an intervention group (an 8-minute immersive 360° VR video tour in the operating theater via a head-mounted display console) or a control group (standard care). MAIN OUTCOMES AND MEASURES The primary outcome of preoperative anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (range, 6-30; higher scores indicate greater anxiety), and the secondary outcomes (ie, stress, preparedness, and pain) were assessed by Visual Analog Scale at 3 time points: baseline at beginning of clinical session (T0), at the end of the clinical session immediately after the intervention (T1), and before the surgery (T2). Pain, satisfaction levels, and postoperative length of stay were evaluated after the surgery (T3). Simulation sickness was assessed after the intervention by use of the Simulation Sickness Questionnaire. A generalized estimating equations model was applied to compare changes in outcomes over time. RESULTS A total of 74 participants (mean [SD] age, 46.34 [14.52] years; 38 men [51.4%] and 36 women [48.6%]) were recruited and randomized to the control group (37 participants) and intervention group (37 participants). Compared with the control group, the VR-based intervention group showed significantly decreased preoperative anxiety at T1 (β, -5.46; 95% CI, -7.60 to -3.32; P < .001) and T2 (β, -5.57; 95% CI, -7.73 to -3.41; P < .001), lower stress at T1 (β, -10.68; 95% CI, -16.00 to -5.36; P < .001) and T2 (β, -5.16; 95% CI, -9.87 to -0.45; P = .03), and higher preparedness at T1 (β, 6.60; 95% CI, 0.97 to 12.19; P = .02). Satisfaction levels were significantly increased in the intervention group vs the control group (mean [SD] score, 81.35 [9.24] vs 65.28 [8.16]; difference, 16.07; 95% CI, 12.00 to 20.15; P < .001). No significant differences in pain and postoperative length of stay were found. CONCLUSIONS AND RELEVANCE The findings of this study suggest that a VR-based intervention is a feasible and effective way to reduce preoperative anxiety in adult patients undergoing elective surgery. Given the promising results of this study, further study in the form of large-scale, multicenter, randomized clinical trials with broader implementation is warranted. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2100051690.
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Affiliation(s)
- Pak Lung Chiu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kevin Yi-Lwern Yap
- Department of Pharmacy, Singapore General Hospital, Singapore
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ka-man Carmen Lam
- Department of Anaesthesia and Operating Theatre Services, Hospital Authority New Territories West Cluster, Hong Kong SAR, China
| | - Pui-ling Renee Yip
- Department of Anaesthesia and Operating Theatre Services, Hospital Authority New Territories West Cluster, Hong Kong SAR, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Bello C, Nuebling M, Koster KL, Heidegger T. Patient-reported perioperative anaesthesia-related anxiety is associated with impaired patient satisfaction: a secondary analysis from a prospective observational study in Switzerland. Sci Rep 2023; 13:16301. [PMID: 37770524 PMCID: PMC10539284 DOI: 10.1038/s41598-023-43447-6] [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: 06/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Perioperative anxiety is common. The relationship between anxiety and patient satisfaction with anaesthesia is still under debate. We assessed the prevalence and different causes of anaesthesia-related fears leading to perioperative anxiety and its association with patient satisfaction. A multiple-time validated, psychometrically developed questionnaire assessing the presence of anxiety, causes of fear, and different dimensions of patient satisfaction was sent to patients after discharge. The clinical data were obtained from a previous study. The sample size was calculated to recruit a minimum of 300 completed questionnaires. Statistical analyses included multivariate logistic regression models. Complete data were available for 474 of the 600 patients recruited for the study (response rate: 79%). A total of 141 patients (30%) reported anxiety regarding anaesthesia before hospital admission. The prevalence of anxiety was significantly associated with patient age (< 54 years: n = 196, prevalence = 37%; > 54 years: n = 263, prevalence = 24%; p = 0.002), female sex (female: n = 242, prevalence 39%; male: n = 223, prevalence 20%; p < 0.001), and surgical speciality (gynaecology (n = 61, prevalence = 49%), otolaryngology (n = 56, prevalence = 46%); p < 0.001). Fear of not awakening from anaesthesia (n = 44, prevalence = 32%, SD 45.8) and developing postoperative nausea or vomiting (n = 42, prevalence = 30%, SD 46.0) were the most reported anaesthesia-related causes of fear. Anxiety was associated with impaired overall patient satisfaction (mean dissatisfaction score 15%, versus 23%, SD 16.3 in the anxious group, SD 16.3, p < 0.001), especially regarding the dimensions "information and involvement in decision-making" (14% of deficits stated in the non-anxious group compared to 23% in the anxious group, p < 0.001), "respect and trust" (2% vs 6.26%, p < 0.001) and "continuity of care" (50% vs 57%, p < 0.015). Patient-reported anaesthesia-related anxiety is common and may affect important outcome parameters such as patient satisfaction. Abstract presented in e-poster format at Euroanaesthesia 2023, June 3-5, Glasgow.
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Affiliation(s)
- Corina Bello
- Department of Anaesthesiology Spital Grabs, Spitalregion Rheintal Werdenberg Sarganserland, Grabs, Switzerland.
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
| | | | - Kira-Lee Koster
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Thomas Heidegger
- Department of Anaesthesiology Spital Grabs, Spitalregion Rheintal Werdenberg Sarganserland, Grabs, Switzerland
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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Hu JH, Xu N, Bian Z, Shi HJ, Ji FH, Peng K. Protocol for development and validation of a prediction model for post-induction hypotension in elderly patients undergoing non-cardiac surgery: a prospective cohort study. BMJ Open 2023; 13:e074181. [PMID: 37734882 PMCID: PMC10514608 DOI: 10.1136/bmjopen-2023-074181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Post-induction hypotension (PIH) is a common event in elderly surgical patients and is associated with increased postoperative morbidity and mortality. This study aims to develop and validate a PIH prediction model for elderly patients undergoing elective non-cardiac surgery to identify potential PIH in advance and help to take preventive measures. METHODS AND ANALYSIS A total of 938 elderly surgical patients (n=657 for development and internal validation, n=281 for temporal validation) will be continuously recruited at The First Affiliated Hospital of Soochow University in Suzhou, China. The main outcome is PIH during the first 15 min after anaesthesia induction or before skin incision (whichever occurs first). We select candidate predictors based on published literature, professional knowledge and clinical expertise. For model development, we will use the least absolute shrinkage and selection operator regression analysis and multivariable logistic regression. For internal validation, we will apply the bootstrapping technique. After model development and internal validation, temporal validation will be conducted in patients recruited in another time period. We will use the discrimination, calibration and max-rescaled Brier score in the temporal validation cohort. Furthermore, the clinical utility of the prediction model will be assessed using the decision curve analysis, and the results will be presented in a nomogram and a web-based risk calculator. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Soochow University (Approval No. 2023-012). This PIH risk prediction model will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2200066201.
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Affiliation(s)
- Jing-Hui Hu
- Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Ning Xu
- Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Zhen Bian
- Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Hai-Jing Shi
- Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Fu-Hai Ji
- Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Ke Peng
- Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
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Singh K, Heralal H. The Effect of a Simple Perioperative Video on Maternal Anxiety and Satisfaction Before Regional Anesthesia in a Caribbean Setting: A Randomized Controlled Trial. Cureus 2023; 15:e36482. [PMID: 37090355 PMCID: PMC10118283 DOI: 10.7759/cureus.36482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Anxiety before regional anesthesia and surgery is common among women undergoing cesarean section. Although perioperative education has been shown to reduce this level of anxiety, the optimal form and timing of this intervention are not known. The goal of this study was to evaluate the efficacy of an educational anesthetic video on reducing anxiety and improving maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia. METHODS Eighty patients scheduled for cesarean section at a tertiary-level obstetric center were randomized to either an interventional group (viewed an educational video on the evening before surgery) or the control group (no educational video). Both groups received a standard preoperative assessment on the morning of surgery. Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale for anxiety (VAS-A). Maternal satisfaction was assessed using the Maternal Satisfaction Scale Score for Cesarean Section (MSSSCS). Anxiety was assessed at baseline (the evening before surgery) and immediately before surgery. Maternal satisfaction was assessed on the first postoperative day. Patients in the intervention group also had their state anxiety measured immediately after viewing the educational anesthetic video using the VAS-A. RESULTS Both groups were equally matched at baseline, and a statistically significant reduction in anxiety measured using VAS-A was seen in the intervention group vs. the control group (6 vs. 4.6, p = 0.018). State-trait anxiety measured using STAI, however, was not significantly lower in the intervention vs. control group (44 vs. 46, p = 0.99). VAS-A immediately after looking at the video was also not significantly different (5 vs. 4, p = 0.323) from the control group. Maternal satisfaction was also higher in the intervention group (113 vs. 104.5, p = 0.015). CONCLUSION The use of a simple educational anesthetic video may be associated with reduced anxiety and improved maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia.
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Affiliation(s)
- Keevan Singh
- Anesthesia and Intensive Care Unit, Department of Clinical and Surgical Sciences, University of the West Indies, San Fernando, TTO
| | - Hema Heralal
- Department of Anesthesia and Intensive Care, Port of Spain General Hospital, Port of Spain, TTO
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Horn N, Gärtner L, Rastan AJ, Andrási TB, Lenz J, Böning A, Salzmann-Djufri M, Puvogel U, Genovese M, Kus S, Rief W, Salzmann S. Preoperative optimization of cardiac valve patients' expectations: Study protocol of the randomized controlled ValvEx-trial. Front Cardiovasc Med 2023; 10:1105507. [PMID: 36937912 PMCID: PMC10018216 DOI: 10.3389/fcvm.2023.1105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Complete recovery after surgery depends on psychological factors such as preoperative information, expectations, and surgery-associated anxiety. Prior studies have shown that even a short preoperative psychological intervention aiming at optimized expectations (EXPECT) can improve postoperative outcomes in coronary artery bypass patients. However, this intervention may benefit only a small subgroup of heart surgery patients since implementing preoperative psychological interventions into the daily clinical routine is difficult due to the additional time and appointments. It is unclear whether the EXPECT intervention can be shortened and whether heart valve patients would also benefit from interventions that optimize patients' expectations. The multicenter ValvEx trial aims (i) to adapt an effective preoperative psychological intervention (EXPECT) to make it brief enough to be easily integrated into the preoperative routine of heart valve patients and (ii) to examine if the adapted preoperative psychological intervention improves the subjectively perceived illness-related disability (PDI) up to 3 months after surgery. Materials and analysis In two German university hospitals, N = 88 heart valve patients who undergo heart surgery are randomized into two groups [standard of care (SOC) vs. standard of care plus interventional expectation manipulation (SOC and EXPECT)] after baseline assessment. Patients in the EXPECT group additionally to standard of care participate in the preoperative psychological intervention (30-40 min), focusing on optimizing expectations and have two booster-telephone calls (4 and 8 weeks after the surgery, approx. 15 min). Both groups have assessments again on the evening before the surgery, 4 to 6 days, and 3 months after the surgery. Discussion The trial demonstrates excellent feasibility in the clinical routine and a high interest by the patients. Ethics and dissemination The Ethics Committees of the Department of Medicine of the Philipps University of Marburg and the Department of Medicine of the University of Giessen approved the study protocol. Study results will be published in peer-reviewed journals and presented at congresses. Clinical trial registration ClinicalTrials.gov, identifier NCT04502121.
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Affiliation(s)
- Nicole Horn
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
- *Correspondence: Nicole Horn,
| | - Laura Gärtner
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ardawan J. Rastan
- Department of Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Térezia B. Andrási
- Department of Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Juliane Lenz
- Department of Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, Justus Liebig University, Giessen, Germany
| | | | - Ulrike Puvogel
- Department of Cardiovascular Surgery, Justus Liebig University, Giessen, Germany
| | - Maria Genovese
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Sibel Kus
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
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Hou Y, Lu J, Xie J, Zhu R, Wu M, Wang K, Zhou J, Li J. Effects of electroacupuncture on perioperative anxiety and stress response in patients undergoing surgery for gastric or colorectal cancer: Study protocol for a randomized controlled trial. Front Psychiatry 2023; 14:1095650. [PMID: 36911113 PMCID: PMC9995716 DOI: 10.3389/fpsyt.2023.1095650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Perioperative anxiety is one of the main psychological stresses experienced by patients who undergo cancer surgery. The surgery itself inevitably causes a stress response characterized by activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. Both the perioperative anxiety and surgical stress response lead to increased levels of catecholamines and prostaglandins, which may be related to perioperative suppression of antimetastatic immunity and tumor-promoting alterations in the microenvironment. Hence, we designed this clinical trial to investigate the effect of electroacupuncture in reducing perioperative anxiety and surgical stress response. METHODS This is a randomized, single-center, parallel, and controlled clinical trial. Seventy-eight participants between the ages of 35 and 85 with gastric or colorectal cancer who plan to undergo tumorectomy will be randomly divided into an electroacupuncture group and a control group. The primary outcome will be the six-item short form of the State-Trait Anxiety Inventory score. The secondary outcomes will be the Amsterdam Preoperative Anxiety and Information Scale score; levels of plasma cortisol, adrenocorticotropic hormone, interleukin-6, and tumor necrosis factor-α; first exhaust time after surgery; postoperative quality of the recovery-15 score, numeric rating scale for pain score; and dosage of postoperative analgesics. DISCUSSION Cumulative studies revealed the efficacy of various types of acupuncture therapy with regard to reducing the anxiety and stress response caused by surgery. We expect that the results of this trial will provide high-quality clinical evidence for the choice of perioperative acupuncture for patients undergoing cancer surgery. CLINICAL TRIAL REGISTRATION https://www.chictr.org.cn, identifier ChiCTR200003 7127.
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Affiliation(s)
- Yuchao Hou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiajing Lu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Xie
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Runjia Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengdie Wu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia Zhou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Li
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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12
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Buonanno P, Marra A, Iacovazzo C, Vargas M, Nappi S, de Siena AU, Servillo G. Preoperative anxiety during COVID-19 pandemic: A single-center observational study and comparison with a historical cohort. Front Med (Lausanne) 2022; 9:1062381. [PMID: 36590950 PMCID: PMC9797972 DOI: 10.3389/fmed.2022.1062381] [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: 10/05/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background Preoperative anxiety is a common sensation experienced by patients undergoing surgical interventions. It can influence intraoperative and postoperative management through the activation of the neuroendocrine system, leading to tachycardia, hypertension, pulmonary complications, higher consumption of anesthetic drugs, and increased postoperative pain. Our aim was to investigate the level of preoperative anxiety during the COVID-19 pandemic; we also compared it to the preoperative anxiety of a historical cohort before the outbreak. Methods This is a single-center observational study. We enrolled 314 patients during the pandemic from May 2021 to November 2021, and our historical cohort consisted of 122 patients enrolled from July 2015 to May 2016 in the university hospital "Federico II" of Naples. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI) were used to evaluate preoperative anxiety. In particular, APAIS measures preoperative anxiety and the need for information, and STAI assesses state and trait anxiety through STAI-Y1 and STAI-Y2, respectively. We analyzed APAIS and STAI scores in our population stratified on the basis of age, gender, marital status, previous surgical experiences, and type of surgery, and we compared them to our historical cohort. Statistical analysis was performed through a t-test and ANOVA for parametric data, and the Mann-Whitney and Kruskal-Wallis tests for non-parametric data. Linear regression was used to investigate the correlation between demographic data and the scores of STAI and APAIS in both groups. Results Our results showed that state and preoperative anxiety remained stable, whereas trait anxiety increased in all the subgroups analyzed. Discussion Even if state anxiety is considered a variable characteristic of the emotional sphere and trait anxiety a stable element, our findings suggested that COVID-19 deeply influenced trait anxiety, thus altering the patients' psychological foundations.
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Muacevic A, Adler JR, Bangarwa N, Budhwar D, Kumar P, Arora V. A Randomized Controlled Trial to Assess the Efficacy of a Pre-operative Virtual Operation Theatre Tour on Anxiety and Patient Satisfaction in Adults Undergoing Elective Surgery. Cureus 2022; 14:e32337. [PMID: 36628012 PMCID: PMC9825815 DOI: 10.7759/cureus.32337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The study objective involves the evaluation of preoperative audiovisual information on the operation theater environment as a tool to relieve anxiety in patients posted for infra umbilical elective surgery under spinal anesthesia. Perioperative anxiety is detrimental to both intraoperative hemodynamic instability and postoperative recovery. MATERIAL AND METHODS The design was a single-center, prospective, randomized control trial. There were 120 patients in this study within the 18-60-year-old age range who were American Society of Anaesthesiologists (ASA) class I-II admitted for infra-umbilical surgery excluding lower segment cesarean section (LSCS) under spinal anesthesia. Patients were randomized into two groups: those who were not exposed to an audiovisual tour (NA) (n = 60) and those who were exposed to an audiovisual tour (A) (n = 60). The measurements are based on the demographic details of the patient; the visual analogue score (VAS); and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for anxiety, hemodynamic parameters i.e., blood pressure (BP), heart rate (HR), respiratory rate (RR), and patient satisfaction score (PSS) on a five-point Likert scale were noted perioperatively for both the groups. RESULTS The main results showed a significant (p-value <0.05) decrease in VAS and APAIS for anxiety, HR, and PSS. This was observed during the intraoperative and postoperative periods in the A group in comparison to the NA group. CONCLUSION The preoperative audiovisual virtual tour of the operation theater effectively reduces perioperative anxiety and stabilizes HR; it also improves the satisfaction of patients undergoing elective surgery under spinal anesthesia.
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14
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Li S, van Boekel RLM, van den Heuvel SAS, Coenen MJH, Vissers KCP. Pain predict genetics: protocol for a prospective observational study of clinical and genetic factors to predict the development of postoperative pain. BMJ Open 2022; 12:e066134. [PMID: 36446453 PMCID: PMC9710368 DOI: 10.1136/bmjopen-2022-066134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Postoperative pain remains a challenging medical condition impacting the quality of life of every patient. Although several predictive factors for postoperative pain have been identified, an adequate prediction of postoperative pain in patients at risk has not been achieved yet.The primary objective of this study is to identify specific genetic risk factors for the development of acute and chronic postoperative pain to construct a prediction model facilitating a more personalised postoperative pain management for each individual. The secondary objectives are to build a databank enabling researchers to identify other risk factors for postoperative pain, for instance, demographic and clinical outcome indicators; provide insight into (genetic) factors that predict pharmacological pain relief; investigate the relationship between acute and chronic postoperative pain. METHODS AND ANALYSIS In this prospective, observational study, patients who undergo elective surgery will be recruited to a sample size of approximately 10 000 patients. Postoperative acute and chronic pain outcomes will be collected through questionnaires at different time points after surgery in the follow-up of 6 months. Potential genetic, demographic and clinical risk factors for prediction model construction will be collected through blood, questionnaires and electronic health records, respectively.Genetic factors associated with acute and/or chronic postoperative pain will be identified using a genome-wide association analysis. Clinical risk factors as stated in the secondary objectives will be assessed by multivariable regression. A clinical easy-to-use prediction model will be created for postoperative pain to allow clinical use for the stratification of patients. ETHICS AND DISSEMINATION The Institutional Review Board of the Radboud university medical centre approved the study (authorisation number: 2012/117). The results of this study will be made available through peer-reviewed scientific journals and presentations at relevant conferences, which will finally contribute to personalised postoperative pain management. TRIAL REGISTRATION NUMBER NCT02383342.
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Affiliation(s)
- Song Li
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Regina L M van Boekel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Sandra A S van den Heuvel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Sertcakacilar G, Yildiz GO, Bayram B, Pektas Y, Cukurova Z, Hergunsel GO. Comparing Preoperative Anxiety Effects of Brachial Plexus Block and General Anesthesia for Orthopedic Upper-Extremity Surgery: A Randomized, Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091296. [PMID: 36143973 PMCID: PMC9504088 DOI: 10.3390/medicina58091296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/25/2022] [Accepted: 09/14/2022] [Indexed: 12/05/2022]
Abstract
Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.
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Affiliation(s)
- Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey
- Correspondence:
| | - Gunes Ozlem Yildiz
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey
| | - Berhan Bayram
- Department of Orthopedic Surgery and Sport Medicine, University of Acıbadem, Acıbadem Altunizade Hospital, 34662 Istanbul, Turkey
| | - Yaser Pektas
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey
| | - Zafer Cukurova
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey
| | - Gulsum Oya Hergunsel
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey
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Feninets V, Adamakidou T, Mantzorou M, Mastrogiannis D, Govina O, Tsiou C. The Effect of Preoperative Educational Intervention on Anxiety and Pain of Patients Undergoing Spinal Decompression Surgery: A Pilot Randomized Controlled Study. Cureus 2022; 14:e28368. [PMID: 36171848 PMCID: PMC9508614 DOI: 10.7759/cureus.28368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
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ALMesned S, Alsalhi AA, Abdelsalam S, Alquwayfili L, Alharbi TK, Almazyad F, Alshaya A, Aldubayyan S, Alkhumayri AS, Almazyad R. Arabic Validation of the Amsterdam Preoperative Anxiety and Information Scale. Cureus 2022; 14:e28004. [PMID: 36134100 PMCID: PMC9470083 DOI: 10.7759/cureus.28004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background Preoperative anxiety is a frequent and challenging problem that may impact a patient's postoperative pain and satisfaction. The level of a patient's anxiety needs to be assessed through a valid and reliable instrument to prevent and treat preoperative anxiety effectively. One such reliable measurement scale is Amsterdam Preoperative Anxiety and information scale, which is based on a self-reported questionnaire but is still not validated in Arabic. Objective To validate the Arabic Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for assessing preoperative anxiety in the Arabic population. Methods A cross-sectional study was conducted to translate and evaluate the validity of the APAIS in the Arabic version. The targeted population was Saudi adults undergoing surgery at the King Fahad Hospital in the Qassim region of Saudi Arabia. One hundred hospital patients were recruited and given the APAIS questionnaire to collect the data. The ethical considerations have been appropriately followed to protect the privacy of the patient's history. The collected data was qualitative and quantitative, which were analyzed using Statistical Package for the Social Sciences (SPSS). Results The questionnaire showed high internal consistency on the anxiety scale (Cronbach's alpha: 0.851) and a strong correlation between age, chronic diseases, and surgery. While Cronbach's alpha for the information scale is 0.827. The gold standard curve between the worried and afraid two variables showed good efficiency during the configuration. In addition, the Confirmatory Factor Analysis (CFA) model of the Arabic version is a two-factor model to evaluate the validity of the Arabic version. Conclusion The Arabic Version of the Amsterdam Preoperative Anxiety and information scale (APAIS) is a valid and reliable instrument for assessing preoperative anxiety. Using this validated scale for Arabic patients is feasible and shows promising results.
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Phaneendra NS, Singla K, Sen IM, Meena S, Jaiswal MK. The Effect of Video-Based Preanaesthetic Preparation Versus Conventional Approach on Parental Anxiety in Paediatric Dental Procedures: A Prospective Cohort Study. Cureus 2022; 14:e26768. [PMID: 35967189 PMCID: PMC9366023 DOI: 10.7759/cureus.26768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Parental anxiety has been identified as a risk factor affecting the behaviour of children before operative intervention. A preanaesthetic visit is a standard component of preoperative preparation, which may reduce parental anxiety. The use of audiovisual aids to demonstrate the conduct of anaesthesia may help improve parental education and reduce anxiety. Patient and methods We analysed data from a prospective randomised trial conducted at a tertiary care hospital. Parents of children posted for day care dental procedures were enrolled in the study. Children could be of either gender, aged 2-6 years, and categorised as American Society of Anesthesiologists Physical Status (ASA-PS) 1 or 2. Parents’ anxiety regarding the surgical and anaesthesia procedure was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The first APAIS scoring was recorded on arrival in the preoperative holding area. Thereafter, the participants were randomly allocated into two groups; one group was shown a short video on a smartphone of a dental operating theatre (OT), dental chair and anaesthesia equipment (SPG group), while the other group was verbally explained the dental procedure (conventional management or CM group). The second APAIS scoring was done in the postoperative recovery area one hour after the procedure. Demographic characteristics, socio-economic conditions and history were recorded. Anxiety scores were compared between the two groups, and any change was analysed. Results Seventy parents were included in the study, with 36 randomised to the SPG group and 34 to the CM group. Both groups were comparable in terms of demographic characteristics. There was a statistically significant decrease in anxiety scores in the SPG group, from a mean of 25.47 at the preoperative assessment to 14.92 at the postoperative timepoint (p<0.001). In the CM group, the mean APAIS score decreased from 25.26 to 24.56 (p=0.059). Conclusion There was a significant reduction in anxiety scores in the postoperative period among parents who were shown an operating room video in the preoperative period.
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Yaddanapudi S, Jain A, Jain D, Gupta A. Prevalence of parental fasting before pediatric surgery. Paediatr Anaesth 2022; 32:880-882. [PMID: 35412674 DOI: 10.1111/pan.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aakriti Gupta
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Stuff K, Kainz E, Kahl U, Pinnschmidt H, Beck S, von Breunig F, Nitzschke R, Funcke S, Zöllner C, Fischer M. Effect of sedative premedication with oral midazolam on postanesthesia care unit delirium in older adults: a secondary analysis following an uncontrolled before-after design. Perioper Med (Lond) 2022; 11:18. [PMID: 35585564 PMCID: PMC9118741 DOI: 10.1186/s13741-022-00253-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sedative premedication with benzodiazepines has been linked with prolonged recovery and inadequate emergence during the immediate postoperative period. We aimed to analyze the association between postanesthesia care unit (PACU) delirium and sedative premedication with oral midazolam. METHODS We performed a secondary analysis of prospectively collected data before (midazolam cohort) and after (non-midazolam cohort) implementation of a restrictive strategy for oral premedication with midazolam. From March 2015 until July 2018, we included patients 60 years and older, who underwent elective radical prostatectomy for prostate cancer. Exclusion criteria were contraindications to premedication with midazolam, preoperative anxiety, and a history of neurological disorders. Patients, who were scheduled for postoperative admission to the intensive care unit, were excluded. Between 2015 and 2016, patients received 7.5 mg oral midazolam preoperatively (midazolam cohort). Patients included between 2017 and 2018 did not receive any sedative medication preoperatively (non-midazolam cohort). The primary endpoint was the incidence of PACU delirium. RESULTS PACU delirium rates were 49% in the midazolam cohort (n = 214) and 33% in the non-midazolam cohort (n = 218). This difference was not statistically significant on multivariable logistic regression analysis (OR 0.847 [95% CI 0.164; 4.367]; P = 0.842). Age (OR 1.102 [95% CI 1.050; 1.156]; P < 0.001), the cumulative dose of sufentanil (OR 1.014 [95% CI 1.005; 1.024]; P = 0.005), and propofol-sufentanil for anesthesia maintenance (OR 2.805 [95% CI 1.497; 5.256]; P = 0.001) were significantly associated with PACU delirium. CONCLUSION Midazolam for sedative premedication was not significantly associated with PACU delirium. The reduction in the incidence of PACU delirium throughout the study period may be attributable to improvements in perioperative management other than a more restrictive preoperative benzodiazepine administration.
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Affiliation(s)
- Karin Stuff
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena Kainz
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ursula Kahl
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Beck
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska von Breunig
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Nitzschke
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Funcke
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Dziadzko M, Mazard T, Bonhomme M, Raffin M, Pradat P, Forcione JM, Minjard R, Aubrun F. Preoperative Anxiety in the Surgical Transfer and Waiting Area: A Cross-Sectional Mixed Method Study. J Clin Med 2022; 11:jcm11092668. [PMID: 35566793 PMCID: PMC9100941 DOI: 10.3390/jcm11092668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
Severe preoperative anxiety (SPA) in surgical patients may have clinical consequences and worsen satisfaction. Some institutions have a surgical transfer and waiting area (TWA) for patient reception/dispatch to operating rooms. We measured the frequency of SPA, investigated predicting factors, and quantified the effect of the TWA stay on anxiety levels in a single centre cross-sectional study. Preoperative anxiety was assessed using three scales. Patients’ perceptions/suggestions were studied by a psychoanalyst. A total of 933 adult patients, undergoing elective procedures, were interviewed. SPA was detected in 24.7%, non-modified by anxiolytic premedication. Patients’ median stay was 9 min, and anxiety level was decreasing in those with SPA. In multivariable analysis, female sex, inpatient settings, and pain before the procedure were predictive for SPA. Previous operating room experience, and a supine arrival position were associated with less SPA. Patients complained about a lack of information, and an uncomfortable environment in the waiting area. To reduce anxiety, they mainly asked for warm blankets/music (physical/sound barriers), and extra sedative agents. The holding area may be a place to measure patients’ anxiety by paramedical staff, and to apply simple non-pharmacological interventions. The psychological concept of psychical envelopes may be useful for the development and investigation of such interventions in improving patients’ experience.
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Affiliation(s)
- Mikhail Dziadzko
- Département d’Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (T.M.); (M.B.); (J.-M.F.); (F.A.)
- INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, 69622 Lyon, France
- Consultation Douleur, Groupement Hospitalier Nord, Hospices Civils de Lyon, 69005 Lyon, France;
- Correspondence: ; Tel.: +33-4-2610-9325
| | - Tessa Mazard
- Département d’Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (T.M.); (M.B.); (J.-M.F.); (F.A.)
| | - Myriam Bonhomme
- Département d’Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (T.M.); (M.B.); (J.-M.F.); (F.A.)
| | - Mahé Raffin
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (M.R.); (P.P.)
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (M.R.); (P.P.)
| | - Jean-Marc Forcione
- Département d’Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (T.M.); (M.B.); (J.-M.F.); (F.A.)
| | - Raphael Minjard
- Consultation Douleur, Groupement Hospitalier Nord, Hospices Civils de Lyon, 69005 Lyon, France;
- Centre de Recherche en Psychopathologie et Psychologie Clinique, Université Lumière Lyon-II, 69500 Bron, France
| | - Frederic Aubrun
- Département d’Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, 69004 Lyon, France; (T.M.); (M.B.); (J.-M.F.); (F.A.)
- INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, 69622 Lyon, France
- Consultation Douleur, Groupement Hospitalier Nord, Hospices Civils de Lyon, 69005 Lyon, France;
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22
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Jovanovic K, Kalezic N, Sipetic Grujicic S, Zivaljevic V, Jovanovic M, Kukic B, Trailovic R, Zlatanovic P, Mutavdzic P, Tomic I, Ilic N, Davidovic L. Preoperative Anxiety is Associated With Postoperative Complications in Vascular Surgery: A Cross-Sectional Study. World J Surg 2022; 46:1987-1996. [PMID: 35507076 DOI: 10.1007/s00268-022-06575-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery. METHODS Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation. RESULTS Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (rpb = 0.193, p = 0.001) and pulmonary complications (rpb = 0.104, p = 0.042). Postoperative nausea (rpb = 0.111, p = 0.03) and postoperative mental disorders (rpb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety. CONCLUSIONS Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.
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Affiliation(s)
- Ksenija Jovanovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Nevena Kalezic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Vladan Zivaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Jovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Center for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Biljana Kukic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia
| | - Ranko Trailovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2 St, 11000, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Perica Mutavdzic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Tomic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lazar Davidovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
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23
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Yu B, Hazlewood PJ, Yin X, Li S, Yue H, Xu K, Xu S, Mi Y. Effect of electroacupuncture on discomfort during gastroscopy: a study protocol for a randomized controlled trial. Trials 2022; 23:364. [PMID: 35477483 PMCID: PMC9044862 DOI: 10.1186/s13063-022-06165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Gastroscopy procedures are frequently performed under general sedation to minimize discomfort. Patients who refuse a sedative injection may experience more discomfort and adverse reactions such as pain and nausea. These instances reduce patient compliance and willingness to participate in future procedures. Acupuncture has been shown to have an anti-nausea and analgesic effect; however, there is limited data available that demonstrates the efficacy of acupuncture when applied before gastroscopy. Methods A total of 60 participants will be randomly assigned to the electroacupuncture (EA) group and the sham electroacupuncture (SEA) group at a ratio of 1:1. Acupuncture treatment will be performed before gastroscopy for a duration of 30 min. All patients will complete detailed questionnaires at 30 min and 7 days post-procedure to record the severity of their symptoms. The primary outcome will be the average of 4 standard visual analogue scale (VAS) scores in the categories of nausea, vomiting, throat discomfort, and agitation as reported by the patient. The secondary outcomes will be patient’s anxiety level as recorded by the 6-item short form of the State-Trait Anxiety Inventory (STAI-S6) and Amsterdam Pre-Operative Anxiety and Information Scale (APAIS), preference in a future endoscopy, pulse oxygen saturation (SpO2), heart rate (HR), and blood pressure (BP). Anxiety scales will be assessed before and after acupuncture; others will be completed at 30 min and 7 days post-procedure. The duration of the gastroscopy and the number of biopsies will be recorded after operation. Discussion This randomized controlled trial will explore the feasibility of the further clinical application of electroacupuncture for the improvement of patient discomfort during gastroscopy without systemic sedation. Trial registration ChiCTR2000040726. This trial has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2020SHL-KY-11). Registration date 12 August 2020.
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Affiliation(s)
- Binyu Yu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Philippa Jemma Hazlewood
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuan Yin
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shanshan Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kun Xu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shifen Xu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Yiqun Mi
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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24
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The effect of preoperative patient-reported anxiety on morbidity and mortality outcomes in patients undergoing major general surgery. Sci Rep 2022; 12:6312. [PMID: 35428818 PMCID: PMC9012824 DOI: 10.1038/s41598-022-10302-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/05/2022] [Indexed: 01/03/2023] Open
Abstract
Excessive levels of anxiety may negatively influence treatment outcomes and likely increase patient suffering. We designed a prospective observational study to assess whether preoperative patient-reported anxiety affects major general surgery outcomes. We prospectively administered the State-Trait Anxiety Inventory (STAI) to measure preoperative anxiety in patients awaiting major general surgical procedures. Patients were grouped by STAI scores according to established cutoffs: no anxiety (STAI < 40) and anxiety (STAI ≥ 40). Four hundred patients completed the questionnaires and underwent surgery, with an average interval from questionnaire completion to surgery of 4 days. Applying a state anxiety (STAI-S) score ≥ 40 as a reference point, the prevalence of patient-reported anxiety was 60.5% (241 of 400). The mean STAI-S score for these patients was 50.48 ± 7.77. The mean age of the entire cohort was 58.5 ± 14.12 years. The majority of participants were male (53.8%). The distribution of sex by anxiety status showed that 53.5% of women and 46.5% of men had anxiety (p = 0.003). In the entire cohort, postoperative complications occurred in 23.9% and 28.6% of the no anxiety and anxiety groups, respectively. The difference was nonsignificant. In a subgroup of patients who underwent high-risk complex procedures (N = 221), however, postoperative complications occurred in 31.4% and 45.2% of the no anxiety and anxiety groups, respectively. This difference was significant at p = 0.004. Of the patients who were anxious, 3.3% (8 of 241) died during hospitalization following surgery, compared with 4.4% of the patients (7 of 159) who were not anxious (p = 0.577). In the multivariable analysis adjusted for covariates and based on the results of subgroup analysis, preoperative anxiety assessed by the STAIS score was associated with morbidity (OR 2.12, CI 1.14–3.96; p = 0.018) but not mortality. The majority of enrolled patients in this study were classified as having high- to very high-level preoperative clinical anxiety, and we found a significant quantitative effect of patient-reported anxiety on morbidity but not mortality after surgery.
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25
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Euteneuer F, Kampmann S, Rienmüller S, Salzmann S, Rüsch D. Patients' desires for anxiolytic premedication - an observational study in adults undergoing elective surgery. BMC Psychiatry 2022; 22:193. [PMID: 35300643 PMCID: PMC8932104 DOI: 10.1186/s12888-022-03845-y] [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: 07/28/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most patients experiencing preoperative anxiety would welcome support in coping with their anxiety. Anxiolytic medication is a common way to address preoperative anxiety. However, the proportion of patients who welcome anxiolytic medication preoperatively and the preferred time of taking it have not been studied thoroughly. METHODS Adult patients (n = 1000) scheduled to undergo elective surgery under general anesthesia were eligible to participate in this single-center observational study. Primary outcomes were the ratio of patients desiring anxiolytic medication (no/yes/on request) and the preferred time of taking it (evening before surgery/morning of day of surgery/on call to the operating room). Secondary outcomes included associations between different measures of anxiety (i.e., anxiety level according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and anxiety status (no/yes)) and desire for anxiolytic medication (no/yes/on request). Primary outcomes were analyzed descriptively, and secondary outcomes were analyzed using multinomial logistic regressions. RESULTS Three hundred fifty-six (35.6%) out of 1000 patients desired anxiolytic medication and 239 (23.9%) patients would welcome anxiolytic medication on request. In patients reporting anxiety (no/yes; n = 493), 228 (46.2%) stated a clear desire for anxiolytic medication (yes) and 142 (28.8%) considered anxiolytic medication (on request). Patients' preferences concerning the timing of premedication vary widely. In patients reporting a clear desire for anxiolytic medication (n = 356), the "morning of the day of surgery" was most frequently (n = 111, 31.2%) stated as the preferred time to get anxiolytic medication, followed by "on call to the operating room" (n = 51, 14.3%). All anxiety measures were significantly associated with desire for anxiolytic medication (p < 0.05). CONCLUSIONS Given the importance of preoperative anxiety to patients, patients' desire for anxiolytic medication should be considered when discussing the pros and cons of premedication. Individualized instead of standardized prescription and timing of premedication is recommended. TRIAL REGISTRATION German Clinical Trials Register ( DRKS 00013319 , approved 23/11/2017).
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Affiliation(s)
- Frank Euteneuer
- grid.10253.350000 0004 1936 9756Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany ,grid.466457.20000 0004 1794 7698Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Calandrellistrasse 1-9, 12247 Berlin, Germany
| | - Stefan Kampmann
- grid.10253.350000 0004 1936 9756Philipps-University Marburg, Biegenstraße 10, 35037 Marburg, Germany
| | - Stephen Rienmüller
- grid.10253.350000 0004 1936 9756Philipps-University Marburg, Biegenstraße 10, 35037 Marburg, Germany
| | - Stefan Salzmann
- grid.10253.350000 0004 1936 9756Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany
| | - Dirk Rüsch
- Philipps-University Marburg, Biegenstraße 10, 35037, Marburg, Germany. .,University Hospital Giessen-Marburg (Marburg Campus), Department of Anesthesia and Intensive Care, Baldingerstrasse, 35043, Marburg, Germany.
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26
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Bang YJ, Lee JH, Kim CS, Lee YY, Min JJ. Anxiolytic effects of chewing gum during preoperative fasting and patient-centered outcome in female patients undergoing elective gynecologic surgery: randomized controlled study. Sci Rep 2022; 12:4165. [PMID: 35264684 PMCID: PMC8907183 DOI: 10.1038/s41598-022-07942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
Although previous studies reported that chewing gum during the preoperative fasting has the benefits of alleviating anxiety and dry mouth, preoperative chewing gum has yet to be accepted as a standard practice due to conventional anesthetic custom. Our study aimed to prospectively evaluate the effects of gum chewing on preoperative anxiety and patient's discomfort in female patients undergoing gynecologic surgery. Ninety-four patients were enrolled and randomized either into conventional fasting group (control group) or chewing gum with fasting group (gum group). The control group was instructed to fast from 3 p.m. on the day before surgery. The gum group performed preoperative fasting in the same manner, but was encouraged to chew gum freely during the fasting period. The primary endpoint was the degree of preoperative anxiety. For the evaluation of preoperative anxiety, Amsterdam preoperative anxiety and information scale (APAIS) was used. Preoperative gastric fluid volume and acidity were also measured as the secondary outcomes. Preoperative anxiety using APAIS was significantly lower in the gum group compared to the control group (control group vs. gum group: 20.9 vs. 17.8, p = 0.009). However, there was no significant difference in the gastric fluid analysis between the groups. In the female patients for elective gynecologic surgery, chewing gum during the preoperative fasting period helped to alleviate preoperative anxiety without additional increase of pulmonary aspiration risks.Trial registration: KCT0004422 (05/11/2019, https://cris.nih.go.kr ; registration number).
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Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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27
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Iscan G, Cetin B, Kilic F, Kalayci H, Kalayci A, Iscan SC. Investigation of anxiety sensitivity levels of cancer patients in terms of COVID-19 vaccine: a cross-sectional study. Support Care Cancer 2022; 30:4139-4147. [PMID: 35067730 PMCID: PMC8784216 DOI: 10.1007/s00520-021-06750-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Our study's purpose was to investigate the viewpoints of cancer patients who had not yet been vaccinated. Cancer patients usually cannot get every vaccine because their immunity is low. For this reason, we aimed to detect their anxiety and curiosity for new vaccines for a new disease. METHODS The goal of this descriptive cross-sectional study was to investigate cancer patients' perceptions of COVID vaccination. Over 18 years of age who have not yet been vaccinated for COVID-19 and who agreed to participate were included in the study. We applied three questionnaires between May and June 2021, one of them was prepared by us; the other two questionnaires were The State-Trait Anxiety Inventory (STAI) form and Anxiety Sensitivity index to a total of 497 participants. Chi-square, Spearmen correlation test, and multivariable multinomial logistic regression tests were used when comparing. RESULTS Our participants' ages were between 21 and 88, with a mean age of 61.38 (SD = 11.68), 48.6% (n = 251) of the participants were female. We discovered that 79.1% (n = 408) of respondents were not afraid of getting the COVID-19 vaccine. 27.7% (n = 143) of these patients were concerned about the COVID-19 vaccine's adverse effects, and 24.2% (n = 125) were afraid of its side effects with their treatments. 91.1% (n = 470) of the patients did not know which vaccine they would have and the type of the vaccine. Since the anxiety level is generally higher in women, anxiety scores were also higher in cancers seen in women, such as breast and ovarian cancer. Of course, in parallel with this, anxiety scores were lower in prostate cancers. Special patient groups should not be neglected during this vaccine season, and their concerns should be addressed. When a new vaccine is found, it can have long-term effects, which should not be ignored.
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Affiliation(s)
- Gokce Iscan
- Department of Family Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey.
| | - Bulent Cetin
- Department of Oncology, Suleyman Demirel University, Isparta, Turkey
| | - Faruk Kilic
- Department of Psychiatry, Suleyman Demirel University, Isparta, Turkey
| | - Hakan Kalayci
- Department of Family Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Aysegul Kalayci
- Department of Family Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Serhan Can Iscan
- Isparta City Hospital, Clinic of Gynecologic Oncology, Isparta, Turkey
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28
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Effect of Preoperative Anxiety on Postoperative Pain after Craniotomy. J Clin Med 2022; 11:jcm11030556. [PMID: 35160007 PMCID: PMC8836517 DOI: 10.3390/jcm11030556] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/12/2022] Open
Abstract
Pain following craniotomy is challenging. Preoperative anxiety can be one of the controllable factors for prevention of post-craniotomy pain. The main objective of this prospective observational study is to determine this relationship in patients undergoing scheduled craniotomy from February to June 2021. After excluding patients with Mini-Mental State Examination (MMSE) ≤ 24 points, we administered a preoperative State Trait Anxiety Inventory (STAI) questionnaire. We recorded the patient's analgesic assessment using the Numerical Rating Score (NRS) at 1, 8, 24, and 48 h after surgery. A total of 73 patients were included in the study. Twelve others were excluded due to a MMSE ≤ 24 points. The main predictors for NRS postoperatively at 1, 8, 24, and 48 h were STAI A/E score, male gender, youth, and depression. We identified a cut-off point of 24.5 in STAI A/E for predicting a NRS > 3 (sensitivity 82% and specificity 65%) at 24 h postoperative and a cut-off of 31.5 in STAI A/R (sensitivity 64% and specificity 77%). In conclusion, preoperative STAI scores could be a useful tool for predicting which patient will experience at least moderate pain after craniotomy. The identification of these patients may allow us to highlight psychological preparation and adjuvant analgesia.
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Barkmann C, Härter V, Trah J, Reinshagen K. Pediatric surgery and self-reported anxiety in children and their parents: A psychometric analysis of the state-trait operation anxiety (STOA) questionnaire. Front Pediatr 2022; 10:987658. [PMID: 36714642 PMCID: PMC9880213 DOI: 10.3389/fped.2022.987658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The preoperative experience in pediatric surgery can cause significant anxiety for both, children and their parents. To date there is no questionnaire available that assesses the child's self-report or both, the child's and parent's self-reported anxiety. The aim of this study was to perform a psychometric analysis of the State-Trait Operation Anxiety (STOA) which provides this option. METHODS The data based on a randomized controlled study conducted with n = 90 child-parent dyads. The psychometric analyses were performed using classical test theory, including item statistics, Cronbach's α, factor analysis, and test-retest reliability. RESULTS The statistics of the anxiety items were good overall for both ratings following common guidelines. The item means indicated that the items tended to be rather difficult which reduces the reliability for lower anxiety levels. The given scale structure was confirmed overall for both informants. However, a one-factor structure instead of two factors was found for state anxiety. The internal consistencies and retest reliabilities were good to very good. Follow-up analyses confirmed the sensitivity to change for state anxiety. Child anxiety was hardly correlated with parental anxiety, and age and gender effects were rather small. CONCLUSIONS The STOA questionnaire is the first psychometrically tested questionnaire specifically for fears of surgery that can be used for self-report among children, adolescents, and their parents. Future studies should collect further evidence of its validity as well as comparative scores for specific patient groups and norm values to increase the utility of the instrument.
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Affiliation(s)
- Claus Barkmann
- Department for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Valentina Härter
- Department for Pediatric Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Trah
- Department for Pediatric Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department for Pediatric Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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30
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Lakshminarasimhan A, Suresh Y. Effect of preoperative anxiety on postoperative pain in patients undergoing elective lower-segment cesarean section under spinal anesthesia: A cross-sectional study in South India. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_39_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Orofacial Manifestation and Dental Management of Sickle Cell Disease: A Scoping Review. Anemia 2021; 2021:5556708. [PMID: 34721900 PMCID: PMC8556080 DOI: 10.1155/2021/5556708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/13/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022] Open
Abstract
Aims Sickle cell disease (SCD) is an upcoming global health problem with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on the dental treatment of sickle cell disease (SCD). This article aims to outline the oral features of the sickle disease and discuss oral management strategies that can serve as guidelines for dental professionals. Material and Methods. A comprehensive literature review was conducted using PubMed, Google Scholar, and Web of Science. The search strategies were developed to cover publications from January 2010 to March 2020. With the help of keywords, multiple abstracts were identified. These abstracts were further reviewed, which included the information about the SCD manifestation, particularly about the oral health features. Based on all these articles and clinical experience, a narrative review was constructed, which summarizes all the aspects of the oral manifestation in people with SCD. Results The results of this study demonstrate that there is distinct evidence available, indicating the developmental enamel defect leading to hypoplasia and increasing susceptibility to dental caries. Another important result of this review found that people with SCD have a vaso-occlusive crisis in the microcirculation in the dental pulp leading to symptomatic and asymptomatic pulpal necrosis without any signs of odontogenic pathology in an apparently healthy tooth. The study also found that early detection, intervention, and prevention are crucial for improving oral health care, and involving a multidisciplinary approach plays an important role in managing people with SCD. Conclusion Patients with sickle cell disease have chronic overall health problems. The hematological disorder becomes their main concern and impaired oral health becomes secondary, increasing the risk for dental caries at the most. This paper broadly describes the oral manifestations of SCD, additionally; this paper also provides recommendations for better dental management of patients with SCD. Patients with SCD are often misjudged and, due to lack of knowledge and guidelines, dental providers are not able to provide adequate care. This paper attempts to highlight the essential measures to provide better dental care.
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Vogt L, Klasen M, Rossaint R, Goeretz U, Ebus P, Sopka S. Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial. J Med Internet Res 2021; 23:e28018. [PMID: 34252034 PMCID: PMC8444035 DOI: 10.2196/28018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia. OBJECTIVE This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety. METHODS We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness. RESULTS There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety. CONCLUSIONS The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended. TRIAL REGISTRATION ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354.
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Affiliation(s)
- Lina Vogt
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Martin Klasen
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Ute Goeretz
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Peter Ebus
- Faculty of Educational Science, Open University, Heerlen, Netherlands
| | - Sasa Sopka
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
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Ayele B, Tadesse M, Tilahun R, Nega B. Translation of the Amsterdam Preoperative Anxiety and Information Score (APAIS) into the Amharic Version and Its Validation for Evaluation of Preoperative Anxiety. Ethiop J Health Sci 2021; 31:349-358. [PMID: 34158787 PMCID: PMC8188089 DOI: 10.4314/ejhs.v31i2.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Peri-operative anxiety is a vague, unpleasant feeling, the source of which is often nonspecific and unknown to the individual. It affects all aspects of anesthesia. Although the magnitude and consequences of preoperative anxiety are well documented in the developed world, there are limited studies conducted in Ethiopia. The primary aim of this study is to produce the Amharic version of APAIS and evaluate its validity in assessing the prevalence of preoperative anxiety in surgical patients. Methods A cross-cultural adaptation process using a forward/backward translation of the APAIS scale was performed. The Amharic version was then tested in 365 sampled elective adult surgical patients scheduled for surgery at Tikur Anbessa specialized Hospital. The validity of the translated version was also checked by evaluating its psychometric properties of internal validity and acceptability. Result The results showed that the reliability of the APAIS-Amharic was high (Cronbach's alpha of 0.87) and the data collected was a good fit (RMSEA of 0.04). In addition, the questionnaire was well-accepted 100% with no missing values for each dimension of the APAIS. The mean APAIS scores for total anxiety and desire for information were 11.6 and 6.0 respectively and 58.9% of the study participants had anxiety and those patients, who had some form of formal education, came from urban areas, had previous anesthesia experience and complications and who had average or high information requirement was more likely to be anxious. Conclusion APAIS-Amharic is a reliable and acceptable tool for measuring patients' preoperative anxiety and their need for information. It can be used routinely as a screening instrument at pre-anesthesia clinics to assess patients' level of anxiety.
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Affiliation(s)
- Blen Ayele
- Department of anesthesiology, school of medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahelet Tadesse
- Department of anesthesiology, school of medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Tilahun
- Department of anesthesiology, school of medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Nega
- Department of surgery, school of medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Identification of preoperative predictors for acute postsurgical pain and for pain at three months after surgery: a prospective observational study. Sci Rep 2021; 11:16459. [PMID: 34385556 PMCID: PMC8361098 DOI: 10.1038/s41598-021-95963-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Identifying patients at risk is the start of adequate perioperative pain management. We aimed to identify preoperative predictors for acute postsurgical pain (APSP) and for pain at 3 months after surgery to develop prediction models. In a prospective observational study, we collected preoperative predictors and the movement-evoked numerical rating scale (NRS-MEP) of postoperative pain at day 1, 2, 3, 7, week 1, 6 and 3 months after surgery from patients with a range of surgical procedures. Regression analyses of data of 2258 surgical in- and outpatients showed that independent predictors for APSP using the mean NRS-MEP over the first three days after surgery were hospital admittance, female sex, higher preoperative pain, younger age, pain catastrophizing, anxiety, higher score on functional disability, highest categories of expected pain, medical specialty, unknown wound size, and wound size > 10 cm compared to wound size ≤ 10 cm (RMSE = 2.11). For pain at three months, the only predictors were preoperative pain and a higher score on functional disability (RMSE = 1.69). Adding pain trajectories improved the prediction of pain at three months (RMSE = 1.37). Our clinically applicable prediction models can be used preoperatively to identify patients at risk, as well as in the direct postoperative period.
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Zhang C, Liu X, Hu T, Zhang F, Pan L, Luo Y, Wang Z. Development and psychometric validity of the perioperative anxiety scale-7 (PAS-7). BMC Psychiatry 2021; 21:358. [PMID: 34271896 PMCID: PMC8284006 DOI: 10.1186/s12888-021-03365-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preoperative anxiety is a common psychological reaction in perioperative patients. The absence of a valid measurement tool hinders the evaluation of interventions to treat preoperative anxiety in China. This study aims to develop the Perioperative Anxiety Scale-7 (PAS-7) and test its reliability, validity, and cut-off value. METHODS A total of 280 patients over 16 years old (M = 55.1, SD = 14.3) who were undergoing elective surgery were recruited to complete the PAS-7 and the Generalized Anxiety Disorder-7 scale (GAD-7) one day before surgery. RESULTS The PAS-7 included seven items divided into two dimensions: mental anxiety and somatic anxiety. These two dimensions could explain 74.294% of the population variance. The internal consistency of each dimension ranged from 0.761-0.933. The confirmatory factor analysis showed that the model fit of the scale was good (χ2= 34.798, df = 13, χ2/df = 2.677, CFI = 0.949, TLI = 0.918, SRMR = 0.057, RMSEA = 0.115). The correlations between the GAD-7 and each dimension and the scale's total score were significant (0.711-0.789). A cut-off score of 8, maximizing the Youden Index, yielded a sensitivity of 75% and a specificity of 84.6% (95% CI: 0.88 ~ 0.97). CONCLUSIONS The PAS-7 had good reliability and validity and could be used as an effective tool to evaluate preoperative anxiety.
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Affiliation(s)
- Chengjiao Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitong Liu
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianran Hu
- grid.412277.50000 0004 1760 6738Department of Anesthesia and Pain Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingyi Pan
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Luo
- grid.412277.50000 0004 1760 6738Department of Anesthesia and Pain Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Buonanno P, Vargas M, Marra A, Iacovazzo C, Servillo G. Preoperative anxiety: what are we really doing? ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021277. [PMID: 34212938 PMCID: PMC8343734 DOI: 10.23750/abm.v92i3.9329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Pasquale Buonanno
- a:1:{s:5:"en_US";s:114:"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy";}.
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
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Salzmann S, Rienmüller S, Kampmann S, Euteneuer F, Rüsch D. Preoperative anxiety and its association with patients' desire for support - an observational study in adults. BMC Anesthesiol 2021; 21:149. [PMID: 34000986 PMCID: PMC8127269 DOI: 10.1186/s12871-021-01361-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background Preoperative anxiety is prevalent and has harmful effects on postoperative outcomes. However, to date, it is still unclear (i) to what extent patients perceive preoperative anxiety as emotionally distressful, (ii) whether patients would welcome support from anesthesiologists in coping with their anxiety, and (iii) whether anxiety scores are useful for everyday clinical practice to determine patients’ need for support. Methods: 1082 patients scheduled to undergo elective procedures under general anesthesia were eligible for this cross-sectional study carried out at a university hospital. Preoperative anxiety, resulting in emotional distress, and patients’ desire for anesthesiologists’ support in coping with their anxiety were assessed dichotomously (no vs. yes) and analyzed descriptively. The intensity of anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale (range 4–20). Associations between the intensity of anxiety and the resulting desire for support were analyzed using logistic regression. Receiver operating characteristic analyses were performed to identify anxiety levels that best predict desire for support. Results Among the 1000 (537 female; M (SD) 57 (18) years) subjects evaluated, 493 (318 (65 %) female) reported anxiety. Anxiety was associated with emotional distress in 320 (65 %) and desire for support in 291 (59 %) patients. Increased preoperative anxiety levels were associated with higher rates of desire for support (B= 0.270; odds ratio 1.31 [95 % CI 1.22–1.41]). An anxiety score > 9 was best to predict a desire for support (sensitivity 0.861, specificity 0.724). However, desire for support was even present in some patients with lowest anxiety scores (5 or 6). Conclusions All patients undergoing surgery should be screened for preoperative anxiety and the resulting desire for support to be able to determine who would welcome support. Anxiety scoring tools do not seem to be useful to identify these patients. By helping patients experience less preoperative anxiety, anesthesiologists may not only reduce patients’ emotional distress but also have a positive impact on postoperative outcome. Trial registration German Clinical Trials Register (DRKS 00013319, 23 November 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01361-2.
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Affiliation(s)
- Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany
| | | | - Stefan Kampmann
- Philipps-University Marburg, Biegenstraße 10, 35037, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Calandrellistrasse 1-9, 12247, Berlin, Germany
| | - Dirk Rüsch
- Philipps-University Marburg, Biegenstraße 10, 35037, Marburg, Germany. .,Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg (Marburg Campus), Baldingerstrasse, 35043, Marburg, Germany.
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Donegan D, Gowan T, Gruber R, Cottingham A, Flanagan M, Erickson D, Imperiale TF. The Need for Patient-centered Education Among Patients Newly Diagnosed With a Pituitary Tumor. J Endocr Soc 2021; 5:bvab061. [PMID: 34056501 PMCID: PMC8143658 DOI: 10.1210/jendso/bvab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Brain tumors, including pituitary adenomas (PA), cause anxiety and distress, with a high unmet need for information correlating with increased anxiety. Condition-specific education may alleviate anxiety. We explored patients’ experience around the diagnosis of a PA and piloted a patient education intervention to address peridiagnostic anxiety in adults diagnosed with PA. Methods Anxiety, patient satisfaction, patient knowledge, and need for information were measured prior to, immediately after, and 1 month following the appointment in this multimethods study. A phone interview to explore patient diagnostic and intervention experiences was analyzed using qualitative methods. Results A total of 17 patients participated in the study; 15 completed the interview. The baseline need for information was high. Disease-specific anxiety decreased, and patient knowledge and satisfaction increased significantly after the initial visit. Interview analysis identified 3 main themes: (1) the importance of communication; (2) the need for information; and (3) the impact of the diagnosis on patient experience. Conclusions For patients with newly diagnosed PA, the diagnostic experience was associated with high levels of anxiety. Patients expressed a need for information. Information delivery reduced anxiety and had a positive impact on patient satisfaction. Practice Implications The study findings suggest a need for a streamlined diagnostic process with readily accessible information.
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Affiliation(s)
- Diane Donegan
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Mayo Clinic, Division of Endocrinology, Diabetes and Metabolism, Rochester, MN 55905, USA
| | - Tayler Gowan
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Rachel Gruber
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Ann Cottingham
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Mindy Flanagan
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Dana Erickson
- Mayo Clinic, Division of Endocrinology, Diabetes and Metabolism, Rochester, MN 55905, USA
| | - Thomas F Imperiale
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
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Maurício S, Rebêlo I, Madeira C, Resende F, Esteves S. Validation of the Portuguese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health Qual Life Outcomes 2021; 19:95. [PMID: 33741005 PMCID: PMC7976695 DOI: 10.1186/s12955-021-01736-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preoperative anxiety is common among the oncological surgical population. Due to its psychological and physiological detrimental effects, identifying and addressing it is of uttermost importance to improve anesthetic management and patient’s outcomes. The aim of this study is to validate the Portuguese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the oncological population. Methods Following forward and backward translation of the original APAIS scale, further adaptation was obtained through cognitive interviewing. The resulting instrument was tested on the day before surgery on a sample of adult cancer surgical patients from a Portuguese oncology centre. Psychometric evaluation was derived from inter-item correlation, confirmatory factor analysis, Cronbach’s alpha, correlation with comparative scales, receiver operating characteristic curve and Youden index.
Results 109 patients (58 males, 51 females) were included. A three-dimensional model—anxiety about anesthesia, anxiety about surgery and desire for information, showed the best fit to the data. The questionnaire revealed high internal consistency (Cronbach alpha 0.81) and good inter-item correlation. Also, Portuguese APAIS correlated well with the gold standard anxiety scale. Therefore, the psychometric properties of this scale version make it a valid and reliable instrument. The optimal cutoff to maximize both sensitivity and specificity was 12 for the APAIS global anxiety score. Conclusions Portuguese APAIS version is an accurate tool to identify preoperative anxiety among cancer patients and might impact its management, from premedication choice to provision of information and reassurance about either anesthesia or surgery.
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Affiliation(s)
- Sandra Maurício
- Serviço de Anestesiologia, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal.
| | - Isabel Rebêlo
- Serviço de Anestesiologia, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Catarina Madeira
- Serviço de Anestesiologia, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Filipa Resende
- Serviço de Anestesiologia, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Susana Esteves
- Unidade de Investigação Clínica, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
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Robert C, Soulier A, Sciard D, Dufour G, Alberti C, Boizeau P, Beaussier M. Cognitive status of patients judged fit for discharge from the post-anaesthesia care unit after general anaesthesia: a randomized comparison between desflurane and propofol. BMC Anesthesiol 2021; 21:76. [PMID: 33706698 PMCID: PMC7948375 DOI: 10.1186/s12871-021-01287-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background The Aldrete’s score is used to determine when a patient can safely leave the Post-Anaesthesia Care Unit (PACU) and be transferred to the surgical ward. The Aldrete score is based on the evaluation of vital signs and consciousness. Cognitive functions according to the anaesthetic strategy at the time the patient is judged fit for discharge from the PACU (Aldrete’s score ≥ 9) have not been previously studied. The aim of this trial was to assess the cognitive status of inpatients emerging either from desflurane or propofol anaesthesia, at the time of PACU discharge (Aldrete score ≥ 9). Methods Sixty adult patients scheduled for hip or knee arthroplasty under general anaesthesia were randomly allocated to receive either desflurane or propofol anaesthesia. Patients were evaluated the day before surgery using Digit Symbol Substitution Test (DSST), Stroop Color Test and Verbal Learning Test. After surgery, the Aldrete score was checked every 5 min until reaching a score ≥ 9. At this time, the same battery of cognitive tests was applied. Each test was evaluated separately. Cognitive status was reported using a combined Z score pooling together the results of all 3 cognitive tests. Results Among the 3 tests, only DSST was significantly reduced at Aldrete Score ≥ 9 in the Desflurane group. Combined Z-scores at Aldrete Score ≥ 9 were (in medians [interquartils]): − 0.2 [− 1.2;+ 0.6] and − 0.4 [− 1.1;+ 0.4] for desflurane and propofol groups respectively (P = 0.62). Cognitive dysfunction at Aldrete score ≥ 9 was observed in 3 patients in the Propofol group and in 2 patients in the Desflurane group) (P = 0.93). Conclusion No difference was observed in cognitive status at Aldrete score ≥ 9 between desflurane and propofol anaesthesia. Although approximately 10% of patients still had cognitive dysfunctions, an Aldrete score ≥ 9 was associated with satisfactory cognitive function recovery in the majority of the patients after lower limb arthroplasty surgery under general anaesthesia. Trial registration Clinical Trials identifier NTC02036736.
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Affiliation(s)
- Cyrille Robert
- Department of Anaesthesia and Critical Care, Clinique Mutualiste de Pessac, Pessac, France
| | - Anne Soulier
- Department of Anaesthesia and Critical Care, St-Antoine Hospital. Assistance Publique-Hôpitaux de Paris, 75012, Paris, France
| | - Didier Sciard
- Department of Anaesthesia, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Guillaume Dufour
- Department of Anaesthesia, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, CHU Robert Debré, University Paris Diderot, Sorbonne Paris-Cité, CIC-EC 1426 and, UMR-S 1123 ECEVE, 75019, Paris, France
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, CHU Robert Debré, University Paris Diderot, Sorbonne Paris-Cité, CIC-EC 1426 and, UMR-S 1123 ECEVE, 75019, Paris, France
| | - Marc Beaussier
- Department of Anaesthesia, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
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Brescia AA, Piazza JR, Jenkins JN, Heering LK, Ivacko AJ, Piazza JC, Dwyer-White MC, Peters SL, Cepero J, Brown BH, Longi FN, Monaghan KP, Bauer FW, Kathawate VG, Jafri SM, Webster MC, Kasperek AM, Garvey NL, Schwenzer C, Wu X, Lagisetty KH, Osborne NH, Waljee JF, Riba M, Likosky DS, Byrnes ME, Deeb GM. The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e21350. [PMID: 33591291 PMCID: PMC7925147 DOI: 10.2196/21350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. OBJECTIVE This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. METHODS To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor's office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. RESULTS This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. CONCLUSIONS Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study's findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21350.
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Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Julie R Piazza
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jessica N Jenkins
- Department of Child and Family Life, CS Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Lindsay K Heering
- Department of Child and Family Life, CS Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Alexander J Ivacko
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - James C Piazza
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Molly C Dwyer-White
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stefanie L Peters
- Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, MI, United States
| | - Jesus Cepero
- Children and Women's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Bailey H Brown
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Faraz N Longi
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katelyn P Monaghan
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Frederick W Bauer
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Varun G Kathawate
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sara M Jafri
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Melissa C Webster
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda M Kasperek
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nickole L Garvey
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Claudia Schwenzer
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kiran H Lagisetty
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas H Osborne
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer F Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michelle Riba
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Mary E Byrnes
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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Sriramka B, Mallik D, Singh J, Khetan M. Effect of hand-holding and conversation alone or with midazolam premedication on preoperative anxiety in adult patients-A randomised controlled trial. Indian J Anaesth 2021; 65:128-132. [PMID: 33776087 PMCID: PMC7983819 DOI: 10.4103/ija.ija_705_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/26/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Anxiety causing stress is most profound before surgery. Anxiolytics are used routinely to combat perioperative anxiety. Studies have shown that hand-holding and communication are useful in reducing anxiety levels intraoperatively. This study compares the effectiveness of the same with pharmacological interventions in allaying preoperative anxiety. Material and Methods: This is a three-arm parallel-group randomised controlled trial. A total of 90 adult patients aged <45 years and of American Society of Anesthesiologists (ASA) grade 1–2, undergoing laparoscopic surgery were enroled in this study. Patients received either intravenous (IV) midazolam (group M) or hand-holding and conversation (group HC), or a combination of IV midazolam and holding and conversation (group HCM) in the preoperative room. Anxiety, heart rate (HR) and mean blood pressure (MBP) were recorded before and 20 minutes after the intervention. Anxiety was measured using the Amsterdam preoperative anxiety and information scale. The analysis of covariance (ANCOVA) test was done to analyse the difference between the groups. Results: The mean anxiety scores were significantly different in the three groups (p = 0.04) after intervention, with the lowest score in group HCM, followed by group HC and the highest score in group M. The mean heart rates were also significantly different in the three groups after intervention but MBP was not significantly different in the three groups. Conclusion: A combination of hand-holding and conversation and midazolam is best for allaying preoperative anxiety in patients undergoing laparoscopic surgeries than either method alone.
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Affiliation(s)
- Bhavna Sriramka
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Diptimayee Mallik
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Jayanti Singh
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Megha Khetan
- Department of Anaesthesia and Critical Care, IMS & SUM Hospital, Bhubaneswar, Odisha, India
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Jayawardane M, Gankanda W, Gunathilake M. Prevalence of pre-operative anxiety and associated factors among a group of women undergoing gynaecological surgeries at a single unit in a tertiary care hospital in Sri Lanka. F1000Res 2021; 10:74. [PMID: 34055313 PMCID: PMC8127014 DOI: 10.12688/f1000research.26964.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Surgery-related anxiety is universal, leading to complications. The objective of this study was to assess the prevalence of pre-operative anxiety levels among a group of patients. Methods: A descriptive cross-sectional study of 64 women was conducted in a tertiary care hospital, Sri Lanka. Patients who underwent emergency surgeries, those with mental illnesses or those aged <18 years were excluded. Pre-operative assessment was done one day prior to the surgery using a self-administered Sinhala validated Amsterdam-Preoperative-Anxiety-and-Information-Scale (APAIS), Hospital Anxiety and Depression Scale (HADS) and Visual-Analogue-Scale (VAS). The APAIS consists of six questions which assess three anxiety components: anesthesia-related-anxiety (Sum A), surgery-related-anxiety (Sum S) and information-desire-component (Sum IDC). The combined score (Sum C) is given by the total of Sum A and Sum S. A Sum C of ≥11 indicates significant anxiety. Results: The mean age of participants was 38.03 years (SD=13.53 years). The mean total score of APAIS was 10.36 (4.06), of HADS was 5.734 (4.487) and of VAS was 3.156 (2.773). All scores were higher in participants <50 years. There were negative correlations between age and anxiety levels in VAS and APAIS scales; the Sum IDC in APAIS (r=-0.416, p=0.001) and VAS scores (r=-246, p=0.050) showed significant negative correlations. Excepting Sum IDC all APAIS, HADS and VAS scores were higher among the group without insurance; despite free healthcare. However only Sum S (t=-3.716, p=0.000) and Sum C (t=-2.281, p=0.026) in APAIS, HADS (t=-3.412, p=0.001) and VAS (t=-2.135, p=0.037) had statistically higher values. Anxiety scores were higher in the group that underwent minor surgeries but where not significantly related to education level, marital status, income, employment or living status. Conclusions: Pre-operative anxiety is common. Age <50 years, lacking insurance cover and undergoing minor surgeries are associated with increased pre-operative anxiety levels. Screening and appropriate interventions would be beneficial.
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Affiliation(s)
- Madura Jayawardane
- Senior Lecturer, Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Wedisha Gankanda
- Acting Consultant in Gynaecology and Obstetrics, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - Malsha Gunathilake
- Senior Registrar in Psychiatry, National Institute of Mental Health, Angoda, Sri Lanka
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Rajput SK, Tiwari T, Chaudhary AK. Effect of preoperative multimedia based video information on perioperative anxiety and hemodynamic stability in patients undergoing surgery under spinal anesthesia. J Family Med Prim Care 2021; 10:237-242. [PMID: 34017733 PMCID: PMC8132850 DOI: 10.4103/jfmpc.jfmpc_1544_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: Pre-anesthesia checkup (PAC) gives unique opportunity for providing necessary information, patient education and allaying anxiety. Our objective was to measure the effect of preoperative multimedia video information (self made short video of 12 minutes) on patient's anxiety and hemodynamic parameters during surgery under spinal anesthesia. Methods: This prospective randomized study was conducted in 80 patients of either sex with ASA physical status I and II posted for lower limb surgery under spinal anesthesia. Patents were randomized to control or test group. At the end of preoperative visit, patients in test group watched the film and patient in control group did not watch any video. Verbal briefing by the attending anesthesiologist on the day of surgery was given to all patients of both the groups. Anxiety using Amsterdam Preoperative Anxiety and Information Scale (APAIS) and hemodynamic parameters (SBP, DBP and HR) at various time intervals (A1: Baseline, A2: post intervention, A3: just before surgery, A4: after surgery) were measured. Results: Baseline anxiety (A1) scores were severe in both the groups and showed no statistical significance (P = 0.436). Patients in test group (video) showed better/lower anxiety levels than the control group (non video) at A2 (P = 0.020) and A3 (P = 0.005) respectively, similarly hemodynamic parameters were better controlled and showed lesser deviation from baseline values in test group as compared to control group and showed statistical significant difference (P < 0.001) just before surgery. Conclusion: Combination of multimedia based video information at the time of PAC and short verbal briefing on the day of surgery by the attending anesthesiologist provides effective management of perioperative anxiety. It can be cost effective way of enhancing patient care and providing adequate information to people with reading and comprehension difficulties.
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Affiliation(s)
- Sachin K Rajput
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay K Chaudhary
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
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Abd Hamid MH, Abdullah S, Ahmad AA, Narin Singh PSG, Soh EZF, Liu CY, Sapuan J. A Randomized Controlled Trial Comparing Wide-Awake Local Anesthesia With No Tourniquet (WALANT) to General Anesthesia in Plating of Distal Radius Fractures With Pain and Anxiety Level Perception. Cureus 2021; 13:e12876. [PMID: 33633905 PMCID: PMC7898937 DOI: 10.7759/cureus.12876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Distal end radius fractures are common fractures commonly treated with an option of open reduction and plating. Traditionally, plating is performed under general anesthesia (GA) or regional block. Recently, a new technique of plating under wide-awake local anesthesia with no tourniquet (WALANT) has been introduced. We aim to compare the preoperative anxiety level, intraoperative pain scores, post-operative pain scores, operating time, blood loss and clinical outcome of distal end radius plating with WALANT versus GA with tourniquet. METHODS We conducted a randomized controlled study on patients with closed fracture of the distal end of the radius requiring open reduction and plating from January 2019 till April 2020. We recruited 65 patients (33 patients in the WALANT group and 32 patients in the GA group). Randomization was done via block randomization. Data were collected to evaluate preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) score, intraoperative pain score during injection (baseline) (V1), 10 minutes after injection (V2), during incision (V3), during gentle manipulation (V4), during aggressive manipulation (V5) and during first drilling of screw (V6), blood loss, duration of surgery and post-operative pain score. Additionally, intraoperative visual analog scale (VAS) score was obtained in the WALANT group. At three weeks, six weeks, three months and six months after operation, the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores and range of motion (ROM) of the wrists were obtained. RESULTS The average age in the WALANT group was 47.19 (range, 36-64) years and GA group was 49.48 (range, 38-60) years. The mean APAIS score obtained was 7.78 (WALANT group) and 7.36 (GA group) with no statistical difference. For intraoperative VAS, only during V4 and V5 were the scores 1/10; otherwise at all other phases, the VAS score was 0. The average time for surgery was statistically longer in the WALANT group (61.22 minutes) compared to the GA group (55.33 minutes) (p = 0.003). There was no statistical difference in mean blood loss in both groups. The average post-operative VAS showed statistical significance only at 1 hour and 12 hours post-operation with no statistical difference at 2 and 24 hours post-operation. There was no difference in the post-operative ROM including wrist flexion, extension, supination and pronation for both groups up to six months' follow-up. CONCLUSION There was no statistically significant difference in terms of preoperative anxiety level, intraoperative and post-operative VAS score, amount of blood loss and clinical outcome in both groups for plating of the distal end radius. However, the operating time was slightly longer in the WALANT group. We conclude that distal radius plating under WALANT has similar outcomes to GA. In centres with limited resources, WALANT offers a safe, reliable and cheaper option, reserving GA time for head, abdominal and thoracic surgery.
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Affiliation(s)
- Mohd Hazim Abd Hamid
- Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Shalimar Abdullah
- Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Amir Adham Ahmad
- Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | | | - Elaine Zi Fan Soh
- Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Chian Yong Liu
- Anaesthesia, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Jamari Sapuan
- Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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Krampe H, Goerling U, Spies CD, Gerhards SK, Enge S, Salz AL, Kerper LF, Schnell T. Sense of coherence, mental well-being and perceived preoperative hospital and surgery related stress in surgical patients with malignant, benign, and no neoplasms. BMC Psychiatry 2020; 20:567. [PMID: 33246438 PMCID: PMC7693497 DOI: 10.1186/s12888-020-02953-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/15/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative stress, and to test for a statistical mediation by mental well-being. METHOD The sample consisted of 4918 patients from diverse surgical fields, of which 945 had malignant neoplasms, 333 benign neoplasms, and 3640 no neoplasms. For each subsample, we conducted simple mediation analyses to test an indirect effect of SOC on preoperative stress mediated by mental well-being. The models were adjusted for age, gender, and essential medical factors. RESULTS Patient groups did not differ significantly regarding degrees of SOC and mental well-being (SOC, M [SD]: 12.31 [2.59], 12.02 [2.62], 12.18 [2.57]; mental well-being M [SD]: 59.26 [24.05], 56.89 [22.67], 57.31 [22.87], in patients with malignant, benign, and without neoplasms, respectively). Patients without neoplasms reported significantly lower stress (4.19 [2.86], M [SD]) than those with benign (5.02 [3.03], M [SD]) and malignant neoplasms (4.99 [2.93], M [SD]). In all three mediation models, SOC had significant direct effects on stress, with higher SOC being associated with lower stress (- 0.3170 [0.0407], - 0.3484 [0.0752], - 0.2919 [0.0206]; c' [SE], p < 0.001 in patients with malignant, benign, and without neoplasms, respectively). In patients with malignant neoplasms and without neoplasms, SOC showed small indirect effects on stress that were statistically mediated by well-being. Higher SOC was related to higher well-being, which in turn was related to lower stress. In patients with benign neoplasms, however, no significant indirect effects of SOC were found. CONCLUSIONS SOC was directly associated with lower perceived hospital and surgery related stress, over and above the direct and mediation effects of mental well-being. Because the data are cross-sectional, conclusions implying causality cannot be drawn. Nevertheless, they indicate important relationships that can inform treatment approaches to reduce elevated preoperative stress by specifically addressing low SOC. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01357694 . Registered 18 May 2011.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Ute Goerling
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Sina K. Gerhards
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Sören Enge
- Department of Psychology, Faculty of Natural Sciences, Medical School Berlin, Berlin, Germany
| | - Anna-Lena Salz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Léonie F. Kerper
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Hospital Wolfenbuettel gGmbH, Wolfenbuettel, Germany
| | - Tatjana Schnell
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Norwegian School of Theology, Religion and Society, Oslo, Norway
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Milisen K, Van Grootven B, Hermans W, Mouton K, Al Tmimi L, Rex S, Detroyer E. Is preoperative anxiety associated with postoperative delirium in older persons undergoing cardiac surgery? Secondary data analysis of a randomized controlled trial. BMC Geriatr 2020; 20:478. [PMID: 33208091 PMCID: PMC7672929 DOI: 10.1186/s12877-020-01872-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Although many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor. The study aimed to investigate the association between preoperative anxiety and postoperative delirium in older patients undergoing cardiac surgery. Methods Secondary data analysis of a randomized, observer-blind, controlled trial. A total of 190 patients 65 years or older and admitted to the intensive care unit and cardiac surgery unit of a university hospital scheduled for elective on-pump cardiac surgery were included. State anxiety was measured preoperatively using the Amsterdam Preoperative Anxiety and Information Scale and the Visual Analogue Scale for anxiety. Incidence of delirium was measured during the first 5 postoperative days using the Confusion Assessment Method for Intensive Care Unit (when ventilated), or the 3 Minute Diagnostic Interview for Confusion Assessment Method (when extubated) and by daily chart review. Results Preoperative state anxiety was reported by 31% of the patients and 41% had postoperative delirium. A multiple step logistic regression analyses revealed no association between preoperative anxiety and postoperative delirium. Significant risk factors for postoperative delirium were age (OR = 1.10, 95% CI (1.03–1.18)), activities of daily living (0.69, 95% CI (0.50–0.96)), diabetes mellitus (OR = 3.15, 95% CI (1.42–7.00)) and time on cardiopulmonary bypass (OR = 1.01, 95% CI (1.00 to 1.02)). Conclusions No relationship could be found between preoperative anxiety and postoperative delirium.
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Affiliation(s)
- Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium. .,Department of Geriatric Medicine, KU Leuven - University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Wim Hermans
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
| | - Karen Mouton
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
| | - Layth Al Tmimi
- Department of Anesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Elke Detroyer
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.,Department of Geriatric Medicine, KU Leuven - University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
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Chan JJI, Yeam CT, Kee HM, Tan CW, Sultana R, Sia ATH, Sng BL. The use of pre-operative virtual reality to reduce anxiety in women undergoing gynecological surgeries: a prospective cohort study. BMC Anesthesiol 2020; 20:261. [PMID: 33036555 PMCID: PMC7547504 DOI: 10.1186/s12871-020-01177-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pre-operative anxiety is common and is associated with negative surgical outcomes. Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition and has been shown to be associated with lower levels of anxiety. In this study, we investigated changes in pre-operative anxiety levels before and after using VR in patients undergoing minor gynecological surgery. METHODS Patients who underwent elective minor gynecological surgeries in KK Women's and Children's hospital, Singapore were recruited. The VR intervention consisted of 10-min exposure via a headset loaded with sceneries, background meditation music and breathing exercises. For the primary outcome of pre-operative anxiety, patients were assessed at pre- and post-intervention using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes of self-reported satisfaction scores and EuroQol 5-dimension 3-level (EQ-5D-3L) were also collected. RESULTS Data analysis from 108 patients revealed that HADS anxiety scores were significantly reduced from 7.2 ± 3.3 pre-intervention to 4.6 ± 3.0 post-intervention (p < 0.0001). Furthermore, HADS depression scores were significantly reduced from 4.7 ± 3.3 pre-intervention to 2.9 ± 2.5 post-intervention (p < 0.0001). Eighty-two percent of the patients self-reported VR intervention as 'Good' or 'Excellent'. EQ-5D-3L showed significant changes in dimensions of 'usual activities' (p = 0.025), 'pain/discomfort' (p = 0.008) and 'anxiety/ depression' (p < 0.0001). CONCLUSIONS For patients undergoing minor gynecological procedures, the VR intervention brought about a significant reduction in pre-operative anxiety. This finding may be clinically important to benefit patients with high pre-operative anxiety without the use of anxiolytics. TRIAL REGISTRATION This study was registered on clinicaltrials.gov registry ( NCT03685422 ) on 26 Sep 2018.
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Affiliation(s)
- Jason Ju In Chan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, Singapore City, 229899, Singapore.,Duke-NUS Medical School, 8 College Road Singapore, Singapore City, 169857, Singapore
| | - Cheng Teng Yeam
- Duke-NUS Medical School, 8 College Road Singapore, Singapore City, 169857, Singapore
| | - Hwei Min Kee
- Division of Nursing, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, Singapore City, 229899, Singapore.,Duke-NUS Medical School, 8 College Road Singapore, Singapore City, 169857, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore City, Singapore
| | - Alex Tiong Heng Sia
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, Singapore City, 229899, Singapore.,Duke-NUS Medical School, 8 College Road Singapore, Singapore City, 169857, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, Singapore City, 229899, Singapore. .,Duke-NUS Medical School, 8 College Road Singapore, Singapore City, 169857, Singapore.
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Wu LP, Kang WQ. Effect of dexmedetomidine for sedation and cognitive function in patients with preoperative anxiety undergoing carotid artery stenting. J Int Med Res 2020; 48:300060520938959. [PMID: 32972265 PMCID: PMC7522831 DOI: 10.1177/0300060520938959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective This study was performed to examine the effect of dexmedetomidine for intraoperative sedation and postoperative cognitive function in patients with preoperative anxiety undergoing carotid artery stenting. Methods Eighty patients were randomly divided into two groups: the dexmedetomidine group and the control group. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale. Routine monitoring indices were recorded during surgery, and cognitive function indices were recorded before drug infusion (T0), 10 minutes after drug infusion (T1), at the end of surgery (T2), and 6 hours after surgery (T3). Results The anxiety scores were not significantly different between the two groups at T0, but they became significantly different at T1–3. The MMSE scores in both groups increased at 1 and 7 days postoperatively; although the increase in the dexmedetomidine group was sharper, there was no significant difference. In both groups, the MMSE scores at 1 and 7 days after surgery were not significantly different from those at 1 day before surgery. Conclusion Dexmedetomidine can improve patients’ anxiety and achieve a sufficient sedation effect without causing postoperative cognitive dysfunction.
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Affiliation(s)
- Liu-Ping Wu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong City, Jiangsu, China
| | - Wen-Qing Kang
- Department of Geriatrics, Yidu Central Hospital of Weifang, Weifang, Shandong, China
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Menéndez-Nieto I, Peñarrocha-Diago M, Cervera-Ballester J, Peñarrocha-Diago M, Peñarrocha-Oltra D. Efficacy of infiltrative local anesthesia and inferior alveolar nerve block in periapical surgery of lower premolars and molars: A preliminary report. J Clin Exp Dent 2020; 12:e581-e587. [PMID: 32665818 PMCID: PMC7335601 DOI: 10.4317/jced.56278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/08/2020] [Indexed: 11/08/2022] Open
Abstract
Background The aims of this study were: 1) compare the amount of anesthesia used with the anesthetic technique; 2) relate the quantity of anesthesia needed with the level of anxiety of the patient; 3) study the relationship between the anesthetic technique and the level of hemostasis; 4) correlate the amount of anesthesia with patient and tooth dependent variables.
Material and Methods A randomized controlled trial was designed with two parallel groups according to the anesthetic technique: infiltrative local anesthesia (infiltrative group) and inferior alveolar nerve block (block group). The following variables were collected: sex, age, smoking habits, plaque index, symptoms, signs, position of the tooth and amount of anesthesia. Before surgery, all patients were asked to assess their anxiety on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The analysis of the hemorrhage control of aluminum chloride was judged by the surgeon and two examiners independently and recorded it as: 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control).
Results Twenty patients were included in this preliminary report. The amount of anesthesia used was lower in block group and in less anxious patients, although these results did not reach statistical significance. A relationship was found between the quantity of anesthesia used and a good hemostasis of the bony crypt before the application of the hemostatic agent (p<.05); and between elderly patients and a lower amount of anesthetic reinforcement (p<.05).
Conclusions Based on these preliminary results, we can conclude that no statistical significance difference was found between the amount of anesthesia used and the anesthetic technique or the anxiety. A relationship was found between hemostasis of the bony crypt and the quantity of anesthesia used; and between younger patients and a greater amount of anesthetic reinforcement. Key words:Anesthesia, anxiety, endodontic surgery, hemostasis, hemostatic agents,periradicular surgery.
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Affiliation(s)
- Isabel Menéndez-Nieto
- Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Miguel Peñarrocha-Diago
- Chairman of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Juan Cervera-Ballester
- Collaborating Professor of the Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - María Peñarrocha-Diago
- Full Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - David Peñarrocha-Oltra
- Assistant Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
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