Preoperational anxiety, or preoperative anxiety, is a common reaction experienced by patients who are admitted to a hospital for surgery. [1] It can be described as an unpleasant state of tension or uneasiness that results from a patient's doubts or fears before an operation. [1]
The State-Trait Anxiety Inventory (STAI) is a widespread method of measuring preoperative anxiety for research purposes. It consists of two 20-item scales on which patients are asked to rate particular symptoms. [2]
The STAI is based on the theory that there are two distinct aspects of anxiety. The State scale is designed to measure the circumstantial or temporary arousal of anxiety, and the Trait scale is designed to measure longstanding personality characteristics related to anxiety. The items on each scale are based on a two-factor model: "anxiety present" or "anxiety absent". [2]
In a 2009 paper in TheJournal of Nursing Measurement, researchers argued that fast-paced hospital environments make it difficult to get each patient through all 20 items, especially when other assessments must also be done. [2] Shorter versions of the STAI have been developed. For example, Marteau and Bekker's six-item version of the State scale was found in 2009 to have "favorable internal consistency reliability and validity when correlated with the parent 20-item State scale". [2]
A variety of fears can cause preoperative anxiety. They include fear of:
Other factors in the intensity of preoperative anxiety are:
Irving Janis separates the factor trends that are commonly seen affecting anxiety into three different levels: [6]
Anxiety can cause physiological responses such as tachycardia, hypertension, elevated temperature, sweating, nausea, and a heightened sense of touch, smell, or hearing. [1] [3]
A patient may also experience peripheral vasoconstriction, which makes it difficult for the hospital staff to obtain blood. [1]
Anxiety may cause behavioral and cognitive changes that result in increased tension, apprehension, nervousness, and aggression. [1]
Some patients may become so apprehensive that they cannot understand or follow simple instructions. Some may be so aggressive and demanding that they require constant attention of the nursing staff. [1]
In research conducted by Irving Janis, common reactions and strategies were separated into three different levels of preoperative anxiety:
Low anxiety
Patients in this category tend to adopt a joking attitude or to say things like "there's nothing to it!" Because most pain is not preconceived by the patient, the patients tends to blame their pain on the hospital staff. [6] In this case, the patient feels as if they have been mistreated. This is because the patient doesn't have the usual mindset that pain is an unavoidable result of an operation. [6]
Other trends include displaying a calm and relaxed attitude during preoperative care. They don't usually experience any sleeping disturbances. [6] They also tend to make little effort to seek more information about medical procedures. This may be due to the fact that they are unaware of the potential threats, or it may just be because they have succeeded in shutting themselves out and eliminating all thought of doubt and fear. [6]
The main concern that low anxiety patients tend to express is finances, and they usually deny apprehension about operational dangers. [6]
Moderate anxiety
Patients in this category may only experience minor emotional tension. The occasional worry or fear that is experienced by a patient with moderate anxiety can usually be suppressed. [6]
Some may develop insomnia, but they also usually respond well to mild sedatives. Their outward manner may seem relatively calm and well controlled, except for small moments where it is apparent to others that the patient is suffering from an inner conflict. They can usually perform daily tasks, only becoming restless from time to time. [6]
These patients are usually very motivated to develop reliable information from medical authority in order to reach a point of comfortable relief. [6]
High anxiety
Patients in this category will usually try to reassure themselves by seeking information, but these attempts, in the long-run, are unsuccessful at helping the patient reach a comfortable point because the fear is so dominant. [6]
It is common for patients in this level of anxiety to engage in mentally distracting activities in an attempt to get their mind off of anticipated danger. They have a hard time idealizing their situation or maintaining any sort of conception that things could turn out well in the end. This because they tend to dwell on improbable dangers. [6]
On the positive side, if a patient experiences moderate amounts of anxiety, the anxiety can aid in the preparation for surgery. [1] On the negative side, the anxiety can cause harm if the patient experiences an excessive or diminutive amount. One reason for this is that small amounts of anxiety will not adequately prepare the patient for pain. [1] Also, higher levels of anxiety can over-sensitize the patient to unpleasant stimuli, which would heighten their senses of touch, smell or hearing. This results in intense pain, dizziness, and nausea. It can also increase the patient's feelings of uneasiness in the unfamiliar surroundings. [4]
Anxiety has also been proven to cause higher analgesic and anaesthetic requirement, postoperative pain, and prolonged hospital stay. [7]
Irving L. Janis separates the effects of preoperative anxiety on postoperative reactions into three levels: [6]
Treatment of preoperative anxiety may include:
Surgery is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas.
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Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory, it is also possible for the victim to have awareness with explicit recall, where victims can remember the events related to their surgery.
Postoperative nausea and vomiting (PONV) is the phenomenon of nausea, vomiting, or retching experienced by a patient in the postanesthesia care unit (PACU) or within 24 hours following a surgical procedure. PONV affects about 10% of the population undergoing general anaesthesia each year. PONV can be unpleasant and lead to a delay in mobilization and food, fluid, and medication intake following surgery.
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A post-anesthesia care unit, often abbreviated PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery, is a vital part of hospitals, ambulatory care centers, and other medical facilities. Patients who received general anesthesia, regional anesthesia, or local anesthesia are transferred from the operating room suites to the recovery area. The patients are monitored typically by anesthesiologists, certified registered nurse anesthetists, and other medical staff. Providers follow a standardized handoff to the medical PACU staff that includes, which medications were given in the operating room suites, how hemodynamics were during the procedures, and what is expected for their recovery. After initial assessment and stabilization, patients are monitored for any potential complications, until the patient is transferred back to their hospital rooms.
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The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and postoperative, though it is a term most often used for the first and third of these only - a term which is often specifically utilized to imply 'around' the time of the surgery. The primary concern of perioperative care is to provide better conditions for patients before operation and after operation.
Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, spinal muscular deconditioning and even Cutibacterium acnes infection. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.
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The State-Trait Anxiety Inventory (STAI) is a psychological inventory consisting of 40 self-report items on a 4-point Likert scale. The STAI measures two types of anxiety – state anxiety and trait anxiety. Higher scores are positively correlated with higher levels of anxiety. Its most current revision is Form Y and it is offered in more than 40 languages.
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Driving phobia, driving anxiety, vehophobia, or driving-related fear (DRF) is a pathological fear of driving. It is an intense, persistent fear of participating in car traffic that affects a person's lifestyle, including aspects such as an inability to participate in certain jobs due to the pathological avoidance of driving. The fear of driving may be triggered by specific driving situations, such as expressway driving or dense traffic. Driving anxiety can range from a mild cautious concern to a phobia.
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