Preoperational anxiety

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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]

Contents

Measuring preoperative anxiety

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]

Causes of anxiety

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] [ needs update ]

Effects of preoperative anxiety

Physiological effects

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]

Psychological effects

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]

Effects

Preparation for surgery

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]

Post-operation

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

Treatment of preoperative anxiety may include:

Related Research Articles

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<span class="mw-page-title-main">Anesthesia</span> State of medically-controlled temporary loss of sensation or awareness

Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. An individual under the effects of anesthetic drugs is referred to as being anesthetized.

<span class="mw-page-title-main">General anaesthesia</span> Medically induced loss of consciousness

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Postoperative nausea and vomiting (PONV) is the phenomenon of nausea, vomiting, or retching experienced by a patient in the post-anesthesia 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.

Nothing by mouth is an American medical instruction meaning to withhold food and fluids. It is also known as nil per os, a Latin phrase that translates to English as "nothing through the mouth". Nil by mouth is the term used in the UK (NBM), nihil/non/nulla per os, or complete bowel rest. A liquid-only diet may also be referred to as bowel rest.

<span class="mw-page-title-main">Knee replacement</span> Surgical procedure

Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.

A post-anesthesia care unit (PACU) and sometimes referred to as post-anesthesia recovery or PAR, or simply recovery, is a 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, 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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<span class="mw-page-title-main">Phantom eye syndrome</span> Medical condition

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The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are:

  1. Healthy person.
  2. Mild systemic disease.
  3. Severe systemic disease.
  4. Severe systemic disease that is a constant threat to life.
  5. A moribund person who is not expected to survive without the operation.
  6. A declared brain-dead person whose organs are being removed for donor purposes.

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<span class="mw-page-title-main">Dental fear</span> Medical condition

Dental fear, or dentophobia, is a normal emotional reaction to one or more specific threatening stimuli in the dental situation. However, dental anxiety is indicative of a state of apprehension that something dreadful is going to happen in relation to dental treatment, and it is usually coupled with a sense of losing control. Similarly, dental phobia denotes a severe type of dental anxiety, and is characterised by marked and persistent anxiety in relation to either clearly discernible situations or objects or to the dental setting in general. The term ‘dental fear and anxiety’ (DFA) is often used to refer to strong negative feelings associated with dental treatment among children, adolescents and adults, whether or not the criteria for a diagnosis of dental phobia are met. Dental phobia can include fear of dental procedures, dental environment or setting, fear of dental instruments or fear of the dentist as a person. People with dental phobia often avoid the dentist and neglect oral health, which may lead to painful dental problems and ultimately force a visit to the dentist. The emergency nature of this appointment may serve to worsen the phobia. This phenomenon may also be called the cycle of dental fear. Dental anxiety typically starts in childhood. There is the potential for this to place strains on relationships and negatively impact on employment.

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Kinesiophobia is the fear of pain due to movement.

Perioperative nursing is a nursing specialty that works with patients who are having operative or other invasive procedures. Perioperative nurses work closely with surgeons, anaesthesiologists, nurse anaesthetists, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, and postoperative care primarily in the operating theatre.

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.

Emergence delirium is a condition in which emergence from general anesthesia is accompanied by psychomotor agitation. Some see a relation to pavor nocturnus while others see a relation to the excitement stage of anesthesia.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Pritchard Michael John (2009). "Identifying and assessing anxiety in pre-operative patients". Nursing Standard. 23 (51): 35–40. doi:10.7748/ns2009.08.23.51.35.c7222. PMID   19753776.
  2. 1 2 3 4 Brown Roger L., Tluczek Audrey, Henriques Jeffrey B. (2009). "Support for the Reliability and Validity of a Six-Item State Anxiety Scale Derived From the State-Trait Anxiety Inventory". Journal of Nursing Measurement.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. 1 2 3 Bajaj, A. et al. "Pre-operative Anxiety" Anaethesia. 51 (1996):344-346. EBSCO. Web. September 2009.
  4. 1 2 3 4 5 6 Carr Eloise; et al. (2006). "Patterns and frequency of anxiety in women undergoing gynaecological surgery" (PDF). Journal of Clinical Nursing. 15 (3): 341–352. doi:10.1111/j.1365-2702.2006.01285.x. PMID   16466484.
  5. 1 2 3 4 5 Dirik G., Karanci A.N. (2003). "Predictors of Pre- and Postoperational Anxiety in Emergency Surgery Patients". Journal of Psychosomatic Research. 55 (4): 363–369. doi:10.1016/S0022-3999(02)00631-1. PMID   14507548.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Janis, Irving L. Psychological Stress: Psychoanalytic and Behavioral Studies of Surgical Patients. Hoboken, NJ, US: John Wiley & Sons Inc, 1958. Web. Dec. 2009.
  7. ↑ Agarwal A; et al. (2005). "Acupressure for prevention of pre-operative anxiety: a prospective, randomised, placebo controlled study". Anaesthesia. 60 (10): 978–981. doi: 10.1111/j.1365-2044.2005.04332.x . PMID   16179042. S2CID   21158736.
  8. ↑ Lepczyk, Marybeth; Raleigh Edith, Hunt; Rowley, Constance (1990). "Timing of preoperative patient teaching". Journal of Advanced Nursing. 15 (3): 300–306. doi:10.1111/j.1365-2648.1990.tb01817.x. hdl: 2027.42/73141 . PMID   2332553.
  9. ↑ Madsen BK, Zetner D, Møller AM, Rosenberg J (December 8, 2020). "Melatonin for preoperative and postoperative anxiety in adults". Cochrane Database of Systematic Reviews. 2020 (12): CD009861. doi:10.1002/14651858.CD009861.pub3. PMC   8092422 . PMID   33319916.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ↑ "Review finds little evidence to support gabapentinoid use in bipolar disorder or insomnia". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2022-10-17. doi:10.3310/nihrevidence_54173. S2CID   252983016. Archived from the original on 2024-06-04.
  11. ↑ Hong JS, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, et al. (March 2022). "Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale". Molecular Psychiatry. 27 (3): 1339–1349. doi:10.1038/s41380-021-01386-6. PMC   9095464 . PMID   34819636.
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