The Effect of Head Massage on Preoperative Anxiety Levels in Women Candidates for Cesarean Section: A Randomized Controlled Trial

BACKGROUND:Although surgical techniques have been improving, preoperative anxiety is still a challenge in preoperative care and is known as an expected response experienced by patients waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three educational hospitals in Kerman.MATERIALS AND METHODS:This cross-sectional study was conducted in three educational hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from each hospital (300 patients in sum) who were selected through the convenience sampling method. Sampling was not restricted to sex and type of surgery. The 40-item Spielberger State-Trait Anxiety Inventory was administered to the patients to assess the level of preoperative anxiety experienced by them. Bivariate linear regression models were used to compare the preoperative state anxiety levels based on the patients' demographic information. A multivariate linear regression model was used to determine the predictors of preoperative state anxiety.RESULTS:The participants were 149 males and 151 females with a mean age of 36.38 (12.75) years (age range: 12–79 years). Almost two-third of the patients showed upper-middle symptoms of state anxiety (n = 197, 65.7%) followed by upper-middle symptoms of trait anxiety (40% and 49.3%, respectively). There was a significant relationship between the patient's sex and state anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62; P ≤ 0.001).CONCLUSION:The results of the present study confirmed the presence of preoperative anxiety in a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention and training programs to control and reduce preoperative anxiety among patients seems essential.

Aims: In this study, it was aimed to determine preoperative anxiety levels, related factors, the relationship between health literacy and anxiety in parents of pediatric patients. Methods: This descriptive cross-sectional study was conducted on the parents of children who will be operated in a tertiary hospital between 15 June and 15 September 2022. The number of 82 people were included in the study. Information form introducing children and families, Health Literacy Scale(HLS), State Trait Anxiety Inventory(STAI) questionnaires were applied to parents. p<0.05 was considered significant in statistical analysis. Results: The state anxiety score of the parents participating in the study was 37.51±9.50, trait anxiety score was 42.55±8.83, HLS 45.46±14.34. Preoperative state anxiety level of mothers(39.63±9.97) was higher than that of fathers(34.36±8.71)(p=0.040), trait anxiety level was similar(p=0.189), mothers' health literacy(40.36±11.11) was found to be lower (48.11±15.19) than fathers(p=0.019). The state anxiety level of parents whose income is equal to expenditure was found to be the lowest(33.43±7.33)(p<0.001). While the state anxiety score was found to be significantly lower(p=0.024), the trait anxiety score was similar(p=0.560) and the health literacy score was higher(p=0.042), among the parents who had knowledge about anesthesia. The relationship between state anxiety score and health literacy score was negative and significant(p<0.001). Conclusion: It is seen that the anxiety levels of parents with low health literacy increase before the surgery. It is important to know the factors related to the anxiety levels of the parents before the surgery.

Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study

Background: Preoperative anxiety is a very important factor in pediatric surgery; 40% - 60% of children experience a high level of anxiety in the preoperative period. Objectives: Given the need for anxiety control in children and considering that limited studies have been conducted in this regard, this research was performed to compare the effect of oral zolpidem and midazolam on level of preoperative anxiety in children. Methods: In a prospective double-blind randomized controlled trial, 56 cases were randomly divided into two groups of 28 participants. A group underwent zolpidem premedication and the other underwent midazolam premedication. The level of preoperative and postoperative anxiety was measured by MYPAS SCORE checklist and compared. Results: The study comprised 56 patients (19 girls and 37 boys) aged between 3 - 9 years. The mean score of anxiety in the group receiving midazolam was 63.80 in pre-test and 32.61 in post-test (P < 0.001). The mean score of anxiety in the group receiving zolpidem was 62.49 in pre-test and 30.94 in post-test (P < 0.001). Mean anxiety in the patients of zolpidem group was lower than that in midazolam group (P < 0.001). Conclusions: Our results show that both zolpidem and midazolam reduce preoperative anxiety, however, the preoperative anxiety was significantly decreased after taking zolpidem in comparison with midazolam. Zolpidem is a hypnotic drug with rapid onset and short duration of action, which might be an alternative premedication for midazolam in pediatric anesthesia, particularly when the reduced anxiety and child cooperation are needed.

Objective. To assess the factors related to perioperative state anxiety in paediatric patients and their parents. Methods. A cohort study was conducted on paediatric patients 9–17 years of age, who underwent the modified Ravitch procedure (n = 96), and their parents (n = 96). The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Multivariable linear regression models were calculated to find the relationships between the pre- and postoperative state anxiety of the patients/parents and the independent variables, both demographic (age, gender) and clinical (e.g., postoperative pain, trait anxiety). Results. Preoperative anxiety in the paediatric patients was positively correlated with their trait anxiety (β = 0.47; 95% CI: 0.29 to 0.64) and preoperative parental anxiety (β = 0.24; 95% CI: 0.07 to 0.42). The high level of preoperative anxiety (vs. low and moderate) (β = 0.40; 95% CI: 0.22 to 0.58), trait anxiety (β = 0.22; 95% CI: 0.04 to 0.40) and average postoperative pain at rest (β = 0.18; 95% CI: 0.01 to 0.34) had a positive impact on the postoperative anxiety in patients. However, the patients’ age was negatively correlated with postoperative anxiety (β = −0.19; 95% CI: −0.35 to −0.02). Three variables were found to predict preoperative parental anxiety: their trait anxiety (β = 0.41; 95% CI: 0.23 to 0.59), female gender (β = 0.18; 95% CI: 0.002 to 0.36) and the intravenous route for the postoperative pain management in the patients (β = −0.18; 95% CI: −0.36 to −0.001). The parental postoperative anxiety was influenced by their trait anxiety (β = 0.24; 95% CI: 0.04 to 0.43), preoperative anxiety in patients (β = 0.21; 95% CI: 0.02 to 0.40) and female gender of children (β = 0.19; 95% CI: 0.001 to 0.39). Conclusions. Trait anxiety was a strong factor positively affecting the perioperative state anxiety. In addition, paediatric patient anxiety before surgery was related to their parents’ anxiety, and, after surgery, this was associated with high preoperative anxiety, pain and age. The parents’ anxiety before surgery was influenced by gender and the type of postoperative analgesia in the patients, while, after surgery, this was influenced by the patients’ preoperative anxiety/gender.

Although some findings indicate that yoga can reduce stress and anxiety, many studies present mixed results. The potential of yoga interventions to alleviate anxiety, including the mechanisms and boundary conditions by which it does so, is an under-researched topic. Anxiety is often divided into "state anxiety" and "trait anxiety," the former being a temporary reaction to stressful events, while the latter is a more stable personality feature that responds to adverse situations or perceived threats. This study investigates whether a yin yoga intervention delivered online reduces state anxiety immediately after each yoga session and whether the anxiety levels are significantly lower at the end of the 10-week yoga intervention than at the beginning of the study. We also predicted no effect of yin yoga intervention on trait anxiety. The study was conducted during the COVID-19 pandemic when participants (N = 48 Latvian women) experienced heightened anxiety levels. This study shows that a ten-week online yin yoga intervention significantly reduced state anxiety in the intervention group compared with the control group. State anxiety levels also significantly decreased after each yin yoga session, providing more support for the anxiety-reducing effect of yin yoga. In contrast, yoga participation did not cause differences in trait anxiety between the control and intervention groups, even though trait anxiety decreased in the intervention group and increased in the control group over the study period. The positive effects of yin yoga on state anxiety indicate the potential of yin yoga intervention as a first-line treatment to control and reduce state anxiety, with possible additional effects on trait anxiety.

The Impact of Family Engagement on Anxiety Levels in a Cardiothoracic Intensive Care Unit.

Childhood trauma is a well-known source of lifelong anxiety and various personality disorders. Also preoperative anxiety is related with perioperative physical and physicological responses. The aim of this study was to investigate possible relationship A‚–which has not been studied yet- between having a childhood trauma history and preoperative anxiety levels. A total of 190 patients (aged between 18-65) with a history of childhood trauma presenting for different types of surgery were investigated prospectively using the Childhood Trauma Questionnaire (CTQ). A childhood trauma questionnaire total score of ≥35 points was accepted as an indicator of significant childhood trauma history. Preoperative and postoperative anxiety levels of patients were assessed using State Trait Anxiety Inventory (STAI). Also relationship between childhood trauma types (physical, emotional neglect/abuse, sexual abuse) and pre-postoperative State Trait Anxiety Inventory levels were evaluated. Correlations between several factors that might effect preoperative anxiety levels including such as; gender, type of surgery, type of anesthesia, educational and maritial levels of patients with or without a childhood trauma history were investigated. We found significant correlations between higher Childhood Trauma Questionnaire scores and increased preoperative State Trait Anxiety Inventory trait and state scores (p

ObjectiveTo investigate the association between preoperative anxiety level and ciprofol consumption in patients undergoing surgical abortion.MethodsA total of 144 patients scheduled for surgical abortion were enrolled and completed both the State–Trait Anxiety Inventory (STAI) and the Self-Rating Anxiety Scale (SAS). Anesthesia was induced with 5 μg/kg alfentanil and 0.3 mg/kg ciprofol. Additional ciprofol (0.1 mg/kg each) was administered as needed to maintain adequate anesthetic depth. The primary outcomes were the total ciprofol dose and State Anxiety (S-STAI) score. Secondary outcomes included the Trait Anxiety (T-STAI) and SAS scores, induction time, awakening time, baseline hemodynamic profiles, and the incidence of adverse events.ResultsPreoperative anxiety levels (S-STAI) were weakly and positively associated with total ciprofol dose (rs = 0.216, 95%CI [0.049, 0.371], p = 0.009), induction time (rs = 0.312, 95%CI [0.1521, 0.4567], p < 0.001), baseline heart rate (HR) (rs = 0.321, 95%CI [0.1611, 0.4640], p < 0.001), and mean arterial pressure (MAP) (rs = 0.213, 95%CI [0.04579, 0.3676], p = 0.011). No significant association was observed between preoperative anxiety and awakening time (rs = −0.156, 95%CI [−0.3163, 0.01239], p = 0.062). Furthermore, after multivariate linear regression analysis considering confounding factors, preoperative anxiety remained a statistically significant, though modest, independent variable associated with total ciprofol dose (β = 0.187, 95%CI [0.089, 0.285]). Subgroup analysis showed a significant overall difference in total ciprofol dose (p = 0.032) and baseline MAP (p = 0.044) across anxiety groups, although pairwise comparisons were not statistically significant. Baseline HR was higher in both moderate and severe anxiety groups, while induction time was longer only in the moderate-anxiety group, compared with the mild-anxiety group. The incidence of adverse events did not differ significantly among the groups (all p > 0.05).ConclusionPreoperative anxiety showed a modest association with ciprofol requirements and induction time. These results indicate that anxiety may be a relevant factor to consider during sedation management for surgical abortion.Clinical trial registrationChiCTR2500108366 (Chinese Clinical Trial Registry, www.chictr.org.cn).

The Autonomous Sensory Meridian Response (ASMR) is an intensely pleasant tingling sensation originating in the scalp and neck and is elicited by a range of online video-induced triggers. Many individuals now regularly watch ASMR videos to relax, and alleviate symptoms of stress and insomnia, all which are indicative of elevated levels of anxiety. Emerging literature suggests that ASMR-capable individuals are characterised by high trait neuroticism, which is associated with a tendency to experience negative emotional states such as anxiety. To date however no literature has empirically linked these personality constructs and watching ASMR videos on the effect of reducing anxiety. In the current study, 36 ASMR-experiencers and 28 non-experiencers watched an ASMR video, and completed assessments of neuroticism, trait anxiety, and pre- / post-video state anxiety. MANCOVA with Group as the independent measures factor showed that ASMR-experiencers had significantly greater scores for neuroticism, trait anxiety, and video engagement than non-experiencers. Pre-video state anxiety was also significantly greater in the ASMR-experiencers and was significantly attenuated on exposure to the ASMR video, whereas non-experiencers reported no difference in state anxiety pre- and post-video. Thus, watching ASMR alleviated state anxiety but only in those who experienced ASMR. Subsequent mediation analyses identified the importance of pre-existing group differences in neuroticism, trait and (pre-video) state anxiety in accounting for the group difference in the reduction of state anxiety. The mediation analysis further lends support for watching ASMR videos as an intervention for the reduction of acute state anxiety. Future areas for research are discussed.

Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity

To assess the preoperative depression and anxiety levels of the patients undergoing liver transplantation (LT). Zung self-rating depression scale (SDS) and Zung self-rating anxiety scale (SAS) were used to assess the preoperative depression and anxiety levels of 40 patients undergoing LT, 40 patients with gastrointestinal cancer, and 40 patients undergoing cholecystectomy. The preoperative anxiety levels of the patients undergoing LT, with gastrointestinal cancer, and undergoing cholecystectomy were all significantly higher than that of the national norm (all P < 0.01), without significant differences among the 3 groups of patients. The depression level of the patients undergoing LT was significantly higher than those of the national norm, and the patients with gastrointestinal cancer and undergoing cholecystectomy (all P < 0.01). There were not significant differences in the preoperative depression and anxiety levels between the patients with gastrointestinal cancer and those undergoing cholecystectomy. The depressive rate of the patients undergoing LT was 40.0% (16/40), significantly higher than those of cholecystectomy group (17.5%) and cancer resection group (15.0%), and the depression score of the 6 female patients undergoing LT was 53, significantly higher than that of the male patients in the same group (P < 0.01). There was no significant differences in the depression and anxiety levels between the patients undergoing living donor liver transplantation (LDLT) and the patients undergoing orthotopic liver transplantation (OLT). Educational level was not correlated with the preoperative anxiety and depression levels. Patients scheduled for LT have high risks of preoperative depression and anxiety, especially the former. Suitable pre-medication, optimal psychosocial assessment, and treatment, especially for the female patients, are needed.

ObjectiveImproving quality of life (QOL) after surgery is very important. Recently, preoperative anxiety has been suggested to predict postoperative health-related (HR) QOL, however the accuracy of anxiety measurement remains problematic. We examined the relationship between preoperative anxiety level and postoperative HRQOL using qualitative and quantitative assessment of anxiety.MethodWe used a detailed anxiety assessment to quantitatively investigate preoperative anxiety as a predictor of postoperative HRQOL in lung cancer patients. Fifty one patients who underwent surgery for lung cancer were included. They were assessed four times: on admission, on discharge, 1 month after surgery, and 3 months after surgery. Anxiety was measured separately as “state anxiety” and “trait anxiety” using the State–Trait Anxiety Inventory, and HRQOL was measured using the EuroQol 5 dimension 5-level.ResultsThe HRQOL decreased at discharge and gradually recovered over time, reaching the same level at 3 months after surgery as at admission. HRQOL score was lower at discharge than at pre-surgery and 3 months after the surgery (p < 0.0001 each), and the score at 1 month after the surgery was lower than at pre-surgery (p = 0.007). In addition, multiple regression analysis showed that HRQOL at discharge was associated with “state anxiety” rather than “trait anxiety” at admission (p = 0.004).ConclusionThis study identifies the types of anxiety that affect postoperative HRQOL. We suggest that postoperative HRQOL on discharge may be improved by interventions such as psychological or medication treatment for preoperative state anxiety if identified preoperative state anxiety can be managed appropriately.

Objective: The study was conducted to determine the preoperative and postoperative anxiety levels, and their causes, in patientswho underwent coronary artery bypass graft (CABG) surgery. Material and Methods: A total of 111 patients who underwent CABGsurgery in the cardiovascular surgery department of a state hospital in the Turkish Republic of Northern Cyprus between August 1, 2019 and August 24, 2020 were included. The patient questionnaire prepared by the researcher and State-Trait Anxiety Inventory were used as data collection tools. Results: The mean preoperative state anxiety (pretest) score of the patients was 44.39±10.12, and the mean trait anxiety (pretest) score was 38.85±7.47. The mean state anxiety (posttest) score after surgery was 44.12±9.02, and the mean trait anxiety (posttest) score was 40.79±6.81. There were no statistically significant differences between the preoperative and postoperative state anxiety scale scores of the patients (p>0.05), and a significant difference was found between the trait anxiety scale scores (p<0.05), and the postoperative trait anxiety scores were found to be high. Conclusion: According to the research results, the patients' postoperative trait anxiety scale scores were found to be high. During the planning of nursing care process, it can be suggested to address the anxiety levels of the patients, and provide planned training to each patient, and make appropriate nursing interventions to reduce their stress.

The Autonomous Sensory Meridian Response (ASMR) is an intensely pleasant tingling sensation originating in the scalp and neck and is elicited by a range of online video-induced triggers. Many individuals now regularly watch ASMR videos to relax, and alleviate symptoms of stress and insomnia, all which are indicative of elevated levels of anxiety. Emerging literature suggests that ASMR-capable individuals are characterised by high trait neuroticism, which is associated with a tendency to experience negative emotional states such as anxiety. To date however no literature has empirically linked these personality constructs and watching ASMR videos on the effect of reducing anxiety. In the current study, 36 ASMR-experiencers and 28 non-experiencers watched an ASMR video, and completed assessments of neuroticism, trait anxiety, and pre- / post-video state anxiety. MANCOVA with Group as the independent measures factor showed that ASMR-experiencers had significantly greater scores for neuroticism, trait anxiety, and video engagement than non-experiencers. Pre-video state anxiety was also significantly greater in the ASMR-experiencers and was significantly attenuated on exposure to the ASMR video, whereas non-experiencers reported no difference in state anxiety pre- and post-video. Thus, watching ASMR alleviated state anxiety but only in those who experienced ASMR. Subsequent mediation analyses identified the importance of pre-existing group differences in neuroticism, trait and (pre-video) state anxiety in accounting for the group difference in the reduction of state anxiety. The mediation analysis further lends support for watching ASMR videos as an intervention for the reduction of acute state anxiety. Future areas for research are discussed.