High Level Of Preoperative Anxiety Research Articles

Pre-Operative Anxiety Related to Major Urogynecologic Surgery: Insights from Perioperative Survey Data in Maine

Background: Higher levels of pre-operative anxiety are associated with adverse outcomes according to the cardiothoracic and orthopedic literature on emergent surgeries. There are limited data on pre-operative anxiety levels in the gynecologic setting. This study sought to identify predictive variables for high pre-operative anxiety levels in patients undergoing major urogynecologic surgery. Methods: Pre- and post-operative surveys that included demographic data, a modification of the Amsterdam Pre-Operative Anxiety and Information Scale, and open-ended questions regarding anxiety were administered. Descriptive, univariate and multivariate analyses were used to analyze the quantitative elements of the survey data. The qualitative components of the survey data were coded and analyzed using thematic analyses. Results: A total of 54 participants completed the pre-operative survey. The median age was 62 years old, and the majority were employed (n = 34, 60.7%). Roughly 1/3 had been diagnosed with a mental health condition (n = 19, 33.9%) and nearly all had other health conditions (n = 51, 91%). The baseline APAIS score ranged from 9 to 40, with higher scores reflecting higher levels of pre-operative anxiety. The median APAIS score was 24, with a score equal to or greater than 30 being in the highest tertile. Conclusion: No associations were made between the variables and pre-operative anxiety levels. However, useful insights into our patient population were made.

Hypnosis as an alternative to general anaesthesia for paediatric superficial surgery: a randomised controlled trial

BackgroundReducing perioperative anxiety and controlling pain in children are essential to optimise recovery and outcomes for both children and their parents. By acting on sensory and affective modulation of anxiety and pain, hypnosis is widely used in medical care, especially in anaesthesia. This randomised controlled clinical trial was designed to compare general anaesthesia and intraoperative hypnosis support for perioperative management of children undergoing superficial surgery. MethodsChildren aged 7–16 yr scheduled for day-case superficial surgery were included and randomly assigned to one of the following two groups: general anaesthesia group or hypnosis group. The primary outcome was length of hospital stay. Child and parent anxiety, child pain, and the occurrence of postoperative negative behavioural changes were also evaluated. ResultsSixty children of mean age 10.3 (standard deviation: 2.6) yr were enrolled in the study. Hypnosis was successful in all but one case. The median (25th–75th percentile) length of hospital stay was shorter in the hypnosis group (120 [95–145] vs 240.5 [218–275] min; P<0.001). The general anaesthesia group was associated with a greater incidence of high levels of preoperative anxiety in children (30 vs 11%; P=0.001) and parents (55 vs 30%; P=0.05). Pain scores did not differ between groups. No negative postoperative behavioural changes were reported. ConclusionsIn children aged 7–16 yr, hypnosis appears to be feasible and accepted. The quality of the perioperative experience and the rapid recovery support the use of hypnosis as an effective and safe alternative to general anaesthesia for paediatric superficial surgery. Clinical trial registrationNCT02505880.

Factors Related to Anxiety in Paediatric Patients and Their Parents before and after a Modified Ravitch Procedure-A Single-Centre Cohort Study.

To assess the factors related to perioperative state anxiety in paediatric patients and their parents. 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). 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). 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.

Assessment of Anxiety Before Surgery In Cardiac Surgery Patients Who Have No History of Anxiety: Supporting Factors and Postoperative Morbidity

Anxiety is a negative or threatening emotion that a person feels in general, in the long term (anxiety trait), or in certain situations that fluctuates over time (anxiety state). The research method used is a systematic review conducted by looking for articles related to the assessment of factors supporting anxiety before surgery in cardiac surgery patients who do not have a history of postoperative anxiety and morbidity through an electronic database search, namely ProQuest, and Google Scholar conducted in June – August 2022. RESULTS AND DISCUSSION: Patients with preoperative heart surgery have a moderate-high level of anxiety with many influencing risk factors. The extent to which each patient manifests his or her preoperative anxiety depends on many factors such as the patient's susceptibility to preoperative anxiety, age, gender, past experience with surgery, educational status, type and degree of proposed surgery, current health status, and socioeconomic status. . Patients with high postoperative pain have high morbidity and mortality, poor recovery, impaired wound healing, poor satisfaction, and longer hospital stays. Conclusion: Based on the results of the study in this systematic review, it was shown that patients undergoing cardiac surgery showed moderate to high levels of preoperative anxiety, with little medical information obtained, especially those related to surgery. Many factors influence the emergence of anxiety in preoperative cardiac patients, including fear of postoperative complications, lack of preoperative information to patients about surgical methods and procedures and the anesthesia they will undergo, not having strong social support, fear of death, fear of the unknown, the danger of doctor or nurse error, the need for blood transfusions, and the patient's comorbidities. Preoperative psychosocial factors are associated with poor short-term and long-term outcomes after cardiac surgery, so the detection and assessment of the patient's anxiety level before undergoing cardiac surgery should be carried

Development and validation of a prediction model for preoperative anxiety in children aged 2-12 years old.

Children with preoperative anxiety are at risk of perioperative adverse events, such as reflux aspiration, prolonged induction time, wake agitation, and delirium. Identifying children at high risk of severe preoperative anxiety may help anesthesiologists intervene and manage them in advance. The authors hypothesized that the risk of developing serious preoperative anxiety in children is predictable by variables related to basic information about the parent and child. We developed a clinical prediction model to identify patients vulnerable to severe preoperative anxiety among children aged 2-12 years. We enrolled patients aged 2-12 years who underwent elective surgery under general anesthesia and divided them into derivation (n=340, 70.8%) and validation (n=140, 29.2%) groups. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale, and a high level of preoperative anxiety was defined as a score of >30. The following predictors were collected preoperatively: gender, age, weight, children's education level, only child, history of surgery, waiting time in the anesthesia waiting area, parental education level, parental anxiety, whether venous access had been established in the ward, and whether they had received anti-anxiety interventions. A prediction model was built using binary logistic regression analysis; bootstrap was applied for internal validation, and external validation was performed using the validation datasets. The prediction model had good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.961 (95% CI=0.943-0.979) and 0.896 (95% CI=0.842-0.950) in the derivation and validation cohorts, respectively. The predictive variables included in the final clinical model were pharmacological intervention (OR=0.008, 95% CI=0.002-0.025), nonpharmacological intervention (OR=0.342, 95% CI=0.104-1.127), parental education level (OR=0.211, 95% CI=0.108-0.411), parental anxiety (OR=6.15, 95% CI=2.396-15.786), only child (OR=2.417, 95% CI=1.065-5.488), history of surgery (OR=3.513, 95% CI=1.137-10.860), and age (OR=0.692, 95% CI=0.500-0.957). In this study, a clinical prediction model was developed and validated for the first time. The proposed clinical prediction model can help doctors identify children most likely to develop a high level of preoperative anxiety. ChiCTR2100054409 (https://www.chictr.org.cn/index.aspx).

Effects of Low-Concentration Nitrous Oxide Anesthesia on Patient Anxiety During Cataract Surgery: A Retrospective Cohort Study.

PurposeWe investigated the effects of 30% low-concentration nitrous oxide (N2O) anesthesia on anxiety, pain, and vital signs and the patient population that would benefit from low-concentration N2O anesthesia during cataract surgery.Patients and MethodsSixty-three patients who underwent cataract surgery due to visual impairment from cataracts were included in this single-center retrospective cohort study conducted at the Ophthalmology Department of Shinseikai Toyama Hospital, Japan. Fifty eyes of 39 patients received a combination of local and N2O anesthesia (N2O group), and 30 eyes of 24 patients received local anesthesia without N2O anesthesia (Air group). The primary outcome measures were visual analogue scale (VAS) scores for patient anxiety, pain, and vital signs. The secondary outcome measures were the patient population.ResultsThe change in the VAS scores for anxiety and pain decreased significantly (p = 0.002 and p = 0.014, respectively) in the N2O group (−15.6 ± 22.9 and 12.4 ± 14.9, respectively) compared with that in the Air group (1.2 ± 20.6 and 24.2 ± 22.4, respectively). The systolic and diastolic blood pressure changes did not significantly differ between both groups (p = 0.093 and p = 0.23, respectively). The change in heart rate decreased significantly (p = 0.001) in the N2O group (−4.8 ± 4.8 bpm) compared with that in the Air group (−0.6 ± 5.8 bpm). Multivariate analyses demonstrated that the change in anxiety level in the N2O group correlated significantly with patient age (p = 0.045) and preoperative VAS score for anxiety (p = 0.0001), whereas the change in anxiety level in the Air group did not correlate with any factor.ConclusionLow-concentration N2O anesthesia showed beneficial effects on intraoperative anxiety and pain during cataract surgery; this may aid the stabilization of intraoperative vital signs. Moreover, low-concentration N2O anesthesia during cataract surgery could benefit young patients and patients with high levels of preoperative anxiety.

Magnitude of Preoperative Anxiety and Associated Factors Among Adult Surgical Patients in Debre Berhan Comprehensive Specialized Hospital.

BackgroundAnxiety is an un-pleasurable emotional state associated with psychophysiological changes in response to an intra-psychic conflict. The perioperative period is one of the worrying events for most surgical patients. Despite preoperative anxiety having many negative consequences on post-operative physical and mental health, no adequate information on the degree to which the preoperative period exposed clients to preoperative anxiety and its associated factors.ObjectiveTo assess the prevalence of preoperative anxiety and associated factors among adult surgical patients in Debre Berhan Comprehensive Specialized Hospital, Ethiopia.MethodsInstitution-based cross-sectional study was conducted from June 1, 2020, to August 30, 2020. State-Trait Anxiety Inventory Scale (S-STAI) was used to measure the level of pre-operative anxiety. A systematic random sampling technique was employed to collect the data. The data were entered to Epi-Data version 4.6 and exported to SPSS version 25 for data analysis. A statistically significant association was declared at a p-value less than 0.05.ResultsA total of 330 patients were enrolled in the study with a response rate of 93.2%. The prevalence of a high level of preoperative anxiety was 53.6% (95% CI (49.6–58.7)). Being female 3.2 (2.19, 3.71) illiterate 4.1 (2.01, 15.39), fear of death 2.12 (1.30, 3.44), results of operation 2.60 (1.75, 4.18), postoperative pain 2.35 (1.37, 4.02), and surgical complication 1.9 (1.03, 12.13) were statistically significant factors.ConclusionPreoperative anxiety affects more than half of surgical patients which is a high and serious health burden. Additionally, this study revealed that being female, illiterate, fear of death, having a history of surgical complications and fear of complications, and fear of postoperative pain were significantly associated with preoperative anxiety. Assessing during the preoperative period helps to detect and ameliorate the problem. Preoperative counseling and informed consent taken as a prerequisite for surgery will help in reducing preoperative anxiety.

Preoperative predictors of postoperative satisfaction with surgery

BackgroundPatient reported outcome measures (PROMs) are an important metric in the assessment of outcomes following elective treatments such as epilepsy surgery. The Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19) is a new (2020), valid, and reliable measure of patient satisfaction that provides measures of satisfaction in multiple domains. This study examined preoperative psychiatric predictors of ESSQ-19 scores. MethodsAll patients who underwent epilepsy surgery at our center in the decade between January 2010 and 2020 and who were at least one year out from surgery were invited to complete the ESSQ-19 (n = 284). ResultsResponses were received from 29% of the sample. Non responders did not differ from responders in age, type of surgery, sex, or seizure outcome, but had a lower Verbal Comprehension Index score. Reported satisfaction rates were high in each ESSQ-19 domain (Seizure control, mean = 83.9; Psychosocial function, mean = 72.4; Surgical Complications, mean = 86.4; Recovery from surgery, mean = 77.4; Overall satisfaction, mean = 80.8) and broadly comparable to those reported in the original validation sample for the ESSQ-19. Preoperative levels of anxiety predicted postoperative satisfaction with recovery from surgery and psychosocial outcomes, with high levels of preoperative anxiety associated with higher levels of dissatisfaction in both sub domains. ConclusionsSatisfaction with some aspects of postoperative outcome is not just dependent upon postoperative factors, but can be predicted from preoperative levels of anxiety. Clinicians offering preoperative counseling and preparation with respect to patients’ expectations of surgical outcome should be cognizant of the possible impact of anxiety on postoperative satisfaction, particularly with respect to psychosocial function.

“Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section”: A cross-sectional study

BackgroundAnxiety is the most common problem in the preoperative period. This anxiety increases postoperative pain, delay healing, and prolong the hospital stay. Among the surgical population, a higher level of preoperative anxiety has been seen in obstetric patients. ObjectiveThe aim of this study was to assess the prevalence and associated factors of preoperative anxiety among obstetric patients undergoing cesarean section. MethodsAn institutional-based cross-sectional study was conducted from January 01, 2021, to May 30, 2021. A total of 376 obstetric patients who underwent cesarean sections were included. Descriptive statistics, cross-tabs, and binary logistic regression analysis were performed to identify the association shivering and independent variables. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and a p-value<0.05 was considered as statistically significant state versions of state-trait anxiety inventory scale (S-STAI) were used for this study. ResultsThe overall prevalence rate of preoperative anxiety was 63% (95% CI: 58.2, 68.1). The patient's preoperative mean anxiety score of STAI was (43.81 ± 8.81). There was a high level of preoperative anxiety in patients undergoing emergency cesarean section as compared to elective patients. Patients' age less than 30 years, level of education, and previous anesthesia and surgery exposure were also highly associated with the dependent variable. ConclusionIn this study, fear of complications and fear of death result of operation were the most common factors responsible for preoperative anxiety while few patients were anxious about financial loss and osmotic issues.

Assessment of Preoperative Anxiety among Patients Attending a Preanaesthetic Check-up Clinic at a Tertiary Care Hospital, Odisha: A Cross-sectional Study

Introduction: Anxiety during the preoperative period predisposes to postoperative complications such as increase in postoperative pain, delay of healing and prolonged hospital stay.Further, patients with a high level of preoperative anxiety require higher doses of anaesthetic agents and recover poorly. Due to these factors, each tertiary care hospital should have an idea about the prevalence of preoperative anxiety in their setting, so that appropriate preventive measures can be planned. Aim: To assess the prevalence of preoperative anxiety in patients attending the Preanaesthetic Check-up (PAC) clinic for elective surgeries and to find out the factors associated with anxiety among them. Materials and Methods: This hospital-based, cross-sectional study was conducted in the PAC Clinic at Kalinga Institute of Medical Sciences (tertiary care hospital), Bhubaneswar, Odisha, India, from May to July 2018. The study included hundred patients, using convenient sampling technique, undergoing preanaesthetic check-up, before the proposed elective surgeries. A researcher made study tool, using Hamilton-A scale for assessing preoperative anxiety was used. Data was analysed using Epi Info software. A p-value &lt;0.05 was considered as statistically significant. Results: Among the sampled 100 study participants, preoperative anxiety was found to be present in 97, 72 of the study participants had mild anxiety, 14 had mild to moderate and 11 moderate to severe anxiety. Of the 97 participants who had preoperative anxiety, 7 (14.89%) of the females had moderate to severe anxiety as compared to 4 (8%) of males. The age group of 60-69 years and Christianity religion were found to be statistically significant factors associated with anxiety in the study population. Conclusion: The prevalence of preoperative anxiety among the study participants was found to be high. Preventive measures like counselling sessions to address their apprehensions should be planned to decrease the anxiety.

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

Background: Anxiety is often encountered but overlooked in patients undergoing elective surgery. Anxiety may influence the perception of postoperative pain which is one of the major concerns for all patients. This study aimed to evaluate the effect of preoperative anxiety on postoperative pain and to find if any relation exists between demographic variables and anxiety in cesarean patients. Methodology: One hundred and twelve patients undergoing elective cesarean section under spinal anesthesia were evaluated for preoperative anxiety on the day before surgery using the Amsterdam Preoperative Anxiety and Information Scale questionnaire-based face-to-face interview, and postoperative pain was recorded every 6 h after surgery for 24 h using the Visual Analog Scale (VAS). Results: The prevalence of preoperative anxiety in the study subjects was 36%. The need for high information was 22%. The mean for anesthesia-related anxiety, information desire component, combined anxiety score, and VAS scores was 4.21 ± 2.63, 3.23 ± 2.15, 8.72 ± 4.60, and 5.30 ± 1.86, respectively. Postoperative pain was found to be correlating with higher levels of preoperative anxiety (r = 0.25, P < 0.01). Information desire component was found to have a positive, moderate, and significant correlation with anxiety score (r = 0.49, P < 0.01). No statistically significant relationship was found between sociodemographic characteristics and preoperative anxiety. Conclusion: This study demonstrated a positive and statistically significant correlation between preoperative anxiety and postoperative pain. Well-conducted randomized controlled studies are required to determine whether reducing anxiety before a surgery results in reduced postoperative pain response. Anxiety-reducing measures can be employed throughout the preoperative period in the surgical population to reduce postoperative pain in addition to analgesics.

The effect of preoperative anxiety and depression on postoperative recovery quality

Despite varying according to the disease and the patient, emotional reactions such as anxiety, depression, regression, anger, and grieving responses are observed in the preoperative period. High preoperative anxiety levels can lead to increased need for postoperative pain relief, prolonged hospital stay, inadequate patient satisfaction and insufficient patient recovery.In the present study, it was aimed to measure preoperative anxiety and depression levels and to determine their relationship with quality of recovery in patients scheduled to undergo elective surgery under general anesthesia. A total of 137 patients older than 18 years of age who were planned for elective surgery and who were to be operated under general anesthesia were included in the study. In the preoperative period, the patients were asked to fill out the demographic information form, Beck anxiety inventory and Beck depression inventory. They were also asked to complete the quality of awakening and the quality of recovery questionnaires at the postoperative first day and first month.It was detected that the anxiety and depression scores were high, whereas the recovery quality was low in females. The depression scores of the patients who were college graduates were found to be low. It was observed that the quality of awakening and the quality of recovery values at the postoperative first day and first month were significantly lower in the patients with higher depression and anxiety scores. According to these results, reducing the anxiety and depression of the patients in the preoperative period to a minimum is necessary to minimize the negative effects in the postoperative period such as inadequate patient recovery, increased need for painkillers, long hospital stay and insufficient patient satisfaction.

General Versus Regional Anaesthesia for Lower Limb Arthroplasty and Associated Patient Satisfaction Levels: A Prospective Service Evaluation in the Oxford University Hospitals.

IntroductionLower limb arthroplasty is performed under general anaesthesia (GA) or regional anaesthesia (RA). There is increasing evidence of the surgical and anaesthetic benefits of RA. National Institute for Health and Care Excellence (NICE) guidelines advise using either but highlight a lack of data comparing outcomes of RA and GA for these procedures. We conducted a service evaluation, prospectively analysing elective orthopaedic cases performed at the Nuffield Orthopaedic Centre, Oxford, UK from 19/11/2018 to 03/04/2019. We aimed to compare data on anaesthetic assessment, intra-operative parameters and patient satisfaction for RA and GA cases.MethodsWe selected elective patients, aged above 18, undergoing total hip, total knee or unilateral knee arthroplasties. Prospective quantitative and qualitative data were collected using two forms. Firstly, anaesthetists completed a case report recording demographic data, intra-operative details and reason for anaesthetic choice. Secondly a questionnaire gathered patient satisfaction data. This was analysed using descriptive statistics and presented in tables.ResultsData for 132 patients were collected over the service evaluation period. After exclusion, 99 patients were included for final analysis; 59 underwent GA and 40 had RA. GA was used predominantly due to patient preference (74.6%). RA was used primarily due to anaesthetic preference (75%); most commonly due to speed of list and duration of operation. Overall patients had low pain scores (0.3/10) and high pre-operative anxiety levels (4.6/10) regardless of anaesthetic.ConclusionOur results show high patient satisfaction with GA and RA for lower limb arthroplasty; however, pre-operative anxiety was common for both. Patient preference and comfort influenced choice of anaesthesia, highlighting the importance of pre-operative counselling and education to facilitate shared decision making, leading to favourable post-operative outcomes.

P–750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients: 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2–6min), compared to 4min50 in the control group (range 1–12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time: 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings: Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

P-750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2-6min), compared to 4min50 in the control group (range 1-12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

Preoperative Considerations for Teenagers Undergoing Orthopaedic Surgery: VTE Prevention, Mental Health Assessment, Vaping, and Drug Addiction.

Adolescents undergoing pediatric orthopaedic surgery typically experience an uncomplicated postoperative course. However, adolescence represents a unique transition period from pediatric to adult physiology. As a result, the astute pediatric orthopaedic surgeon will be aware of unique medical and social scenarios which are relevant to adolescents during the perioperative course including the risk of venous thromboembolism (VTE), prevalence of mental health conditions, and rising use of electronic cigarettes or "vaping" to consume nicotine and cannibas. Adolescents are at a greater risk of VTE after pediatric orthopaedic surgery. In particular, adolescent females with a family history of blood clotting disorders and those with a change in mobility after surgery should be considered for prophylaxis. The prevalence of adolescent mental health conditions including anxiety, depression, and behavioral issues is increasing in the United States. Higher levels of preoperative anxiety and the presence of mental health pathology are associated with slower recovery, higher levels of postoperative pain, and the increased likelihood for chronic pain. Several quick screening instruments are available to assess adolescents for preoperative anxiety risk, including the Visual Analogue Scale for Anxiety or the Amsterdam Perioperative Anxiety Information Scale. Unfortunately, electronic cigarettes have become increasingly popular for the consumption of nicotine and cannabis among adolescents. Preoperative use of combustive cigarettes (nicotine/cannabis) represents perioperative risks for induction/anesthesia, postoperative pain, and analgesia requirements and issues with delayed wound and fracture healing. VTE, underlying mental health conditions, and usage of nicotine and cannabis are clear detriments to the recovery and healing of adolescent patients following orthopaedic surgery. Therefore, standardized screening for adolescents before orthopaedic surgery is indicated to identify perioperative risk factors which have negative impacts on functional outcomes.

Alteration of anxiety and depression after awake craniotomy: a prospective study on patients with language eloquent high-grade glioma.

Awake craniotomy (AC) is considered to achieve maximal safe resection of language eloquent gliomas. Impact of AC on the psychological status of patients (mainly anxiety, and post-traumatic stress disorder [PTSD]) is a potential concern. Despite the studies reporting the early postoperative patient's perception after AC, this study has been performed to quantitatively evaluate the long-term influence of AC on the level of anxiety/depression after surgery. Patients who underwent AC for suspected language eloquent high-grade glioma were enrolled in this study. The anxiety, depression and PTSD of the patients were evaluated via hospital anxiety and depression scale (HADS) one week before and 1 and 6 months after the operation. PTSD symptoms were assessed according to the DSM-V checklist and confirmed by a structured clinical interview for DSM-V. Twenty-eight patients (22 men, six women) with the mean age of 39.2 years were enrolled. The mean preoperative depressive and anxiety score was 4.9±5.9 and 7.7±5.8 respectively. One month after surgery they were 6±4.9 and 7.4±6.2 and at 6 months' follow-up 5.5±5.1 and 5.4±4.2 respectively. There was no statistically significant trend for alterations of the anxiety/depression levels before and after surgery. Female patients, those suspected to have glioblastoma and patients presenting with speech disturbance had remarkably higher preoperative anxiety levels. Three patients had PTSD symptoms 3 months after AC while at 6 months there was no indication of PTSD. The decremental trend of PTSD score within 6 months was statistically significant. Judicious application of AC is not associated with an escalation of the anxiety/depression level among the patients. Even patients with high preoperative anxiety levels could be managed with AC without severe psychological deterioration.

Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery.

Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the early postoperative perception of pain. The study included 100 patients with obesity (women, n = 61; age 37.4 ± 9.9 years, mean ± standard deviation; Body Mass Index (BMI) 47.6 ± 6.5 kg/m2) who underwent bariatric surgery. Preoperative anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale (HADS), and the quantitative and qualitative dimension of early postoperative pain were evaluated by the McGill Pain Questionnaire Short Form (MPQ-SF). Furthermore, the postoperative analgesia protocol was recorded for each patient. Pain declined gradually during the first 24 h postoperative. Although preoperative anxiety had no correlation with the overall pain of postoperative Day 0, patients with a higher level of preoperative anxiety had significantly more intense and more unpleasant pain at 1 h post operation. In addition, depression influences both the intensity and unpleasantness of pain at different time points (1 h, 4 h and 24 h postoperative). Preoperative pain correlated with educational level, but not with age, BMI, gender, marital status, smoking and surgery type. In conclusion, preoperative anxiety and depression influence the early postoperative pain after bariatric surgery, and their preoperative identification is of major importance to enhance the implementation of fast-track postoperative protocols to prevent complications and prolonged hospitalization.

The Relationship between Preoperative Educational Session and Anxiety Level among Women Undergoing Cesarean Section: A Scoping Review

Context: Anxiety is felt in women undergoing elective cesarean section. In obstetric patients, literature has reported a higher level of preoperative anxiety than the general surgical population. One of the commonest surgical procedures in obstetrics is Caesarean section (CS). Preoperative anxiety has been described as being associated with several adverse physiological and psychological effects.&#x0D; Aim: This review aimed to determine the relationship between preoperative educational sessions and anxiety levels among women undergoing cesarean section.&#x0D; Methods: The search strategy of this study relies on some of the electronic bibliographic databases under the Medicine, Nursing, and Health Sciences departments. Various databases have been used to include different perspectives in the findings, CINAHL, Ovid MEDLINE, Pub Med, and Embase databases used to collect primary articles for this study.&#x0D; Results: The current review of the literature included seven quantitative studies that fulfill the inclusion criteria. The included studies revealed the intervention used as mental health training (one study), video is used in three studies, and health instruction in five studies. Two studies used both video and health instruction. In terms of the effect of preoperative sessions on anxiety level, four out of seven studies reported a decrease in the anxiety level. In comparison, the remaining three studies reported a non-significant educational intervention effect in decreasing the women’s anxiety.&#x0D; Conclusion: Most of the reviewed studies indicated that preoperative education intervention could positively impact anxiety levels among women undergoing CS. This makes the reviewed theme open for further randomized control intervention studying.

Preoperative anxiety of patients with orthopedic surgery and its influencing factors

Objective To explore the preoperative anxiety of patients with orthopedic surgery and its influencing factors. Methods From February to July 2019, this study selected 252 orthopedic patients with surgery at a ClassⅢ Grade A hospital in Shanxi Province by convenience sampling to carry out cross-sectional study. The investigation was implemented with the general information questionnaire, State Anxiety Scale (SAI) , Self-rating Anxiety Scale (SAS) , Athens Insomnia Scale (AIS) and Visual Analogue Scale (VAS) ; and the influencing factors of preoperative anxiety of patients were analyzed. Results Among 252 patients with orthopedic surgery, the scores of SAI and SAS were (44.72±6.99) and (40.61±5.69) respectively higher than national norms (P<0.05) . Correlation analysis showed that the scores of AIS and VAS had positive correlations with the scores of SAI and SAS (r=0.745, 0.666, 0.469, 0.491; P<0.05) . Multiple stepwise linear regression showed that the main influencing factors of state-anxiety included the sleep, pain, history of surgery, different occupations, education degree, disease types and disease cognition with statistical differences (P<0.05) ; the main influencing factors of self-assessment anxiety included the sleep, disease cognition, pain, history of surgery, different genders, ages and types of medical insurance. Conclusions Patients with orthopedic surgery have the high level of preoperative anxiety. Medical staff should pay attention to psychological intervention for preoperative anxiety of patients with orthopedic surgery, especially for those without history of surgery, with lack of disease cognition and poor sleep so as to reduce preoperative anxiety and pain, and improve patients' sleep. Key words: Anxiety; Sleep; Pain; Orthopedics; Preoperative period; Influencing factors