Reduction In Preoperative Anxiety Research Articles

Reducing Preoperative Anxiety: The Role of Anesthesia Provider Communication and Empathy

Preoperative anxiety is a common and significant issue that can negatively impact patient outcomes. Effective communication and empathy from anesthesia providers have been suggested as crucial factors in mitigating this anxiety. This study aimed to investigate the relationship between anesthesia provider communication and empathy and preoperative anxiety levels in adult patients undergoing elective surgery. A prospective, observational study was conducted at a tertiary care hospital. Adult patients scheduled for elective surgery under general anesthesia were enrolled. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before the anesthesia provider's preoperative visit and again immediately before surgery. Anesthesia provider communication and empathy were evaluated using the CARE (Communication Assessment Tool for Anesthesia Providers) questionnaire and the Jefferson Scale of Empathy (JSE), respectively. A total of 200 patients were included in the study. The mean preoperative anxiety score decreased significantly from before the anesthesia provider's visit to immediately before surgery (p < 0.001). Higher scores on the CARE questionnaire and the JSE were associated with a greater reduction in preoperative anxiety (p < 0.05). Multivariable analysis revealed that both effective communication and empathy independently contributed to reducing preoperative anxiety. Anesthesia provider communication and empathy play a crucial role in reducing preoperative anxiety. Implementing communication and empathy training programs for anesthesia providers may improve patient experiences and surgical outcomes.

The advantages of general anesthesia subthalamic deep brain stimulation for Parkinson's disease in the enhanced recovery after surgery: A randomized clinical trial

AbstractBackground and AimsWith advancements in imaging and microelectrode recording techniques, general anesthesia (GA) has emerged as an alternative option for Parkinson's disease (PD) patients undergoing subthalamic nucleus deep brain stimulation (STN‐DBS). In this study, we compared the advantages and disadvantages of using GA and local anesthesia for STN‐DBS in enhanced recovery after surgery (ERAS).MethodsSurgical outcomes of STN‐DBS were evaluated using the unified PD rating scales (UPDRS). CT and magnetic resonance imaging scans are used to evaluate intracranial conditions. State‐trait anxiety inventory and hospital anxiety and depression scale are used to evaluate patients' perioperative psychology.ResultsAnesthesia method does not significantly impact the accuracy of microelectrode placement or the improvement of postoperative symptoms. However, the local anesthesia group had a higher incidence of intracranial air, as well as higher rates of postoperative complications such as headache, dizziness, vomiting, and delirium. GA effectively alleviated preoperative anxiety and resulted in lower levels of perioperative anxiety and psychological stress compared to local anesthesia. Additionally, the GA group had shorter surgery duration, earlier ambulation, and a shorter average hospital stay.ConclusionDBS under GA is safe and effective. Due to shorter surgical duration, reduced occurrence of perioperative complications, effective reduction of preoperative anxiety, and faster postoperative recovery, DBS under GA is better aligned with the concept of ERAS.

Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews.

Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety? Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery. According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety. Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety. A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO. A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results. Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs. This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results. Not applied to our study, as it is a systematic review of systematic reviews.

THE EFFECT OF LAVENDER AROMATHERAPHY IN REDUCING PREOPERATIVE ANXIETY IN PATIENT UNDERGOING ELECTIVE SURGERIES.

Background And Aim: Pre-operative anxiety is one of the most common mental problems and disorders before surgery. pre-operative anxiety stimulates the sympathetic, parasympathetic, and endocrine systems, which result in various intraoperative and postoperative complications. Aromatherapy is the controlled use of aromatic oils to maintain and promote physical and mental health which is widely practised in many countries. The Aim of this study was to evaluate the effect of lavender aromatherapy in reducing preoperative anxiety in patient undergoing elective surgical procedures. This prospective study was conducted between the age of 18 t Materials And Methods: o 65 years of either sex, undergoing elective surgical procedures belonging to ASA 1 or 2. All patient received inhalation lavender aromatherapy in the preoperative area. Anxiety score was calculated using Amsterdam Preoperative Anxiety and Information Scale questionnaire (APAIS) upon arriving to the preoperative waiting area and 15 min following aromatherapy. All the demographic were recorded. Hemodynami Results: c variable such as Heart rate, Blood pressure, mean arterial pressure, Sp02 were recorded on arrival to PACU and 15 min following aromatherapy which is comparable. The mean reduction in anxiety score was statistically seen in the patient following aromatherapy with the signicant p value of <0.05. Thus, concludes that Conclusion: the preoperative use of lavender aromatherapy in elective surgery can be considered as one of the cost effective and safe method in the reduction of preoperative anxiety with no side effects.

Does Preoperative Anxiety Decrease When Obesity Is Eliminated?

Aim: To determine the effectiveness of weight loss with obesity surgery in reduction of preoperative anxiety by comparing the anxiety levels of the patients before undergoing One Anastomosis Gastric Bypass (OAGB) surgery and before their subsequent surgery. Material and Method: Sixty patients undergoing OAGB and secondary operations who had gastrectomized were enrolled in the study. The patients were divided into two groups in such a way that the morbidly obese patients who underwent OAGB surgery were included in the Group 1 and the patients who lost weight with OAGB surgery and were then admitted for a second operation were included in the Group 2. The preoperative anxiety levels of all the patients were measured with the State-Trait Anxiety Inventory (STAI). Results: The preoperative anxiety levels were found to be high in both groups. There were no statistically significant differences between the groups in terms of both state (STAI-S) (p=0.134) and trait (STAI-T) measurements (p = 0.436). Conclusion: The preoperative anxiety levels did not decrease with weight loss indicated by reduction in BMI among the patients who underwent OAGB. It has been reported before that the preoperative anxiety as well as anxiety disorders are persistent in such patient groups. Thus, anxiety levels of patients who underwent bariatric surgery should be measured and managed before secondary other operations even if their BMI decreases.

A PROSPECTIVE RANDOMIZED SINGLE-BLIND STUDY COMPARING ALPRAZOLAM VERSUS CLONIDINE AND PREGABALIN AS PREANAESTHETIC MEDICATION IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES

Objective: The objective of the study was to study comparison of alprazolam versus clonidine and pregabalin as pre-anesthetic medication in patients undergoing elective lower limb surgeries. Methods: The present study was undertaken to compare the effects of alprazolam 0.5 mg, clonidine 100 μg, and pregabalin 75 mg as premedicant drugs for the reduction of pre-operative anxiety. 90 patients of ASA Grades I and II, between 18 and 60 years, of either sex, undergoing elective lower limb surgery were divided into three groups of 30 patients each. Baseline anxiety level and level after 2 h of the drug were assessed. Side effects due to drugs were noted before going to OT (Post drug, i.e., 2 h after drug administration), after the completion of the surgery, and at 24 h. Results: There is a significant post-drug reduction in s-STAI score, t-STAI score, and CGI score when compared to baseline values in all the Group’s A, C, and P. Side effects were mild and there were no serious adverse effects observed in all three groups. In Group A, 10% of patients complained of fatigue while in Group C, 13.3% of patients complained of dryness of mouth, and 10% of patients complained of headache 2 h post drug administration but in Group P, no side effect was noted. Conclusion: Premedication with 0.5 mg alprazolam, 100 μg clonidine, and 75 mg pregabalin for control of pre-operative anxiety was comparable though pregabalin offered a significant advantage in terms of less side effects.

Preoperative oral melatonin can reduce preoperative anxiety and postoperative analgesia in a dose-dependent manner

BackgroundPreoperative anxiety has deleterious effects on patients’ outcome through its influence on intraoperative requirements of anesthetics and analgesics (Bayrak et al., J Coll Physicians Surg Pak 29:868–873, 2019), postoperative (PO) pain intensity, and analgesia requirement, and may even increase PO morbidity and mortality after certain types of surgery. Melatonin is a methoxyindole synthesized and secreted principally by the pineal gland at night under control of an endogenous rhythm of secretion generated by the suprachiasmatic nuclei. The current study hypothesized that preoperative melatonin could reduce patients’ anxiety and reduce intraoperative (IO) and postoperative (PO) analgesic in a dose-dependent manner.ResultsPreoperative consultation was, to some extent, effective in reducing patients’ anxiety and apprehension. At 1 h after receiving premedication, Anxiety Specific to Surgery Questionnaire (ASSQ) scores were significantly lower in study groups in comparison to baseline scores and at 1 h scores of P group patients (patients who received 3 ml of plain distilled water), and this significant effect extended for 3-h PO. The reported ∆∆ASSQ between study groups was 25.9% between M2 (melatonin) and Z (midazolam) groups and 36.9% between groups M1 (received melatonin in a dose of 3 mg) and M2 (received melatonin in a dose of 6 mg). Preoperative anxiolytic therapy allowed reduction of PO pain scores and analgesia consumption with prolongation of duration till 1st request of rescue analgesia, and these effects were more pronounced with melatonin 6 mg in comparison to placebo, melatonin 3mg, or midazolam.ConclusionPreoperative melatonin is an appropriate policy for reduction of preoperative anxiety and provided reduction of PO anxiety, pain scores, and consumption of analgesia thus promoting early recovery and short PO hospital stay. Dose dependency was evident, and preoperative melatonin 6-mg dose provided satisfactory effect.

Application of a non-pharmacological technique in addition to the pharmacological protocol for the management of children's preoperative anxiety: A 10 years' experience.

The aim of the study was to investigate how Non- Pharmacological Techniques (NPT), in addition to standard pharmacological techniques, can help to manage and reduce the preoperative anxiety of children waiting for Day Surgery procedures (DS). Isola Serena activity started in 2008 to manage the preoperative time of children waiting for surgery in the playing room. The latter is run by a pedagogist. NPT includes use of games and toys, readings and drawings. A descriptive and comparative study was conducted on 50 children, aged 4 to 12 years, randomly assigned to Isola Serena group ISG and control group CG. All children received standard pharmacological techniques, while those of the ISG also received the NPT. The evaluation of the preoperative anxiety level (modified Yale Preoperative Anxiety Scale) and parent's coping style (Coping Inventory for Stressful Situation) compared the two groups. The ISG showed a significantly lower level of preoperative anxiety than the CG. Parents' coping style was not related to the preoperative anxiety. The activity performed in the Isola Serena Project resulted to be effective for the reduction of preoperative anxiety in children undergoing DS procedures.

The Use of a Respiratory Biofeedback Device to Reduce Dental Anxiety in Children: A Randomized Controlled Clinical Trial

Introduction: Dental anxiety occurs when the patient presents to the dentist with the anticipation of dental treatment. Many children react to dental stressful situations through uncooperative behaviors. Objectives: Investigate the effect of a respiratory biofeedback device (RESPeRATETM) in reduction of preoperative anxiety in children undergoing dental procedures under local anesthesia. Materials and methods: A randomized controlled clinical trial comprising 110 healthy children, of age range 7-12 years, were selected. Their scores were 19 or more according to the Faces version of Modified Child Dental Anxiety Scale. Participants were randomly allocated into two groups: Study and Control group. For both groups, heart rate was recorded prior to local anesthesia administration and a salivary sample was collected to measure the salivary amylase. The study group was submitted to a session of respiratory biofeedback “RESPeRATETM”. The control group was managed by a routine behavioral management technique “Tell, Show and Do”. Infiltration or block local anesthesia injections were administered, after which heart rate measurement and salivary sample was repeated. T and paired T tests were used for statistical analysis. Results: Heart rate decreased significantly in the study group (P=0.001), and increased significantly in the control group (P=0.002). There were non-significant changes among both groups regarding salivary amylase. A weak correlation was found between heart rate and salivary amylase. Conclusions: “RESPeRATETM” group showed a decrease in dental anxiety, as evidenced by decreased heart rate. “RESPeRATETM” can be used effectively before dental procedures for anxious children. Salivary alpha amylase was a poor stress biomarker.

A prospective comparative study of intranasal dexmedetomidine and clonidine on sedation and hemodynamic response during laryngoscopy in adult patients

In general anesthesia, hemodynamic changes during endotracheal intubation are major concerns. Sedative premedications like Dexmedetomidine and Clonidine, when used intranasally are effective options for reduction of preoperative anxiety and preventing untoward hemodynamic responses at the time of induction. Thirty eight patients of ASA 1 and 2 aged 18-70 years were randomly allocated in 2 groups of 19 patients: Group C received inj. Clonidine 3 mcg/kg and Group D received inj. Dexmedetomidine 1 mcg/kg intranasally 45 min before induction. All patients were monitored after premeditation and throughout the surgery. We observed sedation, HR, SBP, DBP, MAP and SPO2 at various intervals. Intranasal Dexmedetomidine was found to be more effective in producing perioperative sedation and more stable hemodynamics at the time of induction. Dexmedetomidine via intranasal route can be considered as a useful alternative of conventional medications to produce sedation and to blunt hemodynamic response during laryngoscopy.

Melatonin for preoperative and postoperative anxiety in adults.

Anxiety in relation to surgery is a well-known problem. Melatonin offers an alternative treatment to benzodiazepines for ameliorating this condition in the preoperative and postoperative periods. To assess the effects of melatonin on preoperative and postoperative anxiety compared to placebo or benzodiazepines. We searched the following databases on 10 July 2020: CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science. For ongoing trials and protocols, we searched clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform. We included randomized, placebo-controlled or standard treatment-controlled (or both) studies that evaluated the effects of preoperatively administered melatonin on preoperative or postoperative anxiety. We included adult patients of both sexes (15 to 90 years of age) undergoing any kind of surgical procedure for which it was necessary to use general, regional, or topical anaesthesia. One review author conducted data extraction in duplicate. Data extracted included information about study design, country of origin, number of participants and demographic details, type of surgery, type of anaesthesia, intervention and dosing regimens, preoperative anxiety outcome measures, and postoperative anxiety outcome measures. We included 27 randomized controlled trials (RCTs), involving 2319 participants, that assessed melatonin for treating preoperative anxiety, postoperative anxiety, or both. Twenty-four studies compared melatonin with placebo. Eleven studies compared melatonin to a benzodiazepine (seven studies with midazolam, three studies with alprazolam, and one study with oxazepam). Other comparators in a small number of studies were gabapentin, clonidine, and pregabalin. No studies were judged to be atlow risk of bias for all domains. Most studies were judged to be at unclear risk of bias overall. Eight studies were judged to be at high risk of bias in one or more domain, and thus,to be at high risk of bias overall. Melatonin versus placebo Melatonin probably results in a reduction in preoperative anxiety measured by a visual analogue scale (VAS, 0 to 100 mm) compared to placebo (mean difference (MD) -11.69, 95% confidence interval (CI) -13.80 to -9.59; 18 studies, 1264 participants; moderate-certainty evidence), based on a meta-analysis of 18 studies. Melatonin may reduceimmediate postoperative anxiety measured on a 0 to 100 mm VAS compared to placebo (MD -5.04, 95% CI -9.52 to -0.55; 7 studies, 524 participants; low-certainty evidence), and may reduce delayed postoperative anxiety measured six hours after surgery using the State-Trait Anxiety Inventory (STAI) (MD -5.31, 95% CI -8.78 to -1.84; 2 studies; 73 participants; low-certainty evidence). Melatonin versus benzodiazepines (midazolam and alprazolam) Melatonin probably results in little or no difference in preoperative anxiety measured on a 0 to 100 mm VAS (MD 0.78, 95% CI -2.02 to 3.58; 7 studies, 409 participants; moderate-certainty evidence) and there may be little or no difference in immediate postoperative anxiety (MD -2.12, 95% CI -4.61 to 0.36; 3 studies, 176 participants; low-certainty evidence). Adverse events Fourteen studies did not report on adverse events. Six studies specifically reported that no side effects were observed, and the remaining seven studies reported cases of nausea, sleepiness, dizziness, and headache; however, no serious adverse events were reported. Eleven studies measured psychomotor and cognitive function, or both, and in general, these studies found that benzodiazepines impaired psychomotor and cognitive function more than placebo and melatonin. Fourteen studies evaluated sedation and generally found that benzodiazepine caused the highest degree of sedation, but melatonin also showed sedative properties compared to placebo. Several studies did not report on adverse events; therefore, it is not possible to conclude with certainty, from the data on adverse effects collected in this review, that melatonin is better tolerated than benzodiazepines. When compared with placebo, melatonin given as premedication (as tablets or sublingually) probably reduces preoperative anxiety in adults (measured 50 to 120 minutes after administration), which is potentially clinically relevant. The effect of melatonin on postoperative anxiety compared to placebo (measured in the recovery room and six hours after surgery) was also evident but was much smaller, and the clinical relevance of this finding is uncertain. There was little or no difference in anxiety when melatonin was compared with benzodiazepines. Thus, melatonin may have a similar effect to benzodiazepines in reducing preoperative and postoperative anxiety in adults.

The use of pre-operative virtual reality to reduce anxiety in women undergoing gynecological surgeries: a prospective cohort study

BackgroundPre-operative anxiety is common and is associated with negative surgical outcomes. Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition and has been shown to be associated with lower levels of anxiety. In this study, we investigated changes in pre-operative anxiety levels before and after using VR in patients undergoing minor gynecological surgery.MethodsPatients who underwent elective minor gynecological surgeries in KK Women’s and Children’s hospital, Singapore were recruited. The VR intervention consisted of 10-min exposure via a headset loaded with sceneries, background meditation music and breathing exercises. For the primary outcome of pre-operative anxiety, patients were assessed at pre- and post-intervention using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes of self-reported satisfaction scores and EuroQol 5-dimension 3-level (EQ-5D-3L) were also collected.ResultsData analysis from 108 patients revealed that HADS anxiety scores were significantly reduced from 7.2 ± 3.3 pre-intervention to 4.6 ± 3.0 post-intervention (p < 0.0001). Furthermore, HADS depression scores were significantly reduced from 4.7 ± 3.3 pre-intervention to 2.9 ± 2.5 post-intervention (p < 0.0001). Eighty-two percent of the patients self-reported VR intervention as ‘Good’ or ‘Excellent’. EQ-5D-3L showed significant changes in dimensions of ‘usual activities’ (p = 0.025), ‘pain/discomfort’ (p = 0.008) and ‘anxiety/ depression’ (p < 0.0001).ConclusionsFor patients undergoing minor gynecological procedures, the VR intervention brought about a significant reduction in pre-operative anxiety. This finding may be clinically important to benefit patients with high pre-operative anxiety without the use of anxiolytics.Trial registrationThis study was registered on clinicaltrials.gov registry (NCT03685422) on 26 Sep 2018.

The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the effectiveness of web-based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre-operative anxiety and secondary outcomes were postoperative pain and parents' anxiety and satisfaction with entire course of the day surgery. A systematic review and meta-analysis of randomized controlled trials. CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018). Studies were appraised using the Cochrane risk of bias tool. A random effect meta-analysis of children's pre-operative anxiety was performed. Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web-based mobile health interventions, including age-appropriate videos, web-based game apps, and educational preparation games made for the hospital environment, was examined in pre-operative settings. A meta-analysis (N=560 children) based on six studies found a statistically significant reduction in pre-operative anxiety measured by the Modified Yale Pre-operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction. Web-based mobile health interventions can reduce children's pre-operative anxiety and increase parental satisfaction. Web-based mobile health interventions could be considered as non-pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions. Web-based mobile health interventions reduce children´s pre-operative anxiety and could therefore be considered as non-pharmacological distraction tools for children in nursing.

Pre-operative anxiolysis in children through a combined pharmacological therapy with hydroxyzine and a non-pharmacological distraction technique with a clown (SONRISA): study protocol for randomised double-blind clinical trial

BackgroundSurgery can generate significant stress and anxiety in up to 70% of the paediatric population. There are several pharmacological and non-pharmacological strategies to reduce pre-operative anxiety in children, however, they have several side effects and the available information about them is contradictory. The role of clowns and hydroxyzine in the management of anxiety is controversial, with some studies supporting and others contraindicating both strategies.MethodsWe propose a randomised double-blind, controlled clinical trial that will evaluate the effectiveness of both interventions (hydroxyzine and clowns), alone or in combination, to reduce pre-operative anxiety (using the modified Yale scale of preoperative anxiety) in children aged 2–16 years undergoing outpatient surgery (n = 188).Subjects will be randomised into two groups – (1) standard procedure (parental accompaniment) combined with placebo or (2) standard procedure combined with preoperative hydroxyzine. After randomisation, they will be divided by chance into two further groups, depending on the presence of clowns on the patient’s surgery day. Control of pre-operative anxiety will be determined in the four groups by a modified Yale scale of preoperative anxiety and cortisol levels. Compliance of children during induction of anaesthesia, time until anaesthesia recovery, presence of postoperative delirium and use of analgesia until discharge will be also assessed. For additional information, the children, parents and healthcare professionals involved in the study will complete a satisfaction survey.ConclusionsThis study aims to gather evidence on which of these four therapeutic options achieves the highest reduction of pre-operative anxiety with the best safety profile to allow paediatricians and anaesthesiologists to use the most effective and safe option for their patients.Trial registrationClinicalTrials.gov identifier: NCT03324828. Registered 21 September 2017.

A pilot study of the effectiveness of a serious game CliniPup® on perioperative anxiety and pain in children

Introduction/AimChildren experience important anxiety before surgery. Anxiety and pain are positively correlated. Serious gaming is a non-pharmacological intervention to prepare children and parents for an operation. We aimed to evaluate the effectiveness of the serious game CliniPup® on anxiety and pain in children undergoing ambulatory surgery. MethodA prospective randomized controlled pilot trial in 72 children aged 5 to 11 years old scheduled for day-care surgery (general surgery, dentistry, otorhinolaryngology, urology) was performed. Participants were randomly assigned into 3 groups: A (CliniPup®), B (“Empty game” without educational information), or C (no game, oral information at the outpatient clinic, current standard of care). Anxiety, pain, and behaviour were evaluated by validated instruments at six time-points: T0: baseline, T1: 1 week preoperatively, T2: at hospital admission, T3: before discharge, T4: 1 week postoperatively, T5: 1 month postoperatively. ResultsAfter playing the game (T1), the estimated mean anxiety score (VASa) was lower in Group A (1.9 units) versus Group B (2.7 units). The estimated mean VASa at T1 for Group A was 2.6 units lower compared to Group C (p = 0.003). For Group B, VASa levels were 1.8 units lower than in Group C (p = 0.045). After correction for “surgery type”, Group A continued to show a significantly lower VASa compared to Group C (p = 0.044). On the other time points, no difference in anxiety and pain were observed, nor in post-hospitalization behaviour. ConclusionChildren that played the CliniPup® game one week before surgery had a significant reduction in preoperative anxiety after playing the game, but not on the other time points. No differences on peri-operative pain were observed during the different time points. Type of StudyRandomized Trial. Level of EvidenceLevel II.

Mirtazapine for Postoperative Nausea and Vomiting: Systematic Review, Meta-analysis, and Trial Sequential Analysis

Patients rank postoperative nausea and vomiting (PONV) as the most undesirable outcome of anesthesia. Mirtazapine is hypothesized to be effective in PONV prophylaxis via 5HT3 receptor antagonism. Systematic review and meta-analysis. We identified seven randomized controlled trials by systematically searching electronic databases that compare the efficacy of mirtazapine versus placebo or ondansetron in reducing PONV. Mirtazapine reduced PONV overall versus placebo in three studies (risk ratio [RR]=0.44; 95% confidence interval [CI] 0.32 to 0.62) both on conventional meta-analysis and trial sequential analysis. One study comparing mirtazapine with ondansetron found similar rates of PONV (RR=0.96; 95% CI 0.48 to 1.94). Mirtazapine reduced preoperative anxiety versus placebo or ondansetron (standardized mean difference -1.4; 95% CI -2.56 to -0.23) but increased sedation (RR=22.47; 95% CI 5.61 to 89.93). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality of evidence was moderate to low. This meta-analysis suggests that mirtazapine reduces PONV overall versus placebo. We found evidence of reduction in preoperative anxiety, although mirtazapine increased the risk of sedation.

Effect of Pregabalin on Preoperative Anxiety and Postoperative Pain in Spine Surgery: A Randomized Controlled Study

Abstract Background Pregabalin is a gabapentinoid which has been shown to possess analgesic and anxiolytic properties. The present study aimed to assess the efficacy of a single dose of pregabalin on postoperative pain and preoperative anxiety in patients undergoing lumbar spine surgery. Materials and Methods Sixty adults posted for elective lumbar laminectomy and discectomy were randomly assigned to one of the three groups; Group C received placebo capsules, Group PI received pregabalin 150 mg, and Group P2 received pregabalin 300 mg capsules, 2 h prior to induction of anesthesia. The levels of anxiety and pain were assessed with respective 100 mm visual analog scale (VAS) score. Postoperative fentanyl consumption and occurrence of side effects were recorded. All patients were observed for 8 h, postoperatively. Results There was a significant reduction in preoperative anxiety in both pregabalin groups as compared to control group (p = 0.001). VAS score for pain (at rest and during movement) was significantly decreased at all time intervals in both PI and P2 groups as compared to control (p &lt; 0.05). Fentanyl consumption in the postoperative period was significantly reduced in pregabalin groups as compared to control (p = 0.001). The level of sedation was higher in P2 group in the first 4 h (p &lt; 0.05). The occurrence of postoperative nausea and vomiting was more in control group as compared to the pregabalin groups (p = 0.018). The incidence of dizziness and blurring of vision was significantly more in P2 group. Conclusion Single preoperative dose of pregabalin 150 or 300 mg was effective in reducing preoperative anxiety, postoperative pain and total fentanyl consumption in patients undergoing lumbar laminectomy and discectomy. However, the incidence of postoperative side effects such as sedation, dizziness and visual blurring was more in patients who received pregabalin 300 mg.

Comparing Active and Passive Distraction-Based Music Therapy Interventions on Preoperative Anxiety in Pediatric Patients and Their Caregivers.

Young children who experience high levels of preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Active and passive music therapy interventions addressing anxiety prior to invasive procedures have been met with success. The purpose of this study was to investigate the comparative effectiveness of two distraction-based music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers. A total of 40 pediatric patient and caregiver dyads undergoing ambulatory surgery were included in this study. Pediatric preoperative anxiety was measured pre- and post-intervention using the modified Yale Pediatric Anxiety Scale, while caregiver anxiety was measured through self-report using the short-form Strait-Trait Anxiety Inventory-Y6. Participants were randomized to either an active or passive intervention group for a preoperative music therapy session. Results indicated a significant reduction in preoperative anxiety for both patients and their caregivers regardless of intervention type. Neither active nor passive music therapy interventions were significantly more effective than the other. For future studies, the researchers recommend an increased sample size, controlling for various factors such as sedative premedication use, and testing interventions with patients in various stages of development.

Using Technology to Reduce Childrens' Anxiety Throughout the Perioperative Period

In the U.S. each year, approximately 5 million children undergo a surgical procedure ( Perry et al., 2012 Perry J.N. Hooper V.D. Masiongale J. Reduction of preop-erative anxiety in pediatric surgery patients using age-appropriate teaching interventions. Journal of Perianesthesia Nursing. 2012; 27: 69-81 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar ). Surgery is one of the most stressful medical procedures that a child can experience. In fact, approximately 50% of children are reported to experience significant anxiety in the preoperative period ( Perry et al., 2012 Perry J.N. Hooper V.D. Masiongale J. Reduction of preop-erative anxiety in pediatric surgery patients using age-appropriate teaching interventions. Journal of Perianesthesia Nursing. 2012; 27: 69-81 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar ). Pediatric nurses know the importance of incorporating parents into the child's plan of care and understand that the child is comforted by the presence of someone that they know and love. It is also well known that parental anxiety is linked to the child's level of anxiety; therefore, in the perioperative period parents who are inadequately prepared may experience anxiety which in turn may affect the child ( Cumino et al., 2017 Cumino D.O. Vieira J.E. Lima L. Stievano C. Silva L. R.A.P. & Mathias, L.A.S.T. Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised controlled trial. European Journal of Anaesthesiology. 2017; 34: 169-175 PubMed Google Scholar ). Anxiety does not only affect the child psychologically, it leads to increased activity in the autonomic nervous system which may result in ineffective anesthesia induction, duration, and effect time to recovery ( Aytekin et al., 2016 Aytekin A. Doru O. Kucukoglu S. The effects of distraction on preoperative anxiety level in children. Journal of Perianesthesia Nursing. 2016; 31: 56-62https://doi.org/10.1016/j.jopan.2014.11.016 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar , Cumino et al., 2017 Cumino D.O. Vieira J.E. Lima L. Stievano C. Silva L. R.A.P. & Mathias, L.A.S.T. Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised controlled trial. European Journal of Anaesthesiology. 2017; 34: 169-175 PubMed Google Scholar ). Children who experience extreme anxiety in the perioperative period may exhibit developmental regression such as delirium, bedwetting, and nightmares in the postoperative period ( Perry et al., 2012 Perry J.N. Hooper V.D. Masiongale J. Reduction of preop-erative anxiety in pediatric surgery patients using age-appropriate teaching interventions. Journal of Perianesthesia Nursing. 2012; 27: 69-81 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar ). To avoid negative sequella associated with perioperative anxiety, there are various assessment tools, prevention techniques and treatment modalities available. Pediatric nurses can initiate preventative measures in the preoperative period to minimize child and parent anxiety.

Reduction of Preoperative Anxiety in Children Using Non-Pharmacological Measures

Several studies have shown that anxiety in children prior to surgical interventions has a negative effect on posthospitalization recovery. The objective of the proposed project is to reduce anxiety in children prior to major outpatient surgery using non-pharmacological measures (costumes, games, magic tricks, jokes). These measures are to be used from the moment the children are admitted to hospital (the same morning of the surgery) until anaesthetic induction in the operating room. According to our results, the use of hospital clowns has been proven to reduce psychological discomfort in children in a hospital setting.