Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes

Wilson, Craig J.; Mitchelson, Andrew J; Tzeng, Tony H.; El-Othmani, Mouhanad M.; Saleh, Jasmine; Vasdev, Sonia; LaMontagne, Hillary J.; Saleh, Khaled J.

doi:10.1016/j.amjsurg.2015.03.023

Cited by 90 publications

(108 citation statements)

References 91 publications

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“…Previous studies have shown that familiarity with the expected post-surgical experience can reduce patients' surgical anxiety. 4,5 In addition, such data would highlight common issues experienced during the post-surgical period that may call for monitoring or intervention, set a baseline for “normal” levels of morbidity, and inform comparisons between treatment options. 3 …”

Section: Introductionmentioning

confidence: 99%

Health-Related Quality of Life After Pancreatectomy: Results From a Randomized Controlled Trial

et al. 2016

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Background A recent prospective randomized trial demonstrated that prophylactic pasireotide reduces the incidence of pancreatic complications (PC) following resection. In this secondary analysis, we aimed to describe quality of life (QoL) before and after resection, characterize the impact of PC on QoL, and assess whether pasireotide improves QoL. Methods We conducted a randomized, double-blind, placebo-controlled trial of preoperative pasireotide in patients undergoing pancreatectomy. Participants completed the EORTC C30 and PAN26 modules preoperatively and on postoperative days 14 and 60. Scores were compared using t-tests. Percent of patients with clinically important worsening (a decline ≥0.5 times the baseline standard deviation) was reported. Results Eighty-seven percent of patients (260/300) completed all questionnaires. No major differences were observed between the pasireotide and placebo groups, therefore the data was pooled for further analyses. A significant worsening of function at 14D was detected on all PAN26 and C30 function scales except hepatic and emotional functioning (EF), and all C30 symptom scales. More than 75% of patients experienced clinically important worsening of fatigue, pain and role functioning. Most effects persisted at 60D. 60D EF was significantly better than baseline (p=0.03). PC were associated with worse outcomes on most function scales. Conclusions During the 14D following resection, patients can be expected to have a significant decline in QoL. Many symptoms abate by 60D, and EF improves. PC were associated with impaired QoL on several domains. Although pasireotide effectively reduced PC, its effect did not appear to translate to improved QoL in this sample of 300 patients.

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Section: Introductionmentioning

confidence: 99%

Health-Related Quality of Life After Pancreatectomy: Results From a Randomized Controlled Trial

et al. 2016

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“…Proper anxiolytic premedication before surgery also results in lower incidence of surgical site infection even up to 30 days after surgery due to decreased stress response [21]. The application of a proper protocol preoperatively, both pharmacological and nonpharmacological, including patient's training and behaviour modification, could affect outcome and even hospital length of stay [22]. There is no consensus regarding the most appropriate anesthetic management for patients with a prior history of stress-induced cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy after Spinal Anesthesia for a Minimally Invasive Urologic Procedure

Lilitsis

Dermitzaki

Avgenakis

et al. 2017

Case Reports in Anesthesiology

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We present the case of a patient who suffered from Takotsubo cardiomyopathy (TCM) immediately after the initiation of subarachnoid anesthesia for a minimally invasive urologic procedure (tension-free vaginal tape (TVT) surgery for stress urine incontinence). TCM mimics acute coronary syndrome and is caused by an exaggerated sympathetic reaction to significant emotional or physical stress. Our patient suffered from chest pain, palpitations, dyspnea, and hemodynamic instability immediately following subarachnoid anesthesia and later in the postanesthesia care unit. Blood troponin was elevated and new electrocardiographic changes appeared indicative of cardiac ischemia. Cardiac ultrasound indicated left ventricular apical akinesia and ballooning with severely affected contractility. The patient was admitted to coronary intensive care for the proper care and finally was discharged. TCM was attributed to high emotional preoperative stress for which no premedication had been administered to the patient. In conclusion, adequate premedication and anxiety management are not only a measure to alleviate psychological stress of surgical patients, but, more importantly, an imperative mean to suppress sympathetic nerve system response and its cardiovascular consequences.

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“…Après sensibilisation du personnel à la communication thérapeutique, le pourcentage de patients ayant un score CN C 5 était significativement inférieur, passant de 20 % (22 patients) dans le groupe préintervention à 6 % (sept patients) dans le groupe CT (P = 0,001, Tableau 2). Le score CN était significativement inférieur dans le groupe CT comparé au groupe préintervention (2 [2][3][4] Les échelles de confort (ENSc) du patient avant anesthésie étaient significativement supérieures dans le groupe CT comparées au groupe préintervention (8 [8-9] vs 8 [7][8], respectivement). De même, les échelles de confort en fin de SSPI étaient supérieures dans le groupe CT comparées au groupe préintervention (8 [8-9] vs 8 [7][8], respectivement, P \ 0,001)).…”

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“…2 Pour diminuer celle-ci, une approche médicamenteuse est souvent utilisée par les anesthésistes, avec la prescription d'une prémédication avant l'intervention. 4 Cette approche est cependant actuellement controversée et son utilisation systématique tend à diminuer. [5][6][7] D'autres approches non médicamenteuses sont également possibles et tendent à se développer actuellement afin d'améliorer l'accueil du patient au bloc opératoire.…”

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“…[5][6][7] D'autres approches non médicamenteuses sont également possibles et tendent à se développer actuellement afin d'améliorer l'accueil du patient au bloc opératoire. 4,8,9 Parmi celles-ci, les techniques d'hypnose et de communication ont montré des résultats intéressants pour réduire l'anxiété préopératoire. 10 La communication est un élément majeur de la relation de soin et les mots peuvent avoir un réel impact positif comme négatif sur les patients.…”

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Évaluation de la communication thérapeutique pour améliorer l’accueil du patient au bloc opératoire: étude d’impact

Boselli

Demaille

Fuchs

et al. 2018

Can J Anesth/J Can Anesth

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Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes

Cited by 90 publications

References 91 publications

Health-Related Quality of Life After Pancreatectomy: Results From a Randomized Controlled Trial

Health-Related Quality of Life After Pancreatectomy: Results From a Randomized Controlled Trial

Takotsubo Cardiomyopathy after Spinal Anesthesia for a Minimally Invasive Urologic Procedure

Évaluation de la communication thérapeutique pour améliorer l’accueil du patient au bloc opératoire: étude d’impact

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