The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

Abstract

SummarySkin surface warming of patients not only improves thermal comfort, but has been shown to reduce anxiety in a pre-hospital setting. We tested the hypothesis that pre-operative warming can reduce pre-operative anxiety as effectively as a conventional dose of intravenous midazolam in patients undergoing neurosurgery. We randomly allocated 80 patients to four groups in the pre-operative holding area. Treatment was applied for 30-45 min with (1) passive insulation and placebo; (2) passive insulation and intravenous midazolam (30 lg.kg )1 ); (3) warming with forced-air and placebo; and (4) warming with forced-air and intravenous midazolam (30 lg.kg )1 ). Thermal comfort levels (VAS 0-100 mm) and anxiety levels (VAS 0-100 mm, Spielberger State-Trait Anxiety Inventory) were assessed twice: before the designated treatment was started and before induction of anaesthesia. In the midazolam and the midazolam ⁄ warming groups, anxiety VAS and Spielberger state anxiety scores decreased by ) 19 (95% CI: ) 29 to ) 9, p < 0.01) and ) 10 (95% CI: ) 14 to ) 6, p < 0.01), respectively. In the warming and the combined groups, thermal VAS increased by + 26 (95% CI: 17-34, p < 0.01). [7], and prolonged hospitalisation [5]. Pre-operative warming before induction can prevent redistribution hypothermia and can improve thermal comfort by keeping the patient warm during the preoperative period [8,9]. This benefit of pre-operative warming has been demonstrated in several studies during regional [10] and general anaesthesia [8,11,12]. The administration of pre-operative warming has even been shown to abolish completely the need for any additional intra-operative warming in certain patient populations [13,14].There is, however, another potential benefit of preoperative warming: it may reduce anxiety. In four recent studies, minor trauma victims [15], patients with lower back pain [16], patients with renal colic [17] and cholelithiasis pain [18] were assigned to passive insulation or carbon-fibre warming: The warmed patients had improved thermal comfort, less pain, and were significantly less anxious.For the reduction of pre-operative anxiety, patients typically receive medications such as oral or intravenous benzodiazepines, yet these medications are not always effective and can be associated with respiratory depression and delayed discharge [19][20][21][22][23]. Thus, several non-pharmacological methods to reduce pre-operative anxiety have been considered, including music therapy [24,25], supply of in-depth information with leaflets [26] or videos

A randomised controlled trial examining the effect of acupuncture at the EX-HN3 (Yintang) point on pre-operative anxiety levels in neurosurgical patients

“…A large proportion of our study cohort were anxious, with 50% having APAISa ≥ 10, which is similar to other studies of neurosurgical patients; Perks et al found 55% of their patients had a pre-operative APAISa score ≥ 10 [8]. The overall mean STAI scores were also similar to other neurosurgical studies [15,16], suggesting our cohort is representative of the neurosurgical patient population. The high anxiety levels were present despite the patients having already been seen and assessed by both their caring anaesthetist and surgeon, which has previously been shown to decrease pre-operative anxiety [3,17,18].…”

“…Median APAISa level in the acupuncture group, but not in the control group: 10 (6-13 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]) to 7 (4-10 [4-18]), p < 0.001 vs. 9 (6-13 [4-18]) to 8.5 (6-12 [4-18]), p = 0.872, respectively.…”

A randomized trial of prewarming on patient satisfaction and thermal comfort in outpatient surgery

“…Thermal comfort in our prewarmed patients increased from 50 mm to 60 mm on a 100-mm scale, whereas core temperature only increased 0.2°C. Previous work has similarly shown that prewarming increases the sensation of warmth and that warming per se does not reduce anxiety [27].…”

The Effect of Preoperative Heart Rate and Anxiety on the Propofol Dose Required for Loss of Consciousness

“…13 This is a validated tool for self-reporting anxiety, already used during the perioperative period. [1][2][3]14 It comprises 2 sets of 20 statements.…”