Fears about Surgery and Anesthesia

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Anxiety before elective surgery is common. Therefore, many studies have examined interventions to reduce preoperative anxiety, including pharmacologic anxiolysis, information, distraction, and relaxation procedures. This study compared different methods to measure preoperative anxiety. The aims of the study were threefold. First, to examine the validity and utility of the self-reporting visual analog scale (VAS) and to compare this test to the standard Spielberger State-Trait Anxiety Inventory (STAI). Second, to find out whether the authors could identify patient risk factors or operations that correlated with high preoperative anxiety. Third, to itemize the concerns of patients admitted for elective anesthesia and surgery. The study was conducted in a university hospital in Switzerland.
The authors developed a questionnaire to evaluate the different aspects of preoperative anxiety. The final questionnaire contained 91 items. Topics covered included the patients’ demographic background, relevant medical and anesthetic history, visual analog scales (for fear of anesthesia, fear of surgery, and different aspects of preoperative anxiety), as well as questions designed to assess the impact of the preoperative visit by the anesthesiologist, patients’ satisfaction with different aspects of their preoperative care and the patients’ perception of their anesthesiologist. This study was performed on all patients admitted preoperatively for surgery over a three-month period . They completed the questionnaire on the evening before surgery, in hospital.
685 of the 734 questionnaires distributed to patients were returned. The authors found a significant correlation between the VAS measuring fear of anesthesia and the STAI, and between the VAS measuring fear of surgery and the STAI. These correlations were not significantly different between male and female patients. 25% of patients scored higher than 1 standard deviation above the normative mean STAI and were defined as having high preoperative anxiety. Factors associated with higher preoperative anxiety levels were age less than 37 years, previous negative experience with anesthesia, information seeking behavior (rather than information avoiding), and patients with high school only education. The different genders had increased fear of different kinds of surgical procedures.
The questions evaluating patients’ preoperative fears were assessed after factor analysis and found to have three characteristic areas. The first group of characteristics was called by the authors “fear of the unknown.” This factor consisted of fear of the waiting period before surgery/anesthesia, of being at the mercy of physicians during anesthesia, of surgical outcome, and of not knowing what occurs while unconscious during anesthesia. This factor correlated highly with the STAI. The second factor, termed “fear of feeling ill,” included the fear of postoperative nausea or vomiting, perioperative pain, as well as fear of discomfort at postoperative awakening and of awareness intraoperatively. The third factor was termed “fear for one’s life” and consisted of fear of not regaining consciousness, fear of dying and remaining in a coma. These latter two factors were less correlated with STAI. The authors also queried specific anxiety factors and found that “waiting for operation” generated the highest anxiety score. Postoperative pain anxiety ranked number four
[out of 10], postoperative nausea and vomiting ranked number six, and awareness under anesthesia ranked number ten of ten.
In summary, this study shows that the VAS may be a useful clinical tool to measure preoperative anxiety. Certain patient characteristics might serve to warn the anesthesiologist about the potential presence of increased preoperative anxiety. This increased knowledge may allow anesthesiologists to provide additional appropriate care to ameliorate the anxiety state.

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Who else is concerned about the anesthesia during surgery?

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This research has just come to my attention and I thought you’d want to see it too! It confirms my research exactly. For those who are able to choose their own favorite slow, steady, instrumental music, it’s great. For those who don’t have the time or the no-how, my music is already chosen and ready to go. In the near future, I plan to have many different genres of music that are also ideal for surgery. Please contact me if you are having surgery in the near future!

Contact: Jacqueline Weaver
jacqueline.weaver@yale.edu
203-432-8555
Yale University

Patients’ favorite music during surgery lessens need for sedative
New Haven, Conn.–Patients listening to their favorite music required much less sedation during surgery than did patients who listened to white noise or operating room noise, according to a Yale School of Medicine study published in May.
The senior author, Zeev Kain, M.D., professor in the Department of Anesthesiology, said previous studies have shown that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under anesthesia. He wanted to know if the decrease resulted from listening to music or eliminating operating room noise

The study included 36 patients at Yale-New Haven Hospital and 54 patients at the American University of Beirut Medical Center. The subjects wore headphones and were randomly assigned to hear music they liked, white noise or to wear no headphones and be exposed to operating room noise. Dropping a surgical instrument into a bowl in the operating room can produce noise levels of up to 80 decibels, which is considered very loud to uncomfortably loud.

What they found is that blocking the sounds of the operating room with white noise did not decrease sedative requirements of listening to operating room sounds. Playing music did reduce the need for sedatives during surgery.

“Doctors and patients should both note that music can be used to supplement sedation in the operating room,” Kain said.

The lead author was Chakib Ayoub,M.D., with co-authors Laudi Rizk, M.D., Chadi Yaacoub, M.D., and Dorothy Gaal, M.D., of the University of Beirut Medical Center. The study was supported in part of National Institutes of Health grants.

Of course, a major solution is now available: www.surgicalheadphones.com.
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Anesthesia & Analgesia 100: pp 1316-1319 (May 2005)

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Surgery allows girl to enjoy Christmas music

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CAROLS by Candlelight in Horsham was extra special this year for one little girl and her parents.
Emily Vettos, 10, was in the Combined Primary Schools Choir, but what made her carols debut special was that six months ago she was deaf.
Her mother Dee said Emily had lived with hearing difficulties for most of her life but was now loving life and singing proudly after an operation.
“Emily was born almost six weeks premature and the tubes in the ears are one of the last things to develop, so she had a lot of pressure building in her ears,” Mrs Vettos said.
“When she was two we realised she was mumbling a lot and so we took her to the doctor and he referred her to an ear, nose and throat surgeon and he found she was profoundly deaf, that she didn’t have a lot of hearing at all.
“He operated on her and widened the tube in both her ears and for a while we thought she was going really well.
“She was very smart, doing well at school but she was very shy and it wasn’t until we had an appointment a year ago that we found she had had a lot of scarring in her right ear and was not actually improving.
“We found out that she had taught herself to lip read and that was how she was getting by.”
Mrs Vettos said that after a second operation, about six months ago, Emily had a new lease on life.
“We had no idea because she never said anything and she had no idea either,” she said. “It wasn’t until she had the surgery that she realised, she came out and said `oh mum, you sound great’. And she’s really come out since then, she’s still got deafness in her right ear, and she will always have some hearing loss, but she’s coming out of her shell and doing a lot better.”
Singing has now become a big part of Emily’s life.
“She joined the school choir about three years ago and used to stand up the back and was really quiet and shy and then after this surgery, because she could hear the beat and was in tune, she sings with gusto. She’s really loud and she loves it,” Mrs Vettos said.
“She likes everything, she’s into 1980s music and Abba at the moment because of Mamma Mia but she’s always singing,” she said.
“We think we’ll get her singing lessons for the coming year, she really does enjoy it.”
Mrs Vettos said seeing Emily sing at carols had been a defining moment for her and husband Con.
“I was so proud, from a little girl who really had the odds against her and was so shy and withdrawn, to come on stage in front of other people and perform, well it was the proudest thing I have ever seen,” she said.
Emily said she had enjoyed singing at the carols celebration.
“It went really good and I liked doing all the actions. It was cool because there were a lot of people that I knew and it was exciting,” she said.
Emily, who wants to be a singer and a photographer when she grows up, said singing made her feel good.
“When I was little I was really embarrassed because I couldn’t do much and now that I can sing I guess I can do a lot more than I used to be able to, it’s a nice feeling,” she said.

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