Pagrindinis darbo tikslas buvo ištirti ir palyginti pacientų priešoperacinį stresą. Tyrime dalyvavo 139 tiriamieji iš jų: 53% moterų ir 47% vyrų. Tiriamųjų amžius: 18-74 metai, amžiaus vidurkis 43 ±11 metų. Tyrimas atliktas Vilniaus miesto ligoninėje. Tiriamąją grupę sudarė atsitiktine tvarka atrinkti chirurginiuose skyriuose gydomi pacientai. Kontrolinę grupę sudarė terapinio pobūdžio skyriuje gydomi pacientai. Tyrimas atliktas naudojant empirinį metodą – anketinę apklausą ir interviu. Klausimyno dalys: 1.Paciento demografiniai duomenys bei papildomi klausimai informacijai apie priešoperacinį stresą, gauti. 2.Hospitalinė nerimo ir depresijos skalė (HAD). 3.Nerimo lygio apklausos klausimynas. (Č.Spielberger‘io apklausa). Chirurginių skyrių pacientai patiria didesnį stresą negu terapinio pobūdžio skyriuose gydomi pacientai.Moterys patiria didesnį stresą prieš operaciją negu vyrai. Skiriasi moterų ir vyrų priešoperacinį stresą sukeliantys veiksniai, priešoperacinės paramos poreikis ir jos šaltiniai. Operacijos laiko derinimo galimybė sukelia stresą. Priešoperacinio laikotarpio trukmė įtakos stresui neturėjo. / The aim of this paper is to research and investigate a patient preoperative stress. 139 cases have been investigated, 53% of that were females and 47% were males. Patients’ age varied between 18 to 74 years, with an average mean of 43 ±11 years. The research was carried out at hospital in Vilnius. A random sample group was drawn from the patients of various surgical departments. A group of medical patients was taken as a comparative reference. The data was captured by using empirical methods, such as questionnaires and interviews. The questionnaire was designed to include the following topics: 1.Demographic information and additional questions about information on preoperative stress 2.Hospital Anxiety and Depression Scale (HAD) 3.Spielberg’s State – Trait Anxiety Inventory (S.T.A.I.) Conclusions: -Surgical patients suffer more extreme stress than medical patients. -Females suffer a higher-level stress than males. The source of stress and the ways of coping are also significantly different for each sex. -A chance to choose a surgical date is a source of stress. -A timing of surgery has no influence on the preoperative stress.

BACKGROUND: Preoperative anxiety commonly occurs in young children prior to anesthesia induction. This anxiety is associated with poor post-operative outcomes such as increases in emergence delirium occurrence and post-operative pain. Studies have demonstrated varying effectiveness of interventions such as clowns and video games used to engage and distract children from their anxiety. Anesthesiologists at Lucile Packard Children’s Hospital have designed a new screen-based modality, called the Bedside Entertainment Theatre (BERT), to distract children from their anxiety. OBJECTIVE: The aim of this study is to examine the anxiety-relieving efficacy of BERT against a hand-held electronic tablet, another screen-based form of entertainment used to alleviate preoperative anxiety in children at the hospital. METHODS: Children aged 4-10 undergoing non-emergent outpatient surgery at Lucile Packard Children’s Hospital and their primary caregiver were recruited for the study. Measures were taken at 5 timepoints from children, parents, and clinicians: in the preoperative holding area (T1), at entrance to the OR (T2), at induction (T3), after emergence from anesthesia (T4), and at a 1-week follow up (T5). Primary outcomes were preoperative anxiety, assessed by the modified Yale Preoperative Anxiety Scale (mYPAS) and Child Fear Scale (CFS), and induction compliance, assessed by the Induction Compliance Checklist (ICC). Secondary outcomes were emergence delirium, measured by the Pediatric Anesthesia Emergence Delirium Scale (PAED) and post-operative pain, measured by the Parents’ Post-operative Pain Measure (PPPM) and a Memory Recall Interview. Child covariates were temperament, measured by the Emotionality Activity Sociability Temperament Survey (EAS-TS) and the Children’s Behavior Questionnaire- Very Short Form (CBQ-VSF), and state-trait anxiety, measured by the Child State-Trait Anxiety Inventory (STAIC). Caregiver covariates were state-trait anxiety, measured by the State-Trait Anxiety Inventory (STAI) and caregiver pain catastrophizing about their child, measured by the Pain Catastrophizing Scale- Parent State (PCS-P State). This study is currently ongoing and plans to recruit 60 participants. Parent, child, and clinician satisfaction with usage of either intervention was also assessed. RESULTS: There were no significant differences between mean preoperative anxiety scores of BERT and tablet users at all pre-induction timepoints. There was a significant increase in mean preoperative anxiety scores in BERT users from T1 to T2 and T1 to T3. There was also a significant increase in mean preoperative anxiety scores from T1 to T3 for tablet users. There were no other significant differences in primary and secondary outcomes between interventions. Only post-surgery PCS-P State scores for BERT users correlated with mYPAS scores at T3 (p < 0.05). No other measured covariates correlated with preoperative anxiety scores (p > 0.05). CONCLUSIONS: Although preliminary results do not show differences between the interventions in relieving preoperative anxiety, there may be potential insights gained in how both interventions affect anxiety at different preoperative timepoints. Statistical analysis with the full sample population will be necessary to draw stronger conclusions. / 2018-07-11T00:00:00Z

<p><strong>Bakgrund: </strong>Tidigare forskning visade att<strong> </strong>ett kirurgiskt ingrepp är en stressfylld upplevelse både fysiskt och psykiskt eftersom kroppens integritet hotas. Preoperativ oro var ett vanligt problem vid elektiv kirurgi. Omvårdnad var ett stöd till medicinsk behandling t.ex. genom information som minskar patientens oro och ängslan samt ökar patientens tolerans för smärta.<strong> Syftet: </strong>Var att beskriva vad patienterna är oroliga för inför elektiv kirurgi samt ge kunskap i vad sjuksköterskan omvårdnadsmässigt kan göra för att minska oron inför elektiv kirurgi. <strong>Metod: </strong>Beskrivande litteraturstudie baserad på fyra kvalitativa och 16 kvantitativa artiklar från år 2001-2008. De sökord som användes var Anaesthesia, Anxiety, Nursing, Preoperative, Presurgery och Surgery. <strong>Resultat: </strong>Fyra centrala fynd framkom; orosmoment, information, musik och akupunktur/ akupressur/värme. Separation från familjen, funktionsoduglighet, att förlora sin självständighet, rädsla för kirurgi och död var alla faktorer som triggar symtom på preoperativ oro. Resultatet visade att musik kan minska oron signifikant. Den omvårdnadsåtgärden kunde tillämpas på flera olika sätt och har visat sig effektiv oavsett vilken musik patienten lyssnar på. Information var viktigt och det bästa var om den individanpassas. <strong></strong></p> / <p><strong>Background: </strong>Previous research has shown that a surgical operation means a lot of stress both physically and mentally since the human integrity is threatened. Preoperative anxiety was a common problem at elective surgery. Caring was a support to medical treatment for example information that decreases the patient anxiety and increases the tolerance for pain. <strong>Aim: </strong>The aim of the research was to describe the preoperative anxiety in elective surgery and to give knowledge in what the nurse can do to decrease this anxiety. <strong>Method: </strong>Descriptive literature review based on four qualitative and 16 quantitative articles from year 2001-2008. The searching words that was used was Anaesthesia, Anxiety, Nursing, Preoperative, Presurgery and Surgery. <strong>Findings: </strong>Four central categories emerged; things patients worries about, information, music and acupuncture/acupressure/heat. Being separated from the family, incapacitation, loss of independence, fear of surgery and death were all things that contribute to preoperative anxiety. The findings showed that music can decrease the anxiety significantly. It can be carried out in different ways and has shown to be effective irrespective of what music the patient is listening to. Information was important and the best thing if it´s adapted to the individual. <strong></strong></p>

Bakgrund: Tidigare forskning visade att ett kirurgiskt ingrepp är en stressfylld upplevelse både fysiskt och psykiskt eftersom kroppens integritet hotas. Preoperativ oro var ett vanligt problem vid elektiv kirurgi. Omvårdnad var ett stöd till medicinsk behandling t.ex. genom information som minskar patientens oro och ängslan samt ökar patientens tolerans för smärta. Syftet: Var att beskriva vad patienterna är oroliga för inför elektiv kirurgi samt ge kunskap i vad sjuksköterskan omvårdnadsmässigt kan göra för att minska oron inför elektiv kirurgi. Metod: Beskrivande litteraturstudie baserad på fyra kvalitativa och 16 kvantitativa artiklar från år 2001-2008. De sökord som användes var Anaesthesia, Anxiety, Nursing, Preoperative, Presurgery och Surgery. Resultat: Fyra centrala fynd framkom; orosmoment, information, musik och akupunktur/ akupressur/värme. Separation från familjen, funktionsoduglighet, att förlora sin självständighet, rädsla för kirurgi och död var alla faktorer som triggar symtom på preoperativ oro. Resultatet visade att musik kan minska oron signifikant. Den omvårdnadsåtgärden kunde tillämpas på flera olika sätt och har visat sig effektiv oavsett vilken musik patienten lyssnar på. Information var viktigt och det bästa var om den individanpassas. / Background: Previous research has shown that a surgical operation means a lot of stress both physically and mentally since the human integrity is threatened. Preoperative anxiety was a common problem at elective surgery. Caring was a support to medical treatment for example information that decreases the patient anxiety and increases the tolerance for pain. Aim: The aim of the research was to describe the preoperative anxiety in elective surgery and to give knowledge in what the nurse can do to decrease this anxiety. Method: Descriptive literature review based on four qualitative and 16 quantitative articles from year 2001-2008. The searching words that was used was Anaesthesia, Anxiety, Nursing, Preoperative, Presurgery and Surgery. Findings: Four central categories emerged; things patients worries about, information, music and acupuncture/acupressure/heat. Being separated from the family, incapacitation, loss of independence, fear of surgery and death were all things that contribute to preoperative anxiety. The findings showed that music can decrease the anxiety significantly. It can be carried out in different ways and has shown to be effective irrespective of what music the patient is listening to. Information was important and the best thing if it´s adapted to the individual.

Syftet med studien var att beskriva förekomst och typ av patienters eventuella oro inför anestesi. Litteraturöversikten har baserats på vetenskapliga artiklar av både kvantitativ och kvalitativ art. Trettioen artiklar granskades och 21 av dessa valdes ut till resultatet.De flesta studier som behandlade oro inför anestesi var av kvantitativ art. Oro i form av olika slags olustkänslor definierades av flera författare utförligt och på flera sätt. Resultatet påvisade att oro var ett vanligt förekommande fenomen och kunde objektivt mätas med hjälp av självskattningsskalor, där de vanligast förekommande är Visuel Analog Skala (VAS) och State Trait Anxiety Inventory (STAI). Dagkirurgin har ökat och tiden att träffa patienten för mental förberedelse har minskat, vilket var till nackdel för både patient och personal. Vi har genom den här studien och kliniska erfarenheter uppmärksammat riskfaktorer för oro, till exempel kvinnor och yngre patienter. En studie påvisade även att patienter med sen placering på operationslistan hade en signifikant högre nivå av oro. För att ge känslomässigt stöd till patienter som har behov av ökad uppmärksamhet, krävs en bred insats som omfattar bemötande, information, patientutbildning och kommunikation. Trots all kunskap som finns presenterad i resultatet av studierna förstår vi det som att den psykologiska omvårdnaden är otillräcklig och måste prioriteras.

Introduktion: Det är vanligt förekommande med oro i samband med operationer. Vissa riskfaktorer finnskonstaterade, så som brist på information och kvinnligt kön. Anestesisjuksköterskan har en viktig uppgift i attbemöta och identifiera oro i samband med operation, och minskade nivåer av preoperativ oro bidrar till kortareåterhämtningstid och ett minskat lidande. Syfte: Syftet med denna studie var att undersöka faktorer som kan påverka preoperativ oro hos patienter som skagenomgå elektiv kirurgi. Metod: En kvantitativ retrospektiv tvärsnittsstudie genomfördes. Data samlades in genom en webbaserad enkätbestående av demografiska frågor, en skattningsskala för preoperativ oro samt en öppen fråga. Kvantitativ dataanalyserades med SPSS, medan data från den öppna frågan analyserades med manifest innehållsanalys. Totaltanalyserades 111 enkäter. Resultat:Resultatet visar att det inte fanns ett samband mellan ålder och preoperativ oro, samt att kvinnor kände meroro än män inför anestesin. Personer med hög utbildning skattade sig som mer oroliga än personer med lågutbildning, och personer som skattade sig som oroliga sedan tidigare, skattade sig också som mer oroliga införanestesi och kirurgi än andra. Slutsats: Informationsbehovet preoperativt är stort. Personer som är oroliga till vardags löper risk att uppleva höganivåer av oro preoperativt. Vidare forskning krävs för att utveckla en metod som kan identifiera oroliga individer.Genom att identifiera dessa preoperativt kan detta fungera som en prediktor för personer som riskerar att upplevamer preoperativ oro. Denna undersökning kan konstatera att det finns en vinst i att belysa faktorer som kan påverkaden preoperativa upplevelsen då verksamheten kan nyttja informationen till att motverka preoperativ oro.

Young children who experience high levels 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. Music therapy interventions addressing a variety of procedural outcomes have been met with success. The purpose of this study was to investigate the comparative effectiveness of two music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers. A total of 40 pediatric patient and caregiver dyads were included in this study on various days that they were present for ambulatory surgery. 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 received a randomized active or passive preoperative music therapy session. Results indicate a significant reduction in preoperative anxiety for both patients and their caregivers. Neither active, nor passive music therapy interventions were significantly more effective than the other. Future studies should increase sample size and control for various factors such as sedative premedication use.

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

Forty to sixty percent of all children having surgery experience preoperative anxiety. Preoperative anxiety is a risk factor for negative behavioural changes postoperative. It is of importance to find strategies in the interaction with the child to reduce anxiety. The overall aim was to describe CRNA's interaction with the child in relation to anxiety during anaesthesia induction and to describe the translation process of m-YPAS into Swedish and the testing of the psychometric properties in a Swedish context. In paper I an explorative qualitative approach with CIT was used and 32 CRNAs were interviewed. Experiences described were about the organisation which included effect of information, teamwork and time. Other experiences were grouped around interrelations such as, communication, meeting both anxious and calm children and experiences of use of physical restraint. Actions taken to reduce anxiety were optimizing the situation, as acting according to the situation, it could mean altering routines, though always without jeopardizing the safety of the child, preparing ahead and using distraction. Creating interpersonal interaction such as, creating contact, participation and using collaboration with the child, parents and colleagues. In paper II m-YPAS was translated into Swedish using cross cultural back translation. The psychometric properties of m-YPAS were tested in two phases. In phase I 52 children were assessed in real time by two SRNAs and one CRNA using m-YPAS and NAS. In phase II 98 video films of children were assessed by experienced CRNAs in the same way as in phase I. The psychometric properties of m-YPAS were good. Conclusion: In the interaction between CRNAs and the child, being flexible and sensitive to the child, taking the role of the child, and acting according to the need of the child were cornerstones in reducing preoperative anxiety and avoiding use of physical restraint. The m-YPAS can be used as an educational tool to enhance the anaesthetist's ability to interpret the child's anxiety. The m-YPAS is a valid and reliable assessment instrument to examine the efficiency of interventions and compare the result of research between cultures.