Systematic Review Audiovisual Interventions for Reducing Preoperative Anxiety in
Introduction
Anxiety is defined as an unpleasant sense associated with fear, tension, and nervousness (1). Surgery every bit a major trauma can cause anxiety. During the period of pre-performance, surgical candidates experience situations that stimulate psychological feet leading to stress during and after surgery. The anxiety secondary to disease, hospitalization, and planned surgery is called preoperative anxiety (ii, three). The most common crusade of preoperative anxiety is waiting for surgery, concern virtually the operation results, separation from family, postoperative pain anticipation, loss of independence, and fear of surgery and death (4).
The prevalence of preoperative feet varies widely and it has been reported to range from twoscore to threescore%amongst young children patients and 11–80% among adult ones (4–6). In a written report, 23.99% of patients experienced astringent preoperative anxiety (iv). Different causes are proposed for preoperative anxiety such every bit the fear of the unknown, fear of existence ill, and fright of death (7). Diverse factors are associated with preoperative anxiety. These factors are classified as sociodemographic factors, psychosocial variables, and surgery and anesthesia-related factors such as previous surgical experience, having information well-nigh the surgical procedure, and anesthesia (4, 7). Age is a protective gene of preoperative anxiety as each i year increase in age reduces five percent of the chance of preoperative anxiety. Females are at higher risk and levels of anxiety than men and educated persons feel higher levels of feet (eight). Married patients accept greater emotional supports and then they experience lower anxiety levels (nine). The significance of the surgery is associated with anxiety equally higher levels of anxiety are reported in patients who had a greater surgical process (10). History of cancer is an important take a chance gene for preoperative anxiety (4). Previous psychiatric diseases, such as low and anxiety may influence the extent of preoperative anxiety (11, 12).
Preoperative anxiety can cause psychological and physiological agin effects on both children and adults. Also, it tin interfere with the process of surgery and can put patients in danger during the surgical process (13). Maladaptive behaviors, emergence delirium, and preoperative anxiety are common amongst children undergoing surgery and these phenomena are related as maladaptive behavioral responses similar sleep and eating disturbances and enuresis are common agin events amidst children with preoperative anxiety (6, 14–sixteen). A 10 point increment in the state anxiety scores in children may result in a 12.5% increase in the probability of the new-onset maladaptive behavior happening later on the performance (16).
The increased need for postoperative analgesics, prolonged hospital stay, and recovery are common amid adults (17, 18). Besides, it can trigger autonomic and endocrine systems which crusade hemodynamic instability (nineteen). Moreover, severe preoperative anxiety is associated with impaired wound healing and postoperative complications like nausea, vomiting, and pain (20–22). In that location is a meaning inverse relationship between anxiety and recovery and effectiveness of anesthesia (23).
Preoperative anxiety is a matter of concern for many wellness professionals including anesthesiologists and surgeons, and nurses at the recovery unit of measurement, ICU, and ward. It is considered a major morbidity factor during and after the surgical process (24, 25). It is likewise known as a financial burden on the healthcare organization (26). The mentioned costs are considered to exist attributed to the prolonged recovery and infirmary stay and increased need for anesthetic and analgesic drugs (27).
Due to the high prevalence and agin effects of preoperative anxiety, treatment is necessary. Till at present, two types of interventions for preoperative anxiety are identified pharmacological and not-pharmacological. Pharmacological interventions include sedatives and anti-anxiety drugs. Midazolam, diazepam, ketamine, and fentanyl are the near common anxiolytics (28). As pharmacological treatments accept adverse furnishings such as breathing issues, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more than commonly used. It is reported that non-pharmacological interventions are more than commonly used by anesthesiologists compared to pharmacologic ones in both pediatric and adult anesthesia procedures. For example, in a survey from Korean anesthesiologists, 46.iii% preferred non-pharmacological interventions compared to 39.0% preferring medications and 14.half dozen% of no preference for pediatric anesthesia (29). In another report from the UK 95% of anesthesiologists reported the use of communication with the patient and reassurance as their most popular method to reduce preoperative feet in the adult population (30).
Not-pharmacological interventions include, merely are non limited to, interviews with patients performed past healthcare providers, communicating strategies, religious or spiritual activity, music, visits from relatives, acupuncture, diverse distraction, and patient education (Figure i) (31–44). Various clinical studies are conducted to evaluate the efficacy of these not-pharmacological interventions (Tabular array 1). In this report, the most popular not-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent prove provided past clinical studies.
Figure ane. Non-pharmacologic approaches in preoperative feet.
Table 1. Clinical studies on cognitive behavioral therapy (CBT), guided imagery relaxation and hypnosis in preoperative feet.
Methods
This study was performed as a narrative literature review, aimed to comprehensively assemble and summarize the available information in the scientific literature on the not-pharmacologic treatments for preoperative anxiety. The databases of PubMed, Scopus, and web of noesis, as well as google scholar search engine, were searched for the relevant manufactures. The searching terms included "preoperative anxiety," "treatment," and "trial" from inception to 2020. All studies reported outcomes for not-pharmacologic treatments are reviewed. This study reviewed the latest clinical trials of 10 types of not-pharmacological interventions. The used key terms of treatments, interventions, approaches, and therapy used as synonyms through the text and ways the mentioned x types of not-pharmacological l interventions aiming the reduction of preoperative anxiety. Nosotros volition review the clinical evidence about the interview, chat and communication strategies, cognitive-behavioral therapy, spiritual/religious interventions, music therapy, pre-performance preparation video, aromatherapy, massage, meditation, and guided imagery relaxation therapy, hypnosis, and acupuncture in the treatment of the preoperative anxiety. Beast, and in-vitro studies as well as clinical studies on drug therapy for preoperative anxiety were excluded. Two reviewers, independently, checked the studies for eligibility and extracted information from each study. For each study type of not-pharmacologic intervention, type of intervention in control group, sample size, population, type of surgery, and results were extracted. Afterward that, we accept discussed the availability, limitations, acceptability, needed teaching and equipment, acceptability and popularity of these interventions.
Interview, Chat, and Communication Strategies
Interview and advice strategies are considered the almost mutual strategy used by anesthesiologists for decision-making preoperative feet in some studies (30). Different studies have evaluated the efficacy of these strategies in reducing preoperative anxiety. A written report evaluating 230 patients undergoing breast and abdominal surgeries past State-Trait Feet Inventory (STAI) regarding their preoperative feet showed that surgeon communication with the patients and their communication abilities was associated with reduced anxiety scale (64). They have used predefined question prompt lists for the consultation session held 1-3 weeks before the surgical schedule. Some other written report on a structured advice betwixt patients and anesthesiologists showed reduced anxiety and fright of anesthesia, specially in younger patients compared to standard interview techniques (65). Notably, the structured interview had a significantly shorter duration compared to the routine sessions. Bear witness also supports the positive effect of preoperative patient-doc advice on pre-operative anxiety (66, 67).
Cerebral-Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is defined every bit science-based behavioral and cognitive interventions. Behavioral interventions aim to increase adaptive behaviors and subtract maladaptive ones. Cerebral interventions change abnormal beliefs, self-statements, and cognitions. CBT is the gold standard psychotherapeutic handling of feet disorders (68–71). Exposure and cognitive therapy are the almost commonly used CBT methods. Imaginal, in vivo (in real life), and interoceptive are 3 forms of exposure. Cognitive therapy is based on irresolute the distorted thoughts by using some techniques such as recognizing inaccurate thinking, controlling automatic thoughts, and irresolute abnormal thoughts (72).
Catastrophizing (such as magnification, rumination, and helplessness), anxiety, and depression are associated with increased postoperative hurting (73). Proper evaluation and identifications of these factors in the patient in the perioperative menstruum may help reduce anxiety and promote recovery (74). For example, the modified Yale Preoperative Anxiety Calibration (mYPAS) and State-Trait Anxiety Inventory for Children (STAIC) is reported equally a significant predictor of anxiety in children (75).
Perioperative Pain Self-management (PePS) intervention based on principles of CBT is a feasible intervention for preventing chronic pain and long-term opioid use (76). A brief Managing Anxiety and Depression using Didactics and Skills (MADES) intervention (a type of CBT) earlier coronary avenue bypass graft surgery had several beneficial effects in the intervention group compared to usual treatment in control (45). This CBT improved depression and anxiety symptoms and quality of life (45). Moreover, it reduces the length of infirmary stay (45) (Table 1).
A randomized controlled trial showed that a 10 week CBT intervention before bariatric surgery, significantly reduced the pre-operative anxiety and depression symptoms (46). Moreover, phone-based cognitive behavioral therapy (Tele-CBT) improved low and psychopathology of eating in candidates of bariatric surgery (47). To reduce preoperative anxiety in children, active distraction with cognitive-behavioral play therapy is more than effective than the tell-show-do technique, and audiovisual distraction (48). The CBT-based pain teaching was not more effective than usual care after total knee joint arthroplasty in reducing hurting and improving physical action (49).
Spiritual/Religious Interventions
Multiple studies have evaluated the association between religiousness and feet with dissimilar results in varying communities and cultures (77–79). Information technology is shown that religiousness may be negatively correlated with the level of preoperative anxiety (36, 80). It is also shown that preoperative spiritual/religious training can reduce anxiety in Muslim patients undergoing coronary artery featherbed grafting (81). The intervention consists of 5 sessions of 45–60 min in 5 sequent days presenting relevant Islamic supplication (Zikr) and the holy Quran verses based on Richards and Bergin's (2000) spiritual therapy technique.
Music Therapy
Music listening triggers the parasympathetic nervous arrangement and reduces sympathetic nervous activity (82). These changes reduce anxiety and help patients to go more relaxed emotionally and physically (82). Moreover, music tin can distract patients from hurting and anxiety (83). Headphones too mask the environmental annoying noises. Eye rate, blood pressure, and respiratory charge per unit may be regulated past listening to music (41, 84). Music is a cheap, safe, non-invasive, and effective non-pharmacological intervention (85). Also, music can reduce the doses of required anesthesia as two clinical trials showed that in patients who listened to favorite music lower doses of propofol (for sedation) and alfentanil were used compared to the control group (86). Music exposure in the preoperative period reduced cocky-reported feet earlier, during, and afterward cataract surgery (87). In addition, systolic blood pressure later on surgery was significantly lower in patients who had music exposure before cataract surgery than patients of the command grouping (87). Listening to the favorite music preoperatively before elective inguinal hernia surgery reduced postoperative State-Trait Anxiety Inventory form 1 (STAI-1) score and improved postoperative patient satisfaction in the music group compared to the control grouping. Although preoperative STAI-1, STAI-2 scores and numeric rating scale (NRS) were like between the groups (88). The median of the Hospital Feet and Depression Scale (HADS) reduced significantly from vii to two after using the music in women who were undergoing elective pocket-sized gynecological surgeries (89).
A clinical trial study compared the efficacy of three genres of music on dental surgery feet and concluded that classical Western music significantly was effective compared to Turkish music and soft stone music (90) (Tabular array 2). In a randomized clinical trial, outpatient surgery children were randomized into 3 groups; music, midazolam, and control. Music therapy didn't salvage anxiety during anesthesia consecration (91).
Table 2. Clinical studies on the efficacy of preoperative music and video in preoperative anxiety.
A prospective randomized written report showed no efficacy of music used in reducing the preoperative anxiety of children based on heart charge per unit changes (92). Although preselected music acquired a reduction of anxiety before cesarean delivery and postoperative hurting, the patient-selected ane did not. Total satisfaction scores of patients and postoperative anxiety were not dissimilar among the music and control groups (93). Among young infants, preoperative and intraoperative music interventions were non constructive on preoperative anxiety based on the Condolement-Behavior scale and physiological measurements such equally blood pressure and heart rate (94).
Pre-Operation Preparation Video
Audiovisual (AV) programs tin can reduce anxiety and improve coping skills and patients' knowledge (106). Also, they are used as active (e.grand., Interactive games) and passive (eastward.thousand., preoperative preparation videos) lark tools (107). Computers and other technologies (such as video spectacles and smartphone applications) are used in this intervention (108, 109). The mechanism of this intervention is based on the interaction between situational feet, data retentiveness, and memory (100). The well-nigh common type of AV interventions is preoperative (pre-op) preparation videos (99).
Compared with the control grouping, preoperative anxiety was lower amid children who watched peer-modeling pre-op preparation videotape 1 hbefore admission (95) (Tabular array 2). Using 12-min pre-op Video Meaty Disc training 48 h before surgery was more constructive than pre-op booklet training in children who planned to undergo inguinal hernia surgery (96). Amidst patients of bariatric surgery, adding audiovisual (film) preoperative data to traditional instructions reduced preoperative feet (97).
Watching favorite animated cartoons before anesthesia induction had the lowest modified Yale Preoperative Feet Scale (mYPAS) compared with playing with toy and control group in children (98). In contrast, a study showed no meaning departure in behaviors related to anxiety between peer-modeling of a pre-op preparation video watching and preoperative teaching (99). Amid patients of colonoscopy control and intervention groups were randomly selected. Watching informative videos before colonoscopy significantly reduced anxiety based on Spielberger state anxiety inventory (STAI) in the intervention group before the colonoscopy (100). A clinical trial report among articulatio genus osteoarthritis patients reported that patients who watched video information before joint lavage had a lower level of preoperative anxiety and more tolerability (101). In a study, 110 patients of upper and lower limb surgery by regional anesthesia were randomized into report and control groups. Patients in the study group received preoperative multimedia information and they were less anxious than the control group (102). A randomized controlled trial among women who were a candidate for constituent cesarean delivery reported that virtual reality data Video did non reduce preoperative anxiety compared to standard preoperative information techniques (103).
Moreover, the efficacy of the combination of video watching with other interventions is evaluated. Using peer-modeling pre-op grooming video combined with an information booklet (104) and watching a generic pic (105) was significantly more constructive than using video alone.
Aromatherapy
Some essential oils which are full-bodied essences extracted from aromatic plants may have a physiological or pharmacological effect. They tin can be used via different modes like massage, inhalation, peel assimilation, ingestion, and bath (110, 111). Pain command is amid the most common indication of essential oils (112). The therapeutic utilize of these oils is called aromatherapy which is known as a modality of complementary and alternate therapy (113–115). Aromatherapy has been used for thousands of years ago in Arab republic of egypt and Bharat (111).
Till now, more than 40 types of establish extracts are used for aromatherapy. Lavender oil, rose oil, and citrus species oils are the nigh commonly used (116–118). Around the earth, Aromatherapy is used broadly past nurses as complementary and alternative medicines because it is applied hands and does not demand whatever licensed experts, equipment, and patient involvement (119). Aromatherapy is used for symptom therapy of preoperative anxiety, nausea, airsickness, disquisitional intendance, wellbeing, anxiety, depression, stress, insomnia, pain, dementia, and oncology in inpatient and outpatient settings (120).
A single-center prospective randomized placebo-controlled trial reported that lavender reduced preoperative feet among cataract surgery patients (121) (Tabular array 3). In a study of 30 women undergoing breast surgery a pregnant reduction of preoperative anxiety was recorded after using a sustained-release lavender oil aromatherapy skin patch (122). Using the inhaled lavender oil in elderly men scheduled for beneficial prostate hyperplasia (BPH) surgery showed a significant subtract in feet and respiration and an increase of oxygen saturation compared to the control grouping (123). Massage with five% lavender oil quality in patients with colorectal surgery reduced the anxiety level and increased sleep quality in the preoperative menses (124). On the other hand, preoperative inhalation of lavender oil (0.1-mL and 0.3-mL diffused in 120 mL of water) did not have an anxiolytic consequence among orthognathic surgery (bilateral sagittal split, Le Fort I, and bimaxillary osteotomies) candidate (125). Moreover, another controlled prospective study in patients who were scheduled for colonoscopy or esophagogastroduodenoscopy showed no benign effect of lavender utilise on preoperative anxiety although that was pleasant to patients (126). Oral utilize of Citrus aurantium blossom reduced preoperative feet in pocket-sized functioning candidates compared to the control group (127).
Table 3. Clinical studies on the efficacy of aromatherapy and massage in preoperative anxiety.
Inhalation of rose oil earlier septorhinoplasty/rhinoplasty surgeries was effective in decreasing preoperative anxiety in a prospective randomized clinical trial (128). In contrast, a unmarried-blind randomized clinical trial showed that inhalation of iii drops of 4% rose essential oil for ten min in one night and 1 h before coronary artery bypass graft (CABG) was not significantly effective in reducing preoperative anxiety (110). Inhalation of ane,8-Cineole (the major component of eucalyptus) in a randomized controlled trial Performed in 62 patients before selective nervus root block (SNRB) showed the efficacy of this type of aromatherapy in feet reduction (129). A pre-mail-designed clinical study performed on candidates for cholecystectomy showed that bergamot orange essence can assist in decreasing anxiety (130).
Massage
Touching and manipulation of soft tissue for therapeutic goals are named massage (138). Information technology has been used as a therapeutic intervention since thousands of years ago especially in china (139). Hand massage as a non-pharmacological, simple, inexpensive, and not-invasive nursing intervention tin can significantly reduce preoperative pain, anxiety, and stress. In addition, information technology can meliorate positive feelings similar relaxation, calmness, and satisfaction (133, 140–142). No side effects are reported about massage (143). Various mechanisms for the therapeutic event of massage are explained theoretically. Massage reduces pain by musculus relaxation and enkephalins release (139, 144). The powerful stimulus of massage is conducted faster than pain along nerve pathways to the brain then massage can block pain conduction at the peripheral points (gaits of hurting) and salvage pain (139, 145). Another mechanism explains that massage can increase the circulation of soft tissue and then irritant substances including lactic acid and inflammatory substances are removed from the tissue. Besides, massage reduces pain sensation by inducing a sense of wellbeing (146).
A pre-and post-test quasi-experimental report (without a control group) reported that one session of fifteen-min hand massage assist in reducing preoperative anxiety levels and increasing satisfaction (Tabular array 3) (131). The massage was provided by Caring Easily massage volunteers from the 7 days Mayo Clinic Volunteer Program (131). A three-arm randomized study compared the efficacy of hand and human foot massage with placebo and reported that a one session 5-min massage before cataract surgery significantly reduced anxiety and no significant differences were seen between manus and foot massage based on visual analog scale and physiological indicators (132). The massage was provided by a qualified nursing assistant, who had successfullycompleteda 12-h a workshop on therapeutic applications of classic massage 10 min earlier the surgery (132). Hand massage also reduced anxiety among patients in the convalescent surgery setting (133). Dull stroke back massage for 15 min thirty min before surgery significantly reduced anxiety in cataract surgery candidates (134). Massage intervention for 20 min in one session for cardiovascular patients before percutaneous coronary intervention (PCI) reduced anxiety level and emergency response. Moreover, blood force per unit area, pain score, and heart rate after the operation were lower in comparison to the control grouping (135). A randomized, controlled trial (RCT) compared massage therapy with usual cares by using the Land-Trait Anxiety Inventory (STAI) and 11-point numerical rating scale (0 = no pain to 10 = worst possible pain) amongst patients with cancer who were scheduled for surgical insertion of the vascular access device and concluded that a 20-min massage therapy earlier and after functioning significantly reduced feet (136). A report evaluated the upshot of music and massage among three intervention groups and 1 control group. In one group, patients had one session of 30 min of massage therapy and 30 min of music listening before the operation. In the 2nd group, patients had 30 min of music listening and patients of the third group had xxx min of massage before the operation. Standard intendance was done for patients in the command group. Then the hemodynamic status (claret pressure and pulse rate), level of serum cortisol, and prolactin and anxiety level (past using STAI-half-dozen) were measured. This study showed that preoperative anxiety scores, preoperative and post-operative cortisol levels, and claret pressure were not significantly different amidst the 4 groups but postoperative anxiety scores were lower in intervention groups compared with the control group. Moreover, the combination of music and massage more effective than using massage or music solitary in reducing postoperative anxiety (137).
Massage for pre-operative anxiety needs some equipment like a specific bed and trained personnel. Patients with hurting and tenderness in massage site, severely immunocompromised state, pregnancy, bleeding disorder, dermatologic problems, allergy/sensitivity to gloves or massage oil, acute coronary syndrome, neuropathy, or delirium are not suitable candidates for this technique and are excluded in many studies. Some other important point nearly the studies on this technique is that blinding the participant is not possible due to the nature of the intervention.
Meditation and Guided Imagery Relaxation Therapy
Guided imagery relaxation therapy is a relaxing technique based on the interaction between the brain, listen, torso, and behavior. Relaxation means being free from physiological and psychological tension. In this technique, the patient changes negative or stressful feelings by focusing on pleasing images (147). Images tin can be visual, auditory, tactile, and motor forms (148).
A randomized, triple-blind clinical trial which was done to evaluate the upshot of Guided imagery relaxation therapy on preoperative anxiety reported that this intervention significantly reduced anxiety among video-laparoscopic bariatric surgery candidates (50). A randomized study investigated the effect of Guided imagery relaxation therapy in reducing preoperative anxiety and postoperative pain amid children and reported that Guided imagery relaxation therapy (Tabular array 1).
Significantly reduced postoperative pain and preoperative feet in children (51). Among patients of cardiac surgery, guided imagery relaxation therapy reduced the pain, length of hospital stay, and feet (52). A study was conducted amid patients of spinal fusion surgery and compared intervention (using a DVD with information and guided imagery/relaxation practices) with the control group. Lower post-operative pain intensity was reported among the intervention grouping only coping strategies (eating, sleeping, and walking) and Country-trait anxiety were not significantly dissimilar (53). A randomized controlled clinical trial written report concluded that a combination of preoperative information with techniques of anxiety management and positive suggestions reduced perioperative anxiety in cataract surgery patients (54). A report compared 26 imagery patients with 25 controls and reported that past using imagery relaxing therapy, cortisol level was reduced only noradrenaline levels were higher than controls, and the level of State-anxiety was similar in both groups (55). Another report on 100 patients undergoing cataract surgery receiving mediation showed reduced preoperative feet measured past the Amsterdam Preoperative Anxiety and Information Scale compared to the control group (149).
Hypnosis
Since many years ago, hypnosis has been used in surgical processes to reduce the amount of administered analgesics (150). Hypnosis is a modified state of consciousness that is different from normal consciousness and sleep stages.
In hypnosis patients are put in induction of a trance state so acceptable suggestions are delivered to patients. Hypnosis helps patients to improve their performance, perceptual, sensory, and memory abilities (151). The therapeutic effect of hypnosis is based on perception and attention alterations. Hypnotherapists achieve clinical goals such as anxiety, hurting, and nausea reduction past distracting attention and modifying perception in patients (152–154). Hypnosis consists of 3 phases, commencement phase is induction that helps the patients to be relaxed. In the 2nd phase suggestions (symptom therapies) are delivered to patients. In the third phase, the patient is backed to a normal consciousness land (155). Hypnosis is considered as an adjunctive or primary intervention and is used for managing feet, astute or chronic pain specially in children (156–158).
In a trial written report consisting of 3 groups, the control, hypnosis, and attention control groups were compared and it was reported that post-intervention anxiety was significantly lower in the hypnosis group (57) (Table ane). A clinical trial was conducted among 150 women who underwent minor breast surgery and reported that hypnosis reduced postoperative anxiety and fatigue score compared to the command group but the level of mail-operative breast hurting was not significantly unlike amidst them (56). A randomized trial in 120 children showed that a short hypnosis session earlier the operation had no beneficial effect on postoperative pain and feet in comparison to the command group (58). Using hypnosis in patients of dental surgery significantly reduced intraoperative anxiety compared to the command group (using but local anesthesia as standard care) (59). A clinical randomized report compared the efficacy of midazolam and hypnosis among children. They assessed feet level past using the mYPAS score in iv phases (the first phase entering the department, 2nd entering the functioning room, 3rd fixing the face mask) and postoperative behavioral changes by using the Mail-hospitalization Behavioral Questionnaire (PHBQ) and concluded that the issue of hypnosis was similar to midazolam in reducing preoperative feet (60). Among children who had hypnosis therapy at the time of anesthesia, anxiety (anxiety level was assessed by the modified Yale preoperative anxiety scale) was significantly lower compared to the command grouping (61). In a study, patients who had self-hypnosis experienced more postoperative relaxation and had lesser use of pain medications dissimilar the control group (62). A 15-min hypnosis therapy before incisional breast biopsy reduced distress before surgery [based on visual analog scales (VAS)] compared to the control grouping (63).
Acupuncture
Acupuncture is a traditional treatment that originated from China and spread through the world that uses needling specific points through the patient's pare for therapeutic purposes (159). Acupuncture is increasingly used and investigated for its potential in treating preoperative anxiety (160). A meta-analysis of the 13 published clinical trials, including 439 patients and 595 control participants, evaluating the result of acupuncture techniques on preoperative feet showed the statistically pregnant superiority of acupuncture compared to placebo or no-treatment groups (160). Studies offered acupuncture sessions lasting betwixt 10 and 30 min; sessions were conducted in operating waiting rooms on the mean solar day of surgery using acupuncture needles, balls, and beads in body and/or auricular acupoints (160).
Give-and-take
The review of literature on the non-pharmacologic interventions for preoperative anxiety showed a broad range of options evaluated for this indication with promising results. However, at that place are some concerns about the availability, price, and required educated personnel to bring these methods into clinical practise. For example CBT, due to the express number of practitioners, even in developed countries, can exist difficult to find. Similar limitations may be nowadays in practicing meditation and guided imagery relaxation therapies. On the other paw applying techniques such as aromatherapy and music is easy without the need for a peculiarly trained therapist and can be more widely recommended and practiced.
Regarding the person who delivers the non-pharmacologic method to the patient, at that place is not unique do in different methods and even in the same method among different studies. Interview and advice strategies have mostly been adept by the surgeon or anesthesiologist of the patient. Cognitive-behavioral therapy is mostly delivered past trained psychologists. The limitations in the access to trained psychologists for practicing CBT led to attempts to plough the technique into a simplified therapy administered by nurses using treatment manuals. However, manualized therapies have limitations, especially facing more complicated patients and the efficacy is more limited compared to the trained psychologists who delivered CBT (161). Hypnosis likewise suffers like limitations. Meditation and guided imagery relaxation therapy, massage, and acupuncture of specific points are among the easier techniques which can be more simplified and manualized. These techniques are routinely good by unlike members of the perioperative intendance team, more often than not nurses, passing the curt training courses. At the stop of the spectrum aromatherapy, preparative video training, and music therapy can be even cocky-do by the patients following elementary instructions without the demand for a specific training course for the delivery of these methods.
Regarding the timing of commitment of non-pharmacologic methods for preoperative anxiety, most studies evaluated the efficacy of these methods the day before or the same day of surgical procedure. However, this time seems to exist tardily because many patients may suffer anxiety from the time scheduled for the surgery which is mostly long before the surgical procedure. It is reported that assessment of patients about the level of preoperative anxiety ane–2 weeks prior to the surgical procedure was more constructive in alleviating the anxiety compared to the preoperative visit on the night before surgery (7). So earlier assessment of feet is recommended which provides us the opportunity of earlier intervention and referral of patients with a college level of feet for a psychological consultation (7).
This study has some limitations. Get-go of all, this study is only a narrative review of some clinical trials which were conducted to evaluate the efficacy of some of the non-pharmacological interventions for reducing preoperative anxiety. Second, we didn't evaluate the quality of the trials by a specific objective instrument. Beside these limitations the study has important strength which is the first study that gathers the current clinical evidence on non-pharmacologic treatments for anxiety, altogether.
Implications of the Results for Do, Policy, and Future Inquiry
As described above, due to the side effects of pharmacological interventions of preoperative anxiety, non-pharmacological interventions are condign an alternative suggested item. Overall, few side effects are reported about not-pharmacological interventions and so they can be used in patients of different ages and types of disease and surgery. Equally at that place are some controversies nearly the efficacy of these interventions in preoperative anxiety, more randomized clinical trials with a larger sample size are needed to evaluate the efficacy of these interventions.
Author Contributions
XH and YW designed the piece of work, reviewed the literature, and drafted the first version of the manuscript. RW and MA researched the literature, added some parts, and critically revised the article. All authors contributed to the article and approved the submitted version.
Conflict of Interest
The authors declare that the research was conducted in the absenteeism of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Notation
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any production that may be evaluated in this article, or merits that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Acknowledgments
The authors wish to thank Dr. Leyla Abbasi at the Research Consultation Center for her invaluable aid in editing this manuscript.
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Source: https://www.frontiersin.org/articles/10.3389/fpubh.2022.854673/full
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