ASSESSMENT OF PREOPERATIVE ANXIETY IN PATIENTS WITH GALLSTONE SURGERY IN THE GENERAL SURGICAL DEPARTMENT, HANOI MEDICAL... HANOI MEDICAL UNIVERSITY*** TA NHL QUYNH ASSESSMENT OF PREOPERA
LITERATURE REVIEW
Gallstones disease
Cholelithiasis, commonly referred to as gallstone disease, poses a considerable global health challenge Although many individuals with this condition are asymptomatic and do not require treatment, a smaller subset experiences severe symptoms associated with cholecystitis These cases often necessitate various forms of conservative management, including medication, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage, or surgical intervention.
Laparoscopic cholecystectomy (LC) is the preferred surgical option for patients suffering from recurrent symptomatic cholelithiasis due to its numerous benefits This minimally invasive procedure offers less postoperative pain, promotes quicker recovery, accelerates the return of bowel function, and results in shorter hospital stays.
Gallstones may cause no signs or symptoms If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:
- Sudden and rapidly intensifying pain in the upper right portion of your abdomen
- Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
- Back pain between your shoulder blades
- Pain in your right shoulder
- Lab tests: Blood tests may reveal infection, jaundice, pancreatitis or other complications caused by gallstones.
+ Endoscopic retrograde cholangiopancreatography (ERCP) Sometimes doctors use ERCP to remove a gallstone that is stuck in the common bile duct.
Oral dissolution therapy involves the use of bile acid medications, such as Ursodiol (Actigall) and Chenodiol (Chcnix), to dissolve gallstones, particularly small cholesterol stones This treatment may require months or even years to effectively break down all stones and is typically considered only when surgery is not an option, as its success rate is generally low.
+ Shock wave lithotripsy A doctor can use shock wave lithotripsy to blast gallstones into small pieces Doctors use this procedure only rarely, and sometimes along with ursodiol.
+ Laparoscopic cholecystectomy The gold standard treatment of symptomatic gallstones is laparoscopic cholecystectomies Patients will probably be able to return to normal physical activity in about a week.
Laparoscopic cholecystectomy remains the surgical choice for symptomatic and complicated gallstones, with a shorter hospital stay and shorter convalescence period than open cholecystectomy.
+ Percutaneous cholecystostomy is an alternative for patients who are critically ill with gallbladder empyema and sepsis.
Open cholecystectomy is a surgical procedure performed by a surgeon when the gallbladder is severely inflamed, infected, or has scar tissue from previous surgeries This approach may also be necessary if complications arise during a laparoscopic cholecystectomy Typically, patients can expect to resume normal physical activities approximately one month after the procedure.
Preoperative anxiety
Anxiety, as defined by the American Psychological Association (APA), is an emotion marked by tension, worried thoughts, and physical changes It is a fundamental human experience characterized by feelings of apprehension and uneasiness in response to real or perceived threats This negative emotion can manifest over time or in specific situations, often fluctuating in intensity In patients, anxiety may arise from various factors, including unusual circumstances, separation from family, limited understanding of medical procedures, high healthcare costs, hospitalization, anesthesia, postoperative pain, potential future disabilities, and the fear of death.
Preoperative anxiety is common among patients awaiting surgical procedures and has significant relevance for anesthetists and surgeons1315 The patient’s preoperative experience was extremely negative, with anxiety.
TI*/ 'ZiH cc 41 ># intense behavioral and psychological reactions, and preoperative concerns about the underlying condition, the anesthesia, and the upcoming surgery5. 1.2.3 Anxiety clinical symptoms
Anxiety can significantly impact both the physical and mental health of patients, manifesting through symptoms such as increased heart rate, palpitations, sweating, tremors, and gastrointestinal issues like nausea and diarrhea It can also lead to heightened feelings of restlessness, impatience, and concentration difficulties, along with common sleep disorders such as insomnia Research indicates that a substantial number of patients experience anxiety prior to surgery; for instance, a study by Bedaso et al found that 47% of 407 patients scheduled for general surgery reported preoperative anxiety In Vietnam, a study of 197 thyroid surgery patients revealed that 71.6% experienced mild anxiety, while 16.2% had moderate anxiety, and only 0.5% reported severe anxiety Additionally, Nguyen Thi Phuong's research on 190 patients at Ha Dong General Hospital showed a preoperative anxiety prevalence of 68%, with 23.7% classified as mild, 39.5% as moderate, and 4.7% as severe.
1.3 The preoperatton anxiety and the concerns of patients
1.3.1 The general psychological mentality of patients
Illness, whether severe or minor, can profoundly affect a patient's mental well-being, with more serious and prolonged conditions leading to greater psychological changes Hospitalized patients often experience anxiety about their health, seeking medical help and hoping for a quick recovery, while also worrying about financial implications and the effects of their illness on their work and family life This ongoing stress can contribute to poor mental health and heightened anxiety levels.
During hospitalization, the interplay between a patient's psychological state and the progression of their illness is significant Understanding the psychological characteristics of surgical patients and those awaiting surgery is crucial, as these factors can influence recovery outcomes.
Surgical patients undergo procedures to remove or replace diseased organs and tissues, necessitating comprehensive preoperative care that ensures safety, manages pain, and facilitates healing This care encompasses both physical and psychological preparation, addressing emotional, cognitive, and physiological responses that patients may experience For those undergoing gallstone surgery, common feelings of anxiety and stress arise, including concerns about the safety of the procedure, the surgeon's qualifications, wound healing, and potential complications Patients often worry about pain during and after surgery, the effects of anesthesia, and separation from family, which can significantly impact their mental health and increase stress levels.
Some patients may underestimate the seriousness of their condition, while others, like those with Ollier's disease, might have an overly positive outlook, assuming they will achieve full recovery post-surgery This psychological defense can lead individuals to overlook crucial pre-operative preparations and the potential risks involved in the surgical procedure.
1.3.3 Prcopcrath c anxiety and its impart on surgery
Preoperative anxiety significantly impacts patients both physically and psychologically, influencing their thoughts, feelings, and behaviors Physically, it triggers the release of epinephrine, leading to vasoconstriction, increased heart rate, elevated blood pressure, and symptoms such as hot flashes and sweating Studies indicate that patients with higher anxiety levels require greater doses of anesthesia; for instance, research by Maranets et al found that women with high trait anxiety needed more propofol for anesthesia induction and maintenance Furthermore, anxiety can hinder wound healing, elevate infection risks, complicate recovery, and intensify postoperative pain Kagan et al highlighted that preoperative anxiety adversely affects recovery outcomes, with preoperative uncertainty impacting both mental and physical recovery post-surgery.
1.3.4 The concerns of patients before an operation
Patients commonly express concerns before surgery, including postoperative pain, high surgical costs, the anesthesia process, and waiting times They also worry about potential complications, the discomfort of the hospital environment, the impact on their work, and their family's well-being Additionally, the possibility of surgery being postponed and uncertainties surrounding the procedure contribute to their anxiety.
1.4 Factor’s associated with preoperative anxiety
Numerous studies have shown that demogr aphic factors can significantly influence patients’ preoperative anxiety Amit Kumar conducted on 3087
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