The Effect of Pre-Operative Distress on the Perioperative Period

Distress is defined as feelings and ideas that lead to unpleasant problems in diseases and treatments. Distress has meanings such as sadness, hopelessness, weakness, fear, excitement, anxiety, panic, depression, indecision and burnout. The pre-operative period is a crisis period for many people. During this period individuals may experience many of the feelings, emotions and ideas that cause distress [1,2]. Fear is the most common cause of distress about surgery. Death, fear that body will be damaged, waking and suffering during surgery, pain, loss of identity and control under anesthesia and loss of organs and tissues are the most common causes of fear. Hospitalization and waiting for surgery, the meaning of the surgery for the patient and lack of knowledge about surgery also cause distress. Being unfamiliar with operating rooms, the idea that attention is not paid to privacy during surgery, postoperative pain and being dependent on others, life conditions being negatively affected, being away from family and friends, inability to provide care to dependents and fear of job loss are other causes of distress [3,4]. The stressful period that starts with telling patients that they will be operated on can negatively affect their disease, care, compliance with treatment, treatment duration, treatment costs and quality of life [1].


Introduction
Distress is defined as feelings and ideas that lead to unpleasant problems in diseases and treatments. Distress has meanings such as sadness, hopelessness, weakness, fear, excitement, anxiety, panic, depression, indecision and burnout. The pre-operative period is a crisis period for many people. During this period individuals may experience many of the feelings, emotions and ideas that cause distress [1,2]. Fear is the most common cause of distress about surgery. Death, fear that body will be damaged, waking and suffering during surgery, pain, loss of identity and control under anesthesia and loss of organs and tissues are the most common causes of fear. Hospitalization and waiting for surgery, the meaning of the surgery for the patient and lack of knowledge about surgery also cause distress. Being unfamiliar with operating rooms, the idea that attention is not paid to privacy during surgery, postoperative pain and being dependent on others, life conditions being negatively affected, being away from family and friends, inability to provide care to dependents and fear of job loss are other causes of distress [3,4]. The stressful period that starts with telling patients that they will be operated on can negatively affect their disease, care, compliance with treatment, treatment duration, treatment costs and quality of life [1].
Akbulut reported that patients had pre-operative anxiety due to causes such as lack of knowledge and experience of anesthesia, failure to wake up after anesthesia, absence of the anesthesiologist in the operating room, altered awareness under anesthesia, post-operative nausea and vomiting, attitudes of the anesthesiologist, staying in intensive care, long postoperative sleep, fear of injections and fear that medical personnel may cause problems [5].
As a result of pre-operative distress, many physiological and psychological changes occur in individuals. Due to the autonomic nervous system affected by distress, anxiety and fear, the sympathetic and parasympathetic nervous systems are affected, and adrenalin increases blood pressure by causing dilatation in the bronchus. Tachycardia, tachypnea, changes in body temperature, cold skin, sweating and dryness of the mouth Journal of Anesthesia & Intensive Care Medicine 002 may occur. Gastrointestinal system functions and secretion reduce. Nervousness, trembling extremities, lack of appetite, speaking quickly, uneasiness, flushed skin, sweating palms, urinary incontinence and hypersensitivity may occur [6]. With the stimulation of autonomic nervous system, blood pressure, heart rate, respiration rate increase. Stomach and bowel movements increase. Saliva decreases, dry mouth occurs and blood glucose levels increase [2,6].
Reactions to distress may include the mobilization of energy stores used for sustaining life, hypermetabolism, activation of the cardiovascular system and increase in blood volume to vital organs. These reactions can be dangerous during surgery and anesthesia because they increase energy consumption and myocardial load [7].
Intraoperative excessive distress leads to hemodynamic changes and thus excessive use of anesthetics may be required during surgery, hypothermia and intraoperative bleeding [8]. The type of anesthetics administered to patients during surgery should not be ignored. The type and amount of the anesthesia and sedative drugs administered can change the mean arterial pressure, heart rate, arterial oxygen saturation, cortisol, insulin and blood glucose levels of patients who have undergone surgical distress.These changes can affect individuals negatively during the post-operative period. In the meantime, patients' recovery is prolonged, their pain threshold falls, and their need for analgesics increases.
Postoperative pain and associated physiological changes increase stress more and thus put patients in a vicious cycle [9,10]. These conditions increase infection risk, nausea and vomiting, immobilization and respiratory difficulty. Eating disorders caused by stress during preoperative period retard surgical recovery, too and thus hospital stay gets prolonged, quality of life deteriorates and various problems are experienced. Studies emphasize that stress augments mortality and morbidity risk in the post-operative period [1,9].
The psychological problems caused by surgical distress include inability to communicate, insomnia, inability to eat, dissatisfaction with activities, psychological tiredness, insensitivity to environment, burnout and feelings of inadequacy towards family members [11].
The psychological preparation of surgery patients is as important as physiological preparation. In the peri-operative period, all members of the surgical team should consider patients holistically when they assess their distress. Because the patient is afraid to know that he will have surgery, but he is also afraid that he does not know what to do and that he is strangers to the people around him. Patients feel fear not only because they know they will have surgery, but also because they do not know what will happen in the postoperative period and they are unfamiliar with people around them. In the pre-operative period, that anesthesiologists and nurses meet patients and introduce them operating room may reduce their operative fears and distress and thus patients feel more secure in a safe and familiar environment in the future period and comfort themselves by sharing negative opinions and emotions with others easily [12]. Kiyohara et al. [13] reported that preoperative visits paid by anesthesiologists and patient training reduced patients' anxiety. Karayurt [14] reported that patients to whom routine preoperative patient training was provided by operating nurses had lower levels of anxiety. Similarly, a study by Sadati et al. [15] found that pre-operative nurse visits decreased pre-operative anxiety and post-operative complications.
It is highly important to provide patient training and psychological support to reduce surgical distress. Surgical team members should assess patients not only physiologically, but also psychologically and socially. All members of health care teams should keep in mind that pre-operative psychological preparation is as important as physiological preparation. Patient-centered and holistic care should be used so that surgeons, anesthesiologists and nurses can manage patients' distress. Patients should be allowed to express their opinions and emotions, and their fears should be understood. Correct, clear and sufficient clarifications should be given at the right time, and patients should be encouraged in all phases of their treatment. The team should not forget that results of a surgery that is technically the most successful will not be a success for a patient who is not ready and prepared.