Pre-operation Interview to reduce anxiety and stress of patients undergoing neurosurgery with Intraoperative Neurophysiological Monitoring (IONM)

Abstract Description

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Authors (including presenting author) :

CHU MK(1)

Affiliation :

(1)Department of Neurosurgery, Princess Margaret Hospital

Introduction :

Intraoperative Neurophysiological Monitoring (IONM) measures neural function and integrity during surgical procedures (Howick et al., 2015). Among the primary modalities used are somatosensory evoked potentials (SSEP), transcranial motor evoked potentials (MEP), electromyography (EMG) and brainstem auditory evoked potentials (BAEP). Alerted to the loss of a neural signal, the surgeon has the opportunity to adjust the procedure to reduce the risk of permanent damage (Howick et al., 2015). Since surgery affecting important neural structures (such as the spinal cord or vascular supply to the brain) carries the risk of temporarily or permanently impairing neurological function, it seems reasonable to employ methods to reduce these risks (Deletis & Sala, 2008). Likewise, surgeons reassured by negative monitoring results may proceed more confidently with difficult maneuvers (Deletis & Sala, 2008). Therefore, IONM has been used extensively in spine, brain, peripheral/cranial nerve and a variety of other potentially risky neurosurgical procedures. Preoperative anxiety is common in patients awaiting surgery. Preoperative anxiety is an unpleasant emotion and may even cause patients to avoid a planned surgery (Lee et al. 2016). A high preoperative anxiety state may lead to adverse psychological and physiological outcomes. In addition, increased preoperative anxiety has been suggested to correlate with increased postoperative pain, increased postoperative analgesic requirements, and prolonged recovery and hospital stay (Broadbent, Petrie, Alley & Booth, 2003). It is thus necessary to understand and manage preoperative anxiety.

Objectives :

- To determine patient’s level of anxiety before the surgery - To identify factors associated with the level of anxiety - To reduce patient’s preoperative anxiety through interview

Methodology :

1.Inclusion Criteria - Patients undergoing scheduled surgery with IONM - GCS 15/15 2.Exclusion Criteria - Patients undergoing emergency operation - Patient’s GCS < 15 3.Intervention - To arrange an interview with patient 1-2 days before surgery - PowerPoint based explanation of IONM to patients - To complete a questionnaire after interview(Assess anxiety by using VAS)

Result & Outcome :

During January 2018 to August 2018, total 20 patients were interviewed. Among the 20 patients, 15 of them claimed that surgeon did not mention Intraoperative Neurophysiological Monitoring before the surgery. Furthermore, All 20 patients reported anxiety before surgery. During the 10 minutes pre-operation interview, patients were explained in details about the use of Intraoperative Neurophysiological Monitoring. As a result, they all expressed there were reduction in anxiety after the interview