The Effect of an Informative Video upon Anxiety and Stress in Patients Requiring an Oral Biopsy: A Randomized Controlled Study

Objective: The use of multimedia tools improves patient understanding of surgical procedures, reduces anxiety and increases satisfaction. The present study evaluates the impact of an audiovisual intervention (video) upon anxiety and stress in patients requiring an oral biopsy. Material and methods: A prospective randomized clinical trial was carried out in patients requiring an oral biopsy. The control group (n = 60) received verbal standard information while the experimental group (n = 60) received information in the form of a video. The following data were recorded: gender, age, educational level and hemodynamic parameters (blood pressure, heart rate and blood oxygen saturation). The following questionnaires were used to assess anxiety and stress before and after the biopsy procedure: Corah’s Modified Dental Anxiety Scale (MDAS), the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS). Results: The final study sample consisted of 120 patients, of which 65.8% were women and 34.2% men, with a mean age of 40.5 ± 15.3 years. At the end of the study, the experimental group presented a significantly lower MDAS score than the control group (p = 0.041). The STAI score also showed a significant decrease with respect to the control group at the end of the study (p = 0.012). There were no statistically significant changes in the hemodynamic parameters in either group. Conclusions: The video constituted a useful and easy tool for reducing anxiety among patients requiring an oral biopsy.

Evaluation of cerebral hemodynamic status in patients with unilateral symptomatic carotid artery stenosis during motor tasks, through use of transcranial Doppler sonography

ABSTRACT Background: Carotid artery stenosis increases cerebral ischemic event risk through changing different cerebral hemodynamic parameters. Objective: To investigate how cerebral hemodynamics in the M1 segment of middle cerebral artery change in patients with carotid artery stenosis, after motor tasks using transcranial Doppler sonography (TCD). Methods: Thirty-two healthy subjects and 30 patients with unilateral symptomatic carotid artery stenosis were recruited. The patient population was divided into three groups according to the degree of stenosis (group 1: ≥50 to 69%, group 2: 70 to 89% and group 3: ≥90 to 99%). TCD was used to measure the pulsatility index (PI) and cerebral vasomotor reactivity (CVR). Results: In the patient group, significant differences for symptomatic side PI values (p=0.01) and mean CVR increases (p=0.05) were observed, compared with the healthy controls. However, the difference was not statistically significant for asymptomatic side PI values and mean CVR increases. The results from the intergroup comparison showed significantly higher percentages of symptomatic and asymptomatic side CVR increases in group 1, compared with groups 2 and 3 (p=0.001 and p=0.002, respectively). Conclusions: Our study showed that cerebral autoregulation and hemodynamic mechanisms are impaired in patients with carotid artery stenosis. Furthermore, the impairment of PI and CVR tends to get worse with increasing degrees of stenosis. In addition, this study demonstrated that assessment of these two hemodynamic parameters in clinical practice might be helpful for monitoring the progress of carotid artery stenosis.

Central Noninvasive Hemodynamics in Combined Spinal Epidural Anesthesia with Expansion of the Epidural Space in Obese Patients

The objective: to substantiate the safety of using combined spinal epidural anesthesia with expansion of the epidural space in hernioplasty in obese patients.Subjects and Methods. Hemodynamic parameters were studied in 100 obese patients who underwent elective hernioplasty of the anterior abdominal wall using the neuroaxial block of two types ‒ combined spinal epidural anesthesia with epidural volume extension (CSEA with EVE) and spinal anesthesia (SA). The patients were randomly divided into two groups: Group 1 (n = 60) ‒ patients operated under combined spinal epidural anesthesia with the epidural volume extension, Group 2 (n = 40) ‒ patients operated under spinal anesthesia. The assessment of changes in main parameters of central hemodynamics, stroke volume (SV), cardiac output (CO), and cardiac index (CI) was performed using the Estimated Continuous Cardiac Output technology based on the measurement of pulse wave transit time.Results. It was revealed that in Group 1 patients, the listed parameters fluctuated slightly during the entire follow-up period. The average values were: SV 76.4 ± 0.37 ml, CO 5.8 ± 0.04 l/min, CI 3.56 ± 0.03 l/min/m2. In patients of Group 2, there was an increase in SV by 35.5%, CO by 24.2%, and CI by 23.6% at minutes 2-4 of the regional blockade.Conclusions. The most obvious fluctuations in hemodynamic parameters are observed in the group of patients who underwent spinal anesthesia using relatively high doses of local anesthetic. When using CSEA with EVE with low doses of bupivacaine, stable hemodynamic parameters are noted with a constant level of the neuroaxial block.