Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients

Introduction Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery. Materials and methods A prospective cohort study was conducted on all patients who underwent TKA during 2016–2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed. Results Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively). Conclusions All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients. Level of evidence II.

Administration of midazolam as sedative premedication for paediatric patients

The paper aims to discuss effective presurgical modalities for reducing preanesthetic and preoperative anxiety in children. It reviews the existing research on psychological interventions and sedative premedication for presurgical anxiety management. Psychological and behavioural pre­ operative preparation of children, through presurgical preparation programs, combined with parental presence during induction of anaesthesia are regarded as alternatives to sedative premedication. A combination of these preparation strategies with midazolam premedication is presented as an effective way of helping children cope with preanesthetic and pre­ operative anxiety. It is highlighted that the use of low dose midazolam is sufficiently safe and beneficial if alternatives to sedative premedication prove ineffective, especially when dealing with increased feelings of anxiety immediately before anesthesia and the surgery.

Presurgical Anxiety Treated with Cognitive Behavioral Therapy in a 13-Year-Old Female with Cleft Lip and Palate: A Psychological Case Report

This case report describes presurgical anxiety in a 13-year-old female with complete cleft lip and palate, treatment of the anxiety with cognitive-behavioral therapy and progressive relaxation with biofeedback prior to a septorhinoplasty, and the treatment outcome.