The effect of lavender aromatherapy on the level of intraoperative anxiety in caesarean case under spinal anesthesia: A randomized controlled trial.

BACKGROUND: Preoperative anxiety can be reduced by aromatherapy. This study aimed to evaluate the effect of lavender aromatherapy in reducing intraoperative anxiety in patients undergoing caesarean section (CS) under spinal anesthesia. METHODS: This study was two-armed and randomized controlled trial. A total of 96 patients who were scheduled for CS were randomly divided into two groups: the aromatherapy (A) group (n=48), comprising patients who were randomized to receive lavender aromatherapy with mask oxygen after the birth of the baby, and the control (C) group (n=48), comprising patients who inhaled carrier oil. During the preoperative period, baseline anxiety levels and Visual Analog Scale (VAS) pain scores were recorded using the State-Trait Anxiety Inventory (STAI-I) scale. After birth, two drops of oil were inhaled in an oxygen mask for 5 min. After 5 min, the Ramsey Sedation Scale was evaluated, and patients with a score of 1 received 2 mg of intravenous midazolam for sedation. The STAI-I and VAS pain scores were re-evaluated at the third postoperative hour. RESULTS: The primary outcome was the significant reduction in the need for midazolam brought about by lavender aromatherapy, and the secondary outcomes included postoperative third-hour STAI-I scores, intraoperative complications and patient satisfaction. CONCLUSION: The effectiveness of lavender aromatherapy, which reduced the need for intraoperative anxiolytics, can be offered as an alternative for pregnant women who undergo CS under spinal anesthesia.

The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia.

Purpose: Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy. Methods: Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period. Results: PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2. Conclusion: PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.

A randomized pilot study of electro-acupuncture treatment for hysterosalpingography pain relief and related anxiety.

OBJECTIVE: To investigate the effect of acupuncture on reducing pain and anxiety related to hysterosalpingography (HSG). MATERIALS AND METHODS: A total of 107 patients planned to undergo HSG were randomly separated into 3 groups; the acupuncture group (n=36), intramuscular diclofenac sodium group (n=35), and control group (n=37). In the acupuncture group, electro-acupuncture was applied to specified points for 20 mins before the procedure. In the intramuscular diclofenac sodium group, an intramuscular injection of 75 mg diclofenac sodium was applied 30 mins before the procedure. No analgesics were administered to the patients in the control group before intervention. Pain was evaluated with a Visual Analog scale (VAS) and anxiety with the State-trait Anxiety inventory -state (STAI-S), preoperatively and at specified times postoperatively. RESULTS: The VAS scores at 1 and 5 minutes after HSG were similar in acupuncture group and intramuscular diclofenac sodium group, and significantly lower than in the control group. At 30 mins postoperatively, there was no significant difference between the 3 groups in respect of the VAS scores. The STAI-S scores at 1 hour preoperatively were similar in all the groups (p=0.563). In the comparisons of the STAI-S values at preoperative 5 mins, following acupuncture in acupuncture group and the diclofenac injection in intramuscular diclofenac sodium group, and at postoperative 30 mins, the acupuncture group values were determined to be statistically significantly lower than those of the other groups (p<0.001, p<0.001). CONCLUSION: Acupuncture has similar effects on the reduction of pain as other analgesics and reduces anxiety. It can therefore be used in HSG in suitable clinics.

Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng.

Widespread and uncontrolled use of ginseng has raised the question of its side effects and drug interactions. A 39-year-old female patient experienced menometrorrhagia. Her complaints had started 5 months earlier. The laboratory tests revealed follicle-stimulating hormone (FSH) and estradiol levels to be 10 mIU and 90 mIU, respectively. Endometrial biopsy was planned for the diagnosis of abnormal uterine bleeding. During the preoperative evaluation, the patient stated that she had been using both oral and topical ginseng for cosmetic reasons. The ECG revealed sinus tachycardia with occasional atrial premature beats. The procedure was postponed for 2 weeks so that the patient would stop taking ginseng, smoking, and drinking coffee. Arrhythmia stopped 10 days later. Tachycardia continued during the procedure but did not require treatment, as it did not cause any hemodynamic instability. An endometrial biopsy specimen showed a disordered proliferative pattern. The patient was advised to stop using oral and topical ginseng. During a follow-up visit, she had no sign of menometrorrhagia or tachyarrhythmia and her hemoglobin levels were in the normal range. Smoking and coffee consumption, along with ginseng use, can be responsible for arrhythmogenic effects. Abnormal uterine bleeding can cause tachycardia secondary to anemia. The clinical progress of this patient is consistent with our hypothesis that ginseng is responsible for menometrorrhagia, although this could be coincidental. Patients should always be asked prior to surgery if they use herbal medications, food supplements, or cosmetics as well as prescription drugs. This is of great importance for both diagnosis and avoidance of drug interactions and side effects during anesthesia.