Title

Physiological, Psychological and Autonomic Responses to Pre-Operative Instructions for Patients Undergoing Cardiac Surgery

Authors

Huey-Ling Liou;Yann-Fen C. Chao;Terry B.J. Kuo;Hsing I Chen

Key Words

pre-operative instruction ; cardiac surgery ; heart rate variability ; perceived stress ; perceived helpfulness

PublicationName

The Chinese Journal of Physiology

Volume or Term/Year and Month of Publication

51卷5期(2008 / 10 / 01)

Page #

317 - 323

Content Language

英文

English Abstract

Several studies have reported that the experience may induce emotional reactions before and after surgery. Various Studies have demonstrated that effective pre-operative information reduces stress and anxiety levels. However, little is known about the effect of pre-operative instruction on autonomic responses as measured by heart rate variability (HRV) before cardiac surgery. Ninety-one patients were randomly assigned to video-tape viewing and teaching booklet group. Electrocardiogram was monitored before and after pre-operative instruction. HRV was analyzed with spectral analysis of frequency domains of heart rate and categorized into low and high frequency (LF and HF). After pre-operative instruction, subjects completed a score of perceived stress and helpfulness. In this study, we found that pre-operative instruction with video-tape was similarly effective as teaching booklets on patients' perceived stress, perceived helpfulness and recovery outcomes. The decrease in HF% and increase in LF/HF ratio of HRV indicate a change in sympathovagal balance toward a lower parasympathetic activity after pre-operative instruction in subjects of both groups. However, the perceived helpfulness of pre-operative instruction may often be associated with a relatively less sympathetic activity. Further studies are needed to determine the optimal timing to enhance the positive effects on the sympathovagal balance after pre-operative instruction.

Topic Category 醫藥衛生 > 基礎醫學
Reference
  1. Akselrod, S.,Gordon, D.,Ube, F.A.,Sbannon, D.C.,Berge, A.C.,Cohen, R.J.(1981).Power spectrum analysis of heart rate fluctuation a quantitative probe of beat-to-beat cardiovascular control.Science,213,220-228.
  2. Appel, M.L.,Berger, R.D.,Saul, J.P.,Smith, J.M.,Cohen, R.J.(1989).Beat to beat variability in cardiovascular variables: noise or music?.J. Am. Coll. Cardiol.,14,1139-1148.
  3. Asilioglu, K.,Celik, S.S.(2004).The effect of preoperative education on anxiety of open cardiac surgery patients.Patient Educ. Couns.,53,65-70.
  4. Berger, R.D.,Saul, J.P.,Cohen, R.J.(1989).Transfer function analysis of autonomic regulation. I. Canine atrial rate response.Am. J. Physiol.,256,142-152.
  5. Cupples, A.(1991).Effect of timing and reinforcement of preoperative education on knowledge and recovery of patients having CABG surgery.Heart Lung,20,654-660.
  6. Dishman, R.K.,Nakamura, Y.,Garcia, M.E.,Thompaon, R.W.,Dunn, A.L.,Blair, S.N.(2000).Heart rate variability, trait anxiety, and perceived stress among physically fit men and women.Int. J. Psychophysiol.,37,121-133.
  7. Friedman, B.H.,Thayer, J.F.(1998).Autonomic balance revisited: panic anxiety and heart rate variability.J. Psychosom. Res.,44,133-151.
  8. Gallo, J.R.,Maciel, B.C.,Marin-Neto, J.A.,Martins, L.E.,Lima-Filho, E.C.,Manco, J.C.(1988).The use of isometric exercise as a means of evaluating the parasympathetic contribution to the tachycardia induced by dynamic exercise in normal man.Pflugers Arch.,412,128-132.
  9. Garretson, S.(2004).Benefits of pre-operative information programmes.Nurs. Stand.,18,33-37.
  10. Hathaway, D.(1986).Effect of preoperative instruction on postoperative outcomes: a meta-analysis.Nurs. Res.,35,269-275.
  11. Johnston, M.(1980).Anxiety in surgical patients.Psychol. Med.,10,145-152.
  12. Kim, H.,Garvin, B.J.,Moser, D.K.(1999).Stress during mechanical ventilation: benefit of having concrete objective information before cardiac surgery.Am. J. Crit. Care,8,118-126.
  13. Kitney, R.I.,Romalman, O.(1977).Thermal entrainmane patterns of heart rate variability.J. Physiol.,270,41-42.
  14. Kuo, T.B.J.,Lin, T.,Yang, C.C.H.,Li, C.L.,Chen, C.F.,Chou, P.(1999).Effect of aging on gender differences in neural control of heart rate.Am. J. Physiol.,277,2233-2239.
  15. Lepczyk, M.,Raleigh, E.H.,Rowley, C.(1990).Timing of preoperative patient teaching.J. Adv. Nurs.,15,300-306.
  16. Lindeman, C.(1988).Nursing research in patient education.Annual Review Nurs. Res.,6,29-60.
  17. Madden, K.,Savard, G.K.(1995).Effects of mental state on heart rate and blood pressure variability in men and women.Clin. Physiol.,15,557-569.
  18. Mahler, H.I.,Kulik, J.A.(1998).Effects of preparatory videotapes on self-efficacy beliefs and recovery from coronary bypass surgery.Ann. Behav. Med.,20,39-46.
  19. Malliani, A.,Pagani, M.,Lombardi, F.,Cerutti, S.(1991).Cardiovascular neural regulation explored in the frequency domain.Circulation,84,482-492.
  20. Mary, D.,Nadim, K.,Pascale, S.(2006).Preoperative patient education for open-heart patients: A source of anxiety?.Patient Educ. Couns.,62,11-17.
  21. Masterova, E.I.,Vasil`ev, V.N.,Nevidimova, T.I.,Vlasenko, V.I.(1999).Relation between the psychoemotional state and the heart rate regulation and immune status in human.Ross Fizio. Zh. Im. I. M. Sechenova.,85,621-627.
  22. Montano, N.,Ruscone, T.G.,Porta, A.,Lombardi, F.,Pagani, M.,Malliani, A.(1994).Power spectrum analysis of heart rate variability to assess the changes in sympathovagal balance during graded orthostatic tilt.Circulation,90,1826-1831.
  23. Nelson, S.(1996).Pre-admission education for patients undergoing cardiac surgery.Brit. J. Nurs.,5,335-340.
  24. Pagani, M.,Montano, N.,Porta, A.(1997).Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans.Circulation,95,1441-1448.
  25. Raleigh, E.H.,Lepczyk, M.,Rowley, C.(1990).Significant others benefit from preoperative information.J. Adv. Nurs.,15,941-945.
  26. Rechlin, T.,Weis, M.,Spitzer, A.,Kaschka, W.P.(1994).Are affective disorders associated with alterations of heart rate variability?.J. Affect. Disord.,32,271-275.
  27. Ruzicki, D.A.(1989).Realistically meeting the educational needs of hospitalized acute and short-stay patients.Nurs. Clin. North. Am.,24,629-637.
  28. Sneed, N.V.,Olson, M.,Bubolz, B.,Finch, N.(2001).Influence of a relaxation intervention on perceived stress and power spectral analysis of heart variability.Prog. Cardiovasc. Nurs.,16,57-64.
  29. Su, C,F.,Kuo, T.B.J.,Kuo, J.S.,Lai, H.Y.,Chen, H.I.(2005).Sympathetic and parasympathetic activities evaluated by heart rate variability in head injury of various severitied.Clin. Neurophysiol.,116,1273-1279.
  30. Weise, F.,Heydenreich, F.,Runge, U.(1987).Contributions of sympathetic and vagal mechanisms to the genesis of heart rate fluctuations during orthostatic load: a spectral analysis.J. Auton. Nerv. Syst.,21,127-134.
  31. Weiss, S.J.,Puntillo, K.(2001).Predictors of cardiac patients` psycho-physiological responses to caregiving.Int. J. Nurs. Pract.,7,177-187.
  32. Wishine, H.,Hackett, A.,Thomas, P.,Casssem, N.H.(1971).Psychological hazzards of convalescence following myocardical infarction.J. Am. Med. Assoc.,215,1292-1295.
  33. Yang, C.C.H.,Chao, T.C.,Kuo, T.B.J, Yin, C.S.,Chen, H.I.(2000).Preeclamptic pregnancy is associated with increased sympathetic and decreased parasympathetic control of HR.Am. J. Physiol.,278,1269-1273.
  34. Yeragani, V.K.,Pohl, R.,Balon, R.,Ramesh, C.,Glitz, D.,Jung, I.,Sherwood, P.(1991).Heart rate variability in patients with major depression.Psychiatry Res.,37,35-46.
  35. Yeragani, V.K.,Pohl, R.,Berger, R.,Balon, R.,Ramesh, C.,Glitz, D.,Srinivasan, K.,Weinberg, P.(1993).Decreased heart rate variability in panic disorder patients: a study of power-spectral analysis of heart rate.Psychiatry Res.,46,89-103.
  36. Zefferino, R.,L`Abbate, N.,Facciorusso, A.,Potenza, A.,Lasalvia, M.,Nuzzaco, A.,Di-Biase, M.,Ambrosi, L.(2003).Assessment of heart rate variability (HRV) as a stress index in an emergency team of urban police.G. Ital. Med. Lav. Ergon.,25,167-169.