术前焦虑

一进手术室血压就飙升，一看到白大褂就心跳加快？

是不是很熟悉的场景？

紧张焦虑在接受麻醉手术患者中非常常见，常表现为术前失眠、进手术室血压高、心跳快、患儿大声哭闹、抗拒等，怎么来安抚患者呢？怎么去除患者的不良应激呢？

在ANESTHESIOLOGY杂志上刊登了一篇education，标题为Preanesthesia Anxiety

文章中的插图非常形象生动！

译文（供参考）

麻醉前焦虑

当麻醉师迅速向前移动面罩时，患者睁大眼睛，恐惧得目瞪口呆（见图）。在麻木的注视下，患者清晰地回忆起2天前医生提到的“混合气体”和“七氟醚”。“就是这样，它正在发生，”患者沉思着，随着面罩越来越近，他焦急地准备着。另外两名医生隐约出现，轻轻地对患者耳语“从10开始倒数”，希望在气体发挥作用时分散患者的注意力。很明显，实施吸入麻醉的行为在患者中引起了强烈的恐惧和焦虑。随着倒计时的继续，不确定的情况开始困扰着患者，让他们产生充满恐惧的想法：“如果我在手术中没有完全入睡怎么办？如果手术后我没有醒来怎么办？”但是，在混乱中，当麻醉师承担起照顾病人的责任时，眼睛最终会闭上，病人会进入无意识状态。

这幅多媒体艺术作品捕捉了患者对全身麻醉的恐惧情绪。一想到要上麻醉，许多人就不寒而栗。对一些人来说，接受全身麻醉的想法比手术本身更可怕；其他人甚至可能会取消手术。虽然焦虑可能是患者常见的经历，但它并非没有风险和并发症。

焦虑的患者在手术室上麻醉，可能需要更高的麻醉剂量来维持可接受的镇静水平，以使手术顺利进行。即使患者在麻醉恢复室睁开眼睛后，术后心理痛苦的浪潮可能会压倒他们最初恐惧的残余。更不用说，当全身麻醉的效果逐渐消失时，可能需要更多的镇痛来减轻生理疼痛。

考虑到患者焦虑的负面后果，它回避了一个问题：麻醉医师如何帮助焦虑的患者进行手术？麻醉医师的术前角色在这里变得越来越重要。除了彻底检查患者及其病史以制定安全的麻醉计划外，麻醉医师还通过麻醉前访谈建立信任的医患关系。在解决了一般性焦虑与特定麻醉相关担忧问题后，患者在手术前可能会从焦虑过渡到完全自信。事实上，许多患者报告说，麻醉前访谈显示了沟通的力量，减少了对麻醉的恐惧，增加了信心和满意度。

回顾过去，也许我们的患者（见图）在手术中只是需要安慰。可以想象的是，当吸入的气体使患者进入睡眠状态时，解决焦虑问题可能已经足够让患者从焦虑到平静地倒数。

原文

Preanesthesia Anxiety

The patientholds their eyes wide open, transfixed with fear as the anesthesiologistswiftly motions a face mask forward (see figure). Numbly watching, the patient has a vividrecollection of the doctor mentioning “gas mixture” and “sevoflurane” from 2 days before. “This is it, it’s happening,” ruminates the patient,anxiously preparing as the mask inches closer. Two more doctors loom over,gently whispering to the patient “count down from 10,” in hopes of distracting the patient as the gases take their effect.It is clear that the act of administering inhalational anesthesia is strikingfear and anxiety in the patient. As the countdown continues, the uncertaintywith going under begins to plague the patient’s mindwith fear-ridden thoughts: “What if I’m not fully asleep during the operation? What if I don’t wake up after?” But, amid the turmoil, theeyes will eventually close and the patient will drift into unconsciousness asthe anesthesiologist assumes responsibility over the care of the patient.

This multimedia art piece captures the sentiment offear among patients toward general anesthesia. The thoughts of going under sendshivers down the spines of many people. To some, the thought of undergoinggeneral anesthesia is a more terrifying ordeal than the surgery itself; othersmay so much as cancel their operation.¹  Whileanxiety may be a common experience among patients, it does not come withoutrisks and complications.

As our anxious patient now lies anesthetized in theoperation theater, higher anesthetic doses may be required to maintain anacceptable level of sedation for the procedure to go smoothly. Even after thepatient opens their eyes in the recovery room, a wave of postoperativepsychologic distress may overwhelm them—remnants of their initial fear. Not to mention, greater analgesiause may be needed to subdue the physical pain paralyzing their body as theeffects of the general anesthesia wear off.^2,3 

Given the negative consequences of patient anxiety, itbegs the question: How do anesthesiologists help anxious patients going intosurgery? The preoperative role of an anesthesiologist becomes increasinglyimportant here. Apart from thoroughly examining the patient and their historyto develop a safe anesthetic plan, anesthesiologists also establish a trustingphysician–patient relationship through apreanesthesia interview.^2,4  Ina series of questions addressing general anxiety to specific anesthesia-relatedworries, a patient may transition from being anxious to completely confidentbefore operation. In fact, many patients report reduced fear of anesthesia aswell as increased reassurance and satisfaction after preanesthesia interviews—illustrating the power of communication.² 

In retrospect, perhaps our patient (see figure) simply needed reassurance going into theiroperation. Conceivably, having concerns addressed may have been enough for thepatient to go from being anxiety stricken to peacefully counting down as theinhaled gas drifts them into slumber.