Operation anxiety under (remote) control

Patients at Peterborough City Hospital are being offered local anaesthesia and a film to watch in the OR during surgery, rather than undergoing general anaesthesia.
Some elderly patients shy away from general anaesthesia due to the long recovery period, while others may carry an increased risk of an adverse reaction during general anaesthesia.

While local anaesthetic alone is a viable option in things like hip and knee operations, and is favourable in that it allows quicker and easier recovery than general anaesthesia, there is a risk of anxiety, especially in elderly patients, which could be associated with noises during surgery or thinking about their surgery.

Studies have shown that anxiety can increase the need for peri- and postoperative pain medication, which may cause problems during recovery, such as slowing respiration, increasing pulmonary risk, decreasing activity thus increasing the likelihood of thrombosis, and increasing the risk of bowel upset. Additionally, associations have been made between anxiety and a lowered immune system response and a higher infection risk.

Patients at Peterborough City Hospital have been given a choice of films, of which Dirty Dancing is a particularly popular choice amongst women, says Dr Richard Griffiths, who implemented the method at this hospital. The patients watch the film with headphones during surgery, which reduces likelihood of hearing alarming noises, and distracts patients from their operation.

Dr Griffiths said: “Patients really relax when they are watching their favourite films. Some have told us the TV can be so captivating that they are unaware that the operation has finished.”

Ms Iris Quirolo, 75, underwent a hip operation at this hospital, choosing to have it under spinal anaesthesia, due to reacting badly to general anaesthesia in the past. She opted to watch The Sound of Music during her operation. She said: “When Dr Griffiths told me that patients were being offered the chance to have a spinal anaesthetic and watch TV while the operation was going on I was really pleased and asked to have it straight away.

“It was a good experience and a much better way to have an operation. I never expected this would be an option and I have vowed that if I ever need another operation like this I will ask to be able to watch TV again!”

Dr Griffiths said: “I’m particularly interested in patients who’ve fractured their hips. There is some evidence that says if you have these operations when you’re awake, and have a regional anaesthetic, you may do better afterwards.

“If they are happy to be awake and watch the TV, I am happy they are going to have a better experience.”

This is not the first time films have been used in the OR to relax patients. Dr Griffiths was inspired by colleagues in Glasgow, who had used this approach in 2010. The idea was conceived by anaesthetist Dr Nick Pace at Gartnavel Hospital.

Dr Pace had asked the hospital’s engineering department to make a stand for a laptop, and allowed patients to choose from his personal collection of DVDs. He found this approach to be popular amongst roughly half of his patients.

Dr Pace’s team trialled music as well, as it is an established method of relaxation and has been used in OR before, but the Scottish team found that it was not as effective in longer surgeries, and that general anaesthesia often ended up having to be administered.

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