The impact of anxiety on analgesic drugs consumption in patients on the first day after cardiac surgery procedures

Wstęp. Wraz ze wzrostem zachorowalności na choroby układu krążenia, w szczególności chorobę wieńcową (CAD), wzrasta liczba zabiegów kardiochirurgicznych. W okresie pooperacyjnym pacjenci zażywają największą liczbę środków przeciwbólowych, jak również narażeni są na wysoki poziom lęku związany z silnym bólem. Cel pracy. Ocena determinantów zużycia środków przeciwbólowych u pacjentów w pierwszej dobie po zabiegach kardiochirurgicznych. Materiał i metody. Badaniem objęto 100 pacjentów zakwalifikowanych do zabiegów kardiochirurgicznych pomostowania aortalno-wieńcowego (CABG), pomostowania tętnic wieńcowych bez użycia krążenia pozaustrojowego (OPCAB) lub wymiany zastawki aortalnej (AVR). Ocenę poziomu lęku dokonano z użyciem Inwentarza Stanu i Cechy Lęku (STAI). Zużycie środków przeciwbólowych analizowano na podstawie dokumentacji (karta anestezjologiczna i karta opieki pooperacyjnej) w pierwszym dniu po operacji dla każdego pacjenta indywidualnie. Wyniki. Poziom lęku w badanej grupie pacjentów kardiochirurgicznych oscyluje na średnim i wysokim poziomie w przedziale 80–90 punktów (STAI). Poziom lęku–stanu kształtował się na przeciętnym poziomie w przedziale 23–66 punktów (STAI-X1), natomiast poziom lęku–cechy oceniony został jako wysoki w przedziale 23–66 punktów (STAI-X2). Wykazano istotne statystycznie korelacje między lękiem– –cechą a zużyciem fentanylu (r = -1,000; p = 0,005) oraz między lękiem sumarycznym a zużyciem morfiny (r = -0,999; p = 0,028), Ketonalu (r = -0,997; p = 0,046) oraz propofolu (r = -0,998; p = 0,039). W przypadku zabiegu OPCAB zużywane są średnio większe dawki Perfalganu niż podczas CABG (p = 0,045) oraz większe dawki morfiny niż podczas AVR (p = 0,02). W przypadku zabiegu CABG zużywane są średnio większe dawki morfiny oraz Perfalganu niż podczas AVR (p = 0,012 oraz p = 0,025, odpowiednio). Zaobserwowano brak istotnych statystycznie różnic między zużyciem środków przeciwbólowych a płcią (p > 0,05) oraz wiekiem pacjentów (p > 0,05). Wnioski. U pacjentów poddanych zabiegom CABG zaobserwowano wysoki poziom odczuwanego lęku ogólnego. Zaobserwowano, że wyższy poziom lęku wpływa na mniejsze zapotrzebowanie na leki przeciwbólowe. Ustalono, że płeć oraz wiek badanych pacjentów nie wpływał na liczbę zażywanych leków przeciwbólowych w okresie około- i pooperacyjnym.Background. Along with the increase in the incidence of cardiovascular disease (CAD), in particular coronary disease (CAD), the number of cardiac surgery procedures increases. In the postoperative period, patients take a lot of analgesic drugs as well as are exposed to high levels of anxiety associated with severe pain. Objectives. The study aimed to assess the determinants of analgesic drugs consumption in patients on the first day after cardiac surgery procedures. Material and methods. The study involved 100 patients qualified for coronary artery bypass grafting (CABG), off-pump coronary artery bypass (OPCAB) or aortic valve replacement (AVR). An assessment of the level of anxiety was done using the State-Trait Anxiety Inventory (STAI). The consumption of analgesic drugs was analysed based on medical documentation (anaesthesiology card and postoperative card) on the first postoperative day for each patient individually. Results. The level of general anxiety in the studied group of cardiac surgery patients oscillates at the medium and high level in the range of 80–90 points (STAI). The level of state–anxiety was on the average level within the range of 23–66 points (STAI-X1), while the level of anxiety–trait was rated as high within the range of 23–66 points (STAIX2). There were statistically significant correlations between anxiety– –trait and the use of fentanyl (r = -1.000; p = 0.005) and between total anxiety and consumption of morphine (r = -0.999; p = 0.028), Ketonal (r = -0.997; p = 0.046) and propofol (r = -0.998; p = 0.039). In the case of the OPCAB procedure, higher doses of Perfalgan were consumed on average than during CABG (p = 0.045) once higher doses of morphine than during AVR (p = 0.02). In the case of CABG surgery, on average, higher doses of morphine and Perfalgan were consumed than during AVR (p = 0.012 and p = 0.025, respectively). There were no statistically significant differences between analgesic drugs consumption and patients’ gender (p > 0.05) and age (p > 0.05). Conclusions. A high level of general anxiety was observed in patients undergoing CABG surgery. It was found that a higher level of anxiety impact on a lower need for analgesics. It was established that the sex and age of the studied patients did not affect the number of analgesics used in the peri- and postoperative period

Occurrence of Professional Burnout and Severity of Depressive Symptoms among Cardiac Nurses: A Cross-Sectional Study

Nurses with depression are not only likely to suffer themselves, but it may have an impact on their coworkers and potentially the quality of care they provide. This study aimed to determine the prevalence of depression and its association with burnout in cardiac nurses. A group of 400 cardiac nurses (361 women and 39 men) was enrolled. The standardized tools such as Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDI), and Patient Health Questionaire-9 (PHQ-9) were used. A high level of professional burnout regarding emotional exhaustion was observed in 53.3% of nurses, high depersonalization in 52.5%, and low personal accomplishment in 72.8%. PHQ-9 and BDI were shown to correlate significantly and positively with all three MBI subscales (p < 0.05). High depressive symptoms and occupational burnout were correlated with depression (p < 0.05). In conclusion, nurses were found to have high levels of depression and professional burnout, which may have resulted in a negative impact on the quality of patient care. Identification of burnout in cardiac nurses is necessary to consider interventions to prevent stress and depression

Analysis of Relationships between DAT1 Polymorphism Variants, Personality Dimensions, and Anxiety in New Psychoactive Substance (Designer Drug) (NPS) Users

The use of ‘new psychoactive substances’ appears to be increasingly common. The aim of this study was to examine biological and personality determinants in individuals who choose to use these substances, which may help in the prevention and treatment of psychoactive substance use disorders. The study group consisted of 374 male volunteers; all were users of ‘new psychoactive substances’ (NPS). The NPS users were recruited after they had abstained—for at least 3 months—from any substance of abuse in addiction treatment facilities. The NPS patients and the control subjects were examined by a psychiatrist using the Mini-International Neuropsychiatric Interview (M.I.N.I.), the NEO Five-Factor Personality Inventory (NEO-FFI), and the State-Trait Anxiety Inventory (STAI) scales. The real-time PCR method was used for genotyping. When we compared the controls with the study group, statistically significant interactions were found between DAT1 polymorphism, neuroticism, and NPS use. NPS use and DAT1 polymorphism were associated with a higher level of neuroticism on the NEO-FFI scale. The study group of NPS users showed a higher severity of anxiety symptoms, both in terms of trait and state, compared to the control group. The results may support the idea that neuroticism and anxiety correlate strongly with coping motives for using NPS

Association of Polymorphism within the Putative miRNA Target Site in the 3′UTR Region of the DRD2 Gene with Neuroticism in Patients with Substance Use Disorder

The study aims at looking into associations between the polymorphism rs6276 that occurs in the putative miRNA target site in the 3′UTR region of the DRD2 gene in patients with substance use disorder (SUD) comorbid with a maniacal syndrome (SUD MANIA). In our study, we did not state any essential difference in DRD2 rs6276 genotype frequencies in the studied samples of SUD MANIA, SUD, and control subjects. A significant result was found for the SUD MANIA group vs. SUD vs. controls on the Neuroticism Scale of NEO FFI test, and DRD2 rs6276 (p = 0.0320) accounted for 1.7% of the variance. The G/G homozygous variants were linked with lower results on the neuroticism scale in the SUD MANIA group because G/G alleles may serve a protective role in the expression of neuroticism in patients with SUD MANIA. So far, there have been no data in the literature on the relationship between the miRSNP rs6276 region in the DRD2 gene and neuroticism (personal traits) in patients with a diagnosis of substance use disorder comorbid with the affective, maniacal type disturbances related to SUD. This is the first report on this topic

Anticoagulation Prior to COVID-19 Infection Has No Impact on 6 Months Mortality: A Propensity Score–Matched Cohort Study

The coronavirus disease 2019 (COVID-19) shows high incidence of thromboembolic events in humans. In the present study, we aimed to evaluate if anticoagulation prior to COVID-19 infection may impact clinical profile, as well as mortality rate among patients hospitalized with COVID-19. The study was based on retrospective analysis of medical records of patients with laboratory confirmed SARS-CoV-2 infection. After propensity score matching (PSM), a group of 236 patients receiving any anticoagulant treatment prior to COVID-19 infection (AT group) was compared to 236 patients without previous anticoagulation (no AT group). In 180 days, the observation we noted comparable mortality rate in AT and no AT groups (38.5% vs. 41.1%, p = 0.51). Similarly, we did not observe any statistically significant differences in admission in the intensive care unit (14.1% vs. 9.6%, p = 0.20), intubation and mechanical ventilation (15.0% vs. 11.6%, p = 0.38), catecholamines usage (14.3% vs. 13.8%, p = 0.86), and bleeding rate (6.3% vs. 8.9%, p = 0.37) in both groups. Our results suggest that antithrombotic treatment prior to COVID-19 infection is unlikely to be protective for morbidity and mortality in patients hospitalized with COVID-19